There is no doubt that the widespread over-use of opiods has become a serious public health problem in the US. But I worry that older adults with palliative care needs may become unintended casualties of efforts to reduce the use and accessibility of these powerful drugs. The opiod problem is real. Nearly 30,000 Americans died from use of these drugs [...]
In recent years, it has become conventional wisdom that physicians avoid the end-of-life mistakes that many of the rest of us make. The story: They die at home rather than in hospital intensive care units. And they rely on comfort care such as hospice or palliative care rather than often-futile high tech medicine. That conventional wisdom, it turns out, is [...]
A new Medicare pilot program will make it easier for patients to access some hospice benefits without giving up standard medical treatment for a terminal disease. It is an important step towards building a health system that fully integrates social, spiritual, and palliative care such as pain management with health care. But it doesn’t get all the way there. Today, [...]
In a recent article in The Atlantic, entitled “Why I Hope to Die at 75,” Ezekiel Emmanuel makes the following provocative argument: I am not interested in living beyond age 75 since I am likely to suffer from functional limitations and will no longer be able to contribute much to society. I will not accept curative medical treatment, only comfort [...]
Imagine being able to receive fully integrated medical, social, and spiritual care in your own home. Nursing care is available 24/7. Home health aides provide basic personal assistance. Care is person-centered and focused on the specific needs of each patient. And for people with incurable chronic conditions, it focuses on managing symptoms, including pain, thus vastly improving their quality of [...]
Imagine your widowed father is 96 and living alone in a distant city. He’s got severe heart disease and mild dementia but is still competent to make his own choices. And is decision is: He refuses to move to a care facility but will not accept any supports and services that could help him remain safely at home. He won’t let [...]
The Washington Post published an extensive investigative story on hospice the other day. The take away: Hospices (mostly for-profits) are making big bucks by manipulating their case loads to maximize Medicare payments. In short, they are taking on many patients who are frail but not dying and thus staying on hospice care for a very long time. But the Post [...]
Almost one of every five patients in the intensive care units of a major teaching hospital got treatment that was futile or “probably” futile, according to the doctors who treated them. And older patients—especially those admitted from a nursing facility—were most likely to get care that does nothing to improve their quality of life, or even keep them alive for [...]
It is often a tough question: Mom has an illness that could be treated with surgery. The operation is routine for a younger patient. But is it too risky for an elder like mom? Today, doctors who consider the special risks of surgery for older patients must use complicated and time-consuming assessments to judge whether an operation is the best choice. But University of [...]
More people over 65 are dying in hospice care and fewer are dying in hospitals. But this good news is tempered by a very different story. People are also being hospitalized more frequently in the last three months of their lives, are more likely to spend time in intensive care units, and are often receiving hospice care for just a [...]