Literature Review

Study finds dementia influences decisions about life-sustaining treatment, even when advance directives request itCU Anschutz newsletter; by Kelsea Pieters; 10/7/26A new CU Anschutz study found that dementia status can influence end-of-life treatment decisions, even when a patient’s advance directive requests life-sustaining care. The findings highlight the importance of ongoing conversations about end-of-life wishes and choosing a surrogate who understands and will honor those preferences. People were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for a patient without dementia, even when an advance directive requested life-sustaining care, according to new research from the University of Colorado Anschutz. The study, published in JAMA Network Open [Surrogate decision-making for older adults with and without dementia by Lauren Hersch Nicholas, Scott D. Halpern, Kenneth M. Langa, Mario Macis], surveyed nearly 6,000 U.S. adults to examine how a patient’s dementia status, advance directive, physician recommendations and a surrogate decision-maker’s own preferences influenced recommendations about end-of-life care.Publisher's note: Bold and italics mine - this is a striking finding! Per the article's conclusion, "These findings highlight the importance of preparing patients and surrogates for care decisions through explicit discussions of goals of care and decision-making roles."

The workforce crisis healthcare leaders can’t afford to ignore | part two Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Ron Hetrick; 10/16/26 The greatest threat to your organization’s future may be having too few people to deliver the care you promise. In Part Two of The Workforce Crisis Healthcare Leaders Can’t Afford to Ignore, Chris Comeaux welcomes back Ron Hetrick to explore how healthcare leaders can prepare for a future shaped by an aging population, growing care needs, and a shrinking pipeline of workers. Hetrick moves from demographic warning signs to practical leadership decisions: redesigning difficult jobs, building training pipelines, creating workplaces people want to stay in, and evaluating expansion through the lens of available talent. He also explores how private home care could intensify competition for caregivers ...   Editor's Note: Explore the related article in today's issue, "NY nursing home hit with $6.8M verdict in understaffing case."

[Canada] Expert Q&A: New palliative care resource for frontline workers supports people experiencing homelessnessUniversity of Victoria press release; by Stephanie Harrington; 10/13/26National curriculum builds on community expertise. A new palliative and end-of-life care resource is providing frontline workers nationally with tools and strategies to better support people who are aging with serious illness alongside poverty and homelessness. The University of Victoria-led collective of researchers, frontline workers and palliative care practitioners launched the new curriculum at the Montreal International Congress on Palliative Care. Kelli Stajduhar is a Canada Research Chair (Tier 1) in Palliative Approaches to Care in Aging and Community Health at UVic and professor in the School of Nursing and Institute on Aging & Lifelong Health. She heads the UVic research program that developed the curriculum, called Palliative Care Is… Strengthening Community-Based Approaches to Palliative and End-of-life care in Homeless and Harm Reduction Settings.

Before the holidays, Glenview families are invited to learn how to start the conversations they keep putting off Newsnet, Glenview, IL; by EIN Presswire; 10/20/26 For many families, the holidays are when they finally notice it. A parent who seems more tired, a few new dents on the car, a house that isn’t quite being kept up the way it used to be. And then everyone goes home without saying anything. ...

A river does not argue with the rock - it flows around it. The river wastes no energy fighting. It finds a way. Wisdom is not stubborn debate; it is quiet, steady movement forward.

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Urban and rural hospital closures in Georgia, 2022-2024JAMA Network Open; by Sara D. Turbow, Kajal Patel, Young-Rock Hong, Jennifer Lom, Mohammed K. Ali; 9/26Hospital closures are a growing concern with a marked increase in both urban and rural hospital closures seen in recent years. These closures, often due to financial strain, decline in patient volumes, and inequities in health care funding, can result in loss of access to critical medical services. The purpose of this study was to examine postclosure changes in discharge volume, charges, and length of stay at hospitals near urban vs rural hospital closures in the state of Georgia. Urban hospital closures are an emerging area that will only become more relevant as policy changes are expected to lead to more urban closures in the coming years.

Current challenges and future innovation in rural heart failure care: A qualitative analysisJournal of Cardiovascular Nursing; by Alexander A. Walkon, Shoshana H. Bardach, Aricca D. Van Citters, Tamar Mosulishvili, Samuel L. Youkilis, Amanda N. Perry, Megan M. Holthoff, Olawale O. Akinola, Amelia M. Cullinan, Melissa Borrows, Katharine A. Manning; 9/26Individuals living with heart failure experience challenges managing frequent hospital admissions and life-altering symptoms, including dyspnea, fatigue, and depression. These challenges are exacerbated by the unique obstacles associated with receiving healthcare in a rural community. Their care partners often do not receive sufficient support to care for someone with heart failure and experience fatigue, social isolation, and anxiety. Interviewees reported challenges related to symptom and care partner burden, fragmented healthcare communication, limited institutional support, and an unclear role for palliative care. Interviewees suggested that integrating personalized care strategies, improving communication and coordination, and expanding specialized support may help address these challenges.

Surrogate decision-making for older adults with and without dementiaJAMA Network Open; by Lauren Hersch Nicholas, Scott D. Halpern, Kenneth M. Langa, Mario Macis; 10/7/26In this survey study of 5965 adults, fewer respondents endorsed life-sustaining treatments (LSTs) when a hypothetical patient had dementia (22% vs 40%). LSTs were more likely to be recommended when the respondent preferred them for their own care, when patient advance directives requested them, and when physicians recommended them. The findings suggest that surrogates’ own values and assumptions about quality of life with dementia, along with documented patient wishes and clinical guidance, may contribute to their recommendations. These findings highlight the importance of preparing patients and surrogates for care decisions through explicit discussions of goals of care and decision-making roles.

[Greece] Early clinical mediation in end-of-life disputes: A procedural justice analysisHealth Care Analysis; by Olympia Lioupi; 9/26Conflicts arise when surrogates request life-sustaining treatments that clinicians consider medically futile. This article proposes that early presumptive medical mediation with opt-out provisions should become the default initial offer for resolving such disputes. Mediation offers four procedural advantages: (a) protected and appropriately inclusive voice, (b) confidential caucus, (c) interest-based framing, and (d) outcome ownership. Embedding an early, structured offer of mediation in end-of-life policy may reduce escalation and strengthen the procedural legitimacy and acceptability of decision-making when voluntariness and appropriate clinical, ethical and legal safeguards are maintained. However, it cannot guarantee agreement, shorter ICU stays, reduced litigation, or substantively correct ethical outcomes.

... though we may come from different places, speak in different tongues, our hearts beat as one.  ~Albus Dumbledore in the movie, 'Harry Potter and the Goblet of Fire' (adapted from book by J.K. Rowling)

Hospice and end-of-life workers discuss what they’ve learned from their work and patients in their last moments The Guardian; by Madelein Aggeler; 10/21/26 ... Courtney first started working with dying patients when she was an oncology nurse. ... After a brief stint working in the ICU, Courtney began working in hospice care full-time. She says her job has reshaped how she approaches her life both personally and professionally. We spoke to her and other hospice and end-of-life workers about what they’ve learned from their work and their patients.