PPS Trajectories in Hospice

Functional status is all the rage in research these days, especially with the impending but often delayed roll out of ICD-10. Any seasoned hospice and palliative care (HPC) clinician will tell you how critical functional status is to understanding trajectories of patients as function has been part of our assessment for quite a long time.  Most of us know functional assessments through the more clinical acronyms of ADL (Activities of Daily Living) and the PPS (Palliative Performance Status).  On a whole HPC staff routinely use function as a key metric of prognostication, but we have not really had a lot of data that looked beyond PPS at admission.  This week in the Journal of the American Geriatric Society, Pam Harris, Joan Teno, David Casarett and the CHOICE* group published Patterns of Functional Decline in Hospice Care, an important insight into the dynamic (or sometimes not quite so dynamic) change in functional status (as measured by the PPS) for patients who died on hospice.The data all came from three hospices (KS/MO, PA, FL) using the Suncoast electronic medical record and looked at nearly 9,000 patients who died on hospice services and their PPS over the time they were admitted to hospice services.  The findings note three basic trajectories that emerged: cancer and stroke, cardiac and pulmonary, and debility and dementia: Disease group PPS Decline Cancer 8.44/week Stroke 7.67/week Pulmonary 5.02/week Cardiac   4.53/week...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Carer Workers Authors: Source Type: blogs

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Palliat Support Care. 2021 Jun 23:1-6. doi: 10.1017/S1478951521000973. Online ahead of print.ABSTRACTOBJECTIVE: The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors.METHOD: A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regardi...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Source Type: research
Abstract Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a s...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
CONCLUSION: Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results. PMID: 33289368 [PubMed - in process]
Source: Journal of Korean Medical Science - Category: Biomedical Science Tags: J Korean Med Sci Source Type: research
In this study, by adenovirus-mediated delivery and inducible transgenic mouse models, we demonstrate the proliferation of both HCs and SCs by combined Notch1 and Myc activation in in vitro and in vivo inner ear adult mouse models. These proliferating mature SCs and HCs maintain their respective identities. Moreover, when presented with HC induction signals, reprogrammed adult SCs transdifferentiate into HC-like cells both in vitro and in vivo. Finally, our data suggest that regenerated HC-like cells likely possess functional transduction channels and are able to form connections with adult auditory neurons. Epige...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Conclusion Acute delirium is commonly underdiagnosed, and can be masked by chronic alterations in cognition and mentation. Delirium has many causes, and can be assessed using the acronym DELIRIUM. The most common presentations suggesting delirium over dementia are short-term memory loss, rapid fluctuation in condition, acute alteration, and a condition present that may be responsible for delirium. Management includes searching for causes of acute alteration in mental status, negating environmental factors of delirium, and—only when necessary—reducing the patient’s threat to themselves or providers by usin...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Exclusive Articles Patient Care Source Type: news
ConclusionPain is a critical underestimated problem in elderly patients. A timely systematic evaluation of the pain would call attention to palliative care needs and reduce the negative effects of uncontrolled pain on the quality of life.
Source: International Journal of Gerontology - Category: Geriatrics Source Type: research
Patients with incurable diseases like dementia, liver failure, Parkinson's or strokes were unlikely to receive the same degree of care as those with cancer, according to a Leeds University study
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
A person does not die directly from Alzheimer's disease; but instead, from complications caused by Alzheimer's disease.How do you know when a dementia patient is dying?Over time, and as Alzheimer's progresses, the body's immune system weakens, increasing susceptibility to infection and other causes of death related to the elderly.Typical complications from Alzheimer's and related dementia are:heart attacks, strokes, kidney failure, and lung infections due to aspiration of food. Multi-organ failure is often the cause of death in dementia patients.Learn More -Can you die from Alzheimer's disease?By Bob DeMarcoAlzheimer's Rea...
Source: Alzheimer's Reading Room, The - Category: Neurology Tags: alzheimer's alzheimer's care alzheimer's death Alzheimer's Dementia death alzheimer's dying alzheimer's dying dementia end of life caregiving family caergiving health searches related to alzheimer's Source Type: blogs
Conclusion Pain is a critical underestimated problem in elderly patients. A timely systematic evaluation of the pain would call attention to palliative care needs and reduce the negative effects of uncontrolled pain on the quality of life.
Source: International Journal of Gerontology - Category: Geriatrics Source Type: research
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