Literature Review

Hearing loss, loneliness may contribute to cognitive decline in older adults McKnights Senior Living; by John Roszkowski; 7/28/25 Hearing loss and loneliness can contribute to dementia in older adults, and simple interventions to address hearing loss, such as hearing aids, may reduce cognitive decline in some cases, new research finds. ... Results of the study showed that higher levels and worsening self-reported hearing impairment were associated with steeper decline in episodic memory issues and executive functioning (verbal fluency). Further, the researchers found that individuals who were not socially isolated but still felt lonely saw their cognitive decline accelerate if they were deaf.

Hospices navigating ethically complex end-of-life situations Hospice News; by Holly Vossel; 7/25/25 The final stages of life can be filled with challenging, nuanced situations for some patients and their families. Ensuring goal-concordant care and autonomous end-of-life decision-making requires careful ethical, legal and operational considerations. Staff education and proactive policy development are important for hospices to harness in complex situations, according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of New York State (HPCANYS). A number of difficult life circumstances can limit hospices’ ability to provide patients with care that is in line with their wishes, Chirico indicated. Hospices need to have a firm understanding of the possible ethical and legal limitations that staff may encounter, as well as establish procedures that help address them. 

Prairie Doc Perspective: Navigating spiritual pain and grief Rawlins Times - Prairie Doc Perspective, Rawlins, WY; by Rev. Kari Sansgaard, Avera Hospice; 7/23/25 After nearly 20 years of parish ministry, I entered the world of health care, which, I learned, abounds in acronyms. My first clue was in chaplaincy training, known as CPE (Clinical Pastoral Education), the required education for most hospital and hospice chaplains. CNA, SoB (Shortness of Breath), PRN, HoH (Hard of Hearing), and a myriad of other acronyms are now part of my own vernacular. QoL (Quality of Life) is the big one in hospice, sometimes called “comfort care.” When quantity of life becomes diminished, it’s all about quality. ... In hospice, when death is impending, spiritual pain can lead us to ponder existential questions, such as the following:

A woman in hospice granted a wish of one last swim WEAU-13 News, Bloomer, WI; by Danile Gomez; 7/16/25 Often times the small things are taken for granted. Like a dip in the pool. For Barbara Melby, it was on the final list of things to do as she lives out her time in hospice care. “Barbara has been doing pretty well. She has had some fatigue and some tiredness,” said Leah Grace, the registered nurse with St. Croix Hospice assigned to Melby’s case. ... Grace worked hard to make sure Melby’s last dip in the pool would come to fruition. She cleared it with Melby, her family and the managers at the hospice center. The aquatic center helped in granting the wish too. ... “The way the chair put me in down the water was very nice,” said Melby. Of those in Melby’s family that jumped in the pool with her included Stoll and her kids Colby, Sydney and Brody. “I grew up swimming in my grandmother’s pool. ...” said Stoll. She is happy to be there for her grandmother’s last swim. “Just a pretty special memory we will all hold on to for a pretty long time.” Melby was a swim instructor, ... It was something she always loved and it made her happy to have had her wish granted.

Ok, please help calm my anxiety. My mother has drastically improved in the last couple of days since goin on hospice. Aging Care; by Oedgar23; 7/17/25 So in the hospital, my mother was in kidney failure. The last couple days after stopping vancomycin for about five days, her GFR had come up to 19. That’s the most recent Number and then they stopped drawing labs because we placed her on Hospice. We consulted with palliative care team. They wanted to do a feeding tube and we said no. They said she had advanced dementia. [Describes improvements since hospice.] ... What if she gets taken off hospice? ... What if she no longer qualifies for hospice, passes as normal cognitively, starts demanding to go home, does not qualify for long-term care, Medicaid, etc. ... But I am super unnerved because she looks a whole lot better than she has been looking. ...Editor's Note: Yes, we all know that the person can get better with hospice care, because of holistic person-centered care, caregiver education and support, and many more factors. This can be confusing. The dying trajectory may have been interrupted or simply calmed with better symptom management and quality of life. This daughter is asking normal, crucial questions which the hospice team needs to be addressing with her. Examine your live discharge data, Policies and Procedures, communication practices with the patient and family about recertifications, Incident Reports from upset caregivers/families, and CAHPS Hospice scores.

Rochester hospice provider pulls out of Owatonna project, sunsets community grief services PostBulletin,com, Rochester, NY; by Dené K. Dryden; 7/17/25 Citing multiple challenges, Rochester's Seasons Hospice will no longer be expanding into Owatonna and will pare back its community services through the Center for Grief Education and Support. In a Friday, July 18, press release to the Post Bulletin, Dawn Beck, president of the nonprofit hospice provider's board of directors, said "we have had to make the extremely difficult decision to restructure our grief services and to cease efforts to reopen the Homestead Hospice House in Owatonna." The Homestead Hospice House, previously operated by Allina Health, has been closed since summer 2023, the Owatonna Peoples Press reported. Since last year, Seasons Hospice had been fundraising to reopen the facility, but Beck said this week that staffing challenges, financial difficulties, issues with licensing and certification, for-profit competition and uncertainty around federal changes contributed to Seasons Hospice withdrawing from the project. ... In Rochester, starting Aug. 1, the Center for Grief Education and Support will no longer provide services to the community at large ...

Collective leadership in home-based palliative care: Advancing APRN roles to enhance successHome Health Care Management & Practice; Nicole DePace, MS, APRN, GNP-BC, ACHPN; Rebecca Souza, DNP, ANP-BC, ACHPN; Therese Rochon, MA, MS, FNP-C; Paula Rego, DNP, AGPCNP-BC; Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; 6/25Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.

Opinion: My health and my politics walk into a doctor’s office … The Washington Post; by Kim Fellner; 7/16/25 [Note: Access is behind a paid firewall, with an option to set up a temporary free account]... My palliative care doctor and I have almost nothing in common. We’re still learning from each other. ... It began simply enough. By October, my sarcoma had moved from possibly curable to definitively terminal, and, since metastasis to the bones can be painful, my anchor oncologist offered to connect me with a palliative care doctor to help with the physical and conceptual aches and pains of dying. Which seemed like a good thing to do. ... I did not anticipate, however, that the personal and the political would collide in my doctor’s office. ... [Descriptions unfold of significant, conflicted dialogue between (1) this Jewish daughter of holocaust survivors whose life-long vocation was social justice and (2) this Christian palliative care physician who asked about mental health and then dismissed this person's primary concerns that were affecting her dying.] ... Clearly, my doctor and I shared some beliefs about the importance of the palliative approach. ... But as the doctor noted, the best palliative care goes beyond the purely physical to address the more cosmic questions of life and death, and I was uncertain we were well matched as partners for this intimate process. ... I had no idea how to proceed. ... [More descriptions.] ... And that’s where the magic happened. Within a few days, my palliative care doctor sent me back a transparent, thoughtful and moving response. ... Her courage and openness, her willingness to risk a forthright response, have precipitated a remarkable dialogue about what each of us brings into the room, and how we can honor the space and each other once we get there. ... Editor's Note: Whatever one's political or religious stance, this article is sure to spark fireworks—of conflict, dissonance, and, hopefully, powerful insight. I encourage readers to engage with it attentively, attuned to three things:

Time and location of specialty palliative care for women dying with metastatic breast cancer Breast Cancer Research and Treatment; by Andrea King, Cynthia Ortiz, Rachna Goswami, Tara L Kaufmann, MinJae Lee, Lynn Ibekwe-Agunanna, Navid Sadeghi, Donghan M Yang, Lindsay G Cowell, Timothy P Hogan, Lauren P Wallner, Megan A Mullins; 7/15/25 online ahead of print Background: Despite guideline recommendations, evidence suggests many women with metastatic breast cancer (mBC) do not receive specialty palliative care services despite high morbidity burden. ... Results: ... Most palliative care encounters were inpatient and occurred within ~ 1 month of death. ...Conclusion: Palliative care for women with mBC is infrequent and often late, with referrals seemingly driven by the imminence of death rather than metastatic diagnosis. Strategies to better identify and triage specialty palliative care needs and make timely referrals are needed.

Grieving the living: How Hospice of St. Lawrence Valley helps caregivers cope North Country Now, St. Lawrence County, NY; by Kate Favaro, Hospice of St. Lawrence Valley; 7/10/25 With caregiving comes grief, there’s no way around it. You will grieve two important things that you’ve lost: who the person you’re caring for used to be, and the things that will never be. Take the time to explore the grief you’re experiencing so you can provide the best care possible. If you’re not taking care of yourself, you won’t be able to take care of anyone else. Hospice of St. Lawrence Valley offers the following on the grief of caregiving:

When less is more: Addressing polypharmacy in high-risk populations Pharmacy Times; by Andrew E. Esch, MD, MBA and Alain Hipensteele; 7/7/25 As digital health tools and artificial intelligence (AI)–powered clinical decision support systems become increasingly embedded in pharmacy workflows, pharmacists are gaining new opportunities to identify and address the risks of polypharmacy—particularly in high-risk populations such as older adults and those receiving palliative care. At the same time, evolving deprescribing guidelines and ongoing drug shortages have underscored the need for coordinated, patient-centered medication management strategies. In this interview with Pharmacy Times®, Andrew E. Esch, MD, MBA, director of the Palliative Care Program Development at the Center to Advance Palliative Care, discusses how pharmacists are using emerging technologies to streamline medication reviews, reduce therapeutic duplication, and engage caregivers in deprescribing conversations. 

From burnout to belonging: Creating space for grief in clinical education American Academy of Pediatrics (AAP) Journals Blog; by Rachita Gupta; 6/16/25 ... While significant progress has been made in addressing burnout and emotional distress in medicine, and in incorporating these topics into medical education, many clinicians remain hesitant and uncertain about how to address grief and distress from patient care in day-to-day clinical practice. This uncertainty exists both in terms of their own experiences and, even more so, in supporting trainees. A lack of emotional processing in these difficult situations can accelerate burnout and further disconnect clinicians from the humanism and vulnerability that are intrinsic to the privilege of practicing medicine. ... The recently published Hospital Pediatrics article by Bloomhardt et al, “Good Grief? Introducing the TEARS Framework for Educator to Support Learners Experiencing Grief,” (10.1542/hpeds.2024-008096) addresses the hesitancy many clinicians experience when assessing learners’ emotional processing during or after distressing patient cases by introducing the TEARS framework. ...Editor's Note: See a related post in today's newsletter, "“Her toes fell off into my hand”: 50 moments that changed healthcare workers forever."

Short notice, long love: A hospice wedding full of heart Citrus County Chronicle, Inverness, FL; by Mike Arnold; 6/16/25 Brendan Malone and Vanessa Rodriguez made a snap decision that would change their lives – and touch the hearts of everyone around them. The couple were driving up from Estero in the early afternoon of June 5 to visit Malone’s father, Michael “Big Mike” Malone, who had recently moved into Citrus Health and Rehab in Inverness and was also receiving care from Vitas Hospice. [Already engaged,] ... they made the decision to get married the next morning, at Citrus Health and Rehab. There were no tuxedo fittings, no cake tastings, no invitations sent. There was no time. There were flowers, guests, toasts, bubbles – and love. And “Big Mike” had a front row seat. Brendan Malone didn’t want to get married without the man who had been his biggest supporter by his side. ... What followed was a whirlwind of compassion, planning, and action from the staff at the nursing facility and the local hospice team. Within hours, they coordinated decorations, arranged courtyard seating, and made sure Michael could be present in his wheelchair for the ceremony.