Literature Review

Pumping irony: When the hospice is inhospitable Experience Life; by Craig Cox; 10/22/25 ... University of Michigan researchers, reviewing the health records of some 139,000 hospice patients diagnosed with dementia, found that nearly half of them were given benzodiazepines, a class of drugs designed to relieve agitation and anxiety. ... The results, in many cases, were deadly. ... “For patients who are not actively dying, patients and families may prioritize preserving cognition, communication, and function — goals that may be compromised by sedating medications,” she writes. “This further underscores the need for dementia-specific hospice interventions to help offer scalable, nonpharmacologic approaches, to equip hospice clinicians with effective alternatives.”

Why are more older people dying after falls? KFF Health News; by Paula Span; 9/30/25 ... Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month. More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply. ... [Death] rates from fall injuries among Americans over 65 had more than tripled over the past 30 years. Among those over 85, the cohort at highest risk, death rates from falls jumped to 339 per 100,000 in 2023, from 92 per 100,000 in 1990.  ...

A hospice intervention for caregivers: Improving home hospice management of end-of-life symptoms (I-HoME) pilot study Journal of the American Geriatrics Society; by Veerawat Phongtankuel, Sara J. Czaja, Taeyoung Park, Jerad Moxley, Ronald D. Adelman, Ritchell Dignam, Dulce M. Cruz-Oliver, Micah Denzel Toliver, M. C. Reid; 9/24/25 Background: While home-based hospice care seeks to reduce suffering at the end of life (EoL), patients continue to experience a high symptom burden. High symptom burden contributes to adverse outcomes, including patient suffering, burdensome care transitions, and caregiver burden. Yet, most caregivers lack formal education in patient symptom management despite providing up to 65 h of care per week. ... Conclusion: The I-HoME intervention was feasible to implement in the home hospice setting and acceptable to caregivers and hospice staff. Future efficacy trials are needed to determine whether this caregiver-focused intervention ... can measurably improve patient and caregiver outcomes in the home hospice setting.

Wound care at Sheridan VA gives 95-year-old Veteran a second chance: Veteran removed from hospice care at Sheridan VA after wounds heal VA News; by Jesus Flores; 9/12/25 When 95-year-old Air Force Veteran Roy Clifton arrived at Sheridan VA Medical Center (SVAMC) in March 2025, he thought he didn’t have much time left. “I had a bone infection in both feet and could barely walk,” he said. “Then I had a fall that caused a bleed in my brain. That’s when I decided to call it quits and go to hospice.” ... [Scroll ahead to this hospice's expert wound care.] Although both feet had exposed bones, and the injuries looked and smelled bad, Clifton’s body was healing. ... Clifton’s condition improved so much, he was taken off hospice care. “It made me feel great to survive hospice,” he said, smiling. “They’re all great. The staff took good care of me.”

Caring for every breath: Carolina Caring Advanced Lung Care Program launched August 1st Carolina Caring, Newton, NC; Press Release; 8/8/25 A specialized lung care program providing care for complex respiratory conditions will bring needed comfort and support to many individuals. Launched on August 1st, 2025, Carolina Caring’s Advanced Lung Care Program helps patients receive the personalized care they need for their advanced respiratory illness at end of life, while remaining comfortably at home—leading to a reduction of hospitalizations and improved quality of life for patients and their families. 

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. Guest Editor's Note, Drew Mihaylo, PharmD: Practicing clinical vigilance regarding medication utilization is essential at any stage of illness. Prescribing cascades are common, under-recognized and often harmful. Approaching the emotional topic of medication change must be done with compassion and sensitivity tied to patient specific goals of care. Creativity to this end has been a focus of mine for sometime now as a clinical pharmacist serving serious illness patients nationally.

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. 

WHO unveils new guideline to improve global access to controlled medicines World Health Organization; by Departmental update; 5/26/25 The World Health Organization (WHO) has released a rapid communication outlining its comprehensive new guideline on balanced national policies for controlled medicines. The guideline’s recommendations were officially presented during a high-level side event at the Seventy-eighth World Health Assembly on Friday 23 May 2025. It is designed to support countries in ensuring safe, equitable and affordable access to essential controlled medicines which are critical for treating acute and chronic pain, mental health conditions, substance use disorders and other serious health issues.

Pharmacist-led care in palliative settings: Using anticholinergics thoughtfully and compassionately Pharmacy times; by Diana Violanti, PharmD, Pamela S. Moore, PharmD, BCGP, and Alana Hippensteele; 5/5/25 The use of anticholinergic agents to manage terminal secretions, often referred to as the death rattle, remains a nuanced and evolving area of end-of-life care. While these medications are frequently used in hospice and palliative care settings to reduce secretion-related sounds that may be distressing to caregivers, their efficacy in improving patient comfort is less clear and often debated. ... Diana Violanti, PharmD, and Pamela S. Moore, PharmD, BCGP, discuss the nuanced use of anticholinergic agents for managing terminal secretions at end of life, highlighting practical considerations, timing, safety concerns such as delirium, and the limited yet evolving evidence supporting their role in palliative care.

Dr. Drabek's "The Comfortologist" hits #1 bestseller, revolutionizing pain management & end-of-life care approaches Classic 96.7 FM BWZ, Yukon, OK; Press Release; 4/28/25 Dr. Steven Drabek's groundbreaking memoir, "The Comfortologist: A Physician's Empathetic Perspective on Compassion, Caring, and Pain Relief," has achieved #1 bestseller status, resonating deeply with healthcare professionals, chronic pain patients, and families navigating end-of-life care decisions. Drawing from his four-decade career and personal journey as a cancer survivor and chronic pain patient, Dr. Drabek offers readers a unique dual perspective that has earned him recognition as a "comfortologist" a term he coined to describe his approach to medicine that prioritizes patient comfort and dignity. "My experience as both physician and patient taught me that modern medicine often misses what matters most," says Dr. Drabek. "Technical expertise means little without empathy. We must treat the whole person, not just the symptoms."

More than just meds: What a palliative care pharmacist learned from the bedside Pharmacy Times; by Trinh Bui, PharmD, Yale New Haven Health; April 2025 Issue A palliative care pharmacist highlights a spectrum of clinical opportunities for patients, caregivers, and clinicians when rounding at the bedside. ... I hold a unique clinical position. In 2018, the National Palliative Care Registry reported that less than 10% of national palliative care (PC) programs have a dedicated pharmacist. I am a member of the PC consultation service at a cancer hospital affiliated with a large tertiary academic medical center in New Haven, Connecticut. Routinely, we are consulted for at least 40 patients a day, with more than 2000 consults in 2024. ... A benefit of having a clinical pharmacist on the interdisciplinary team includes the ability to provide off-label medication to optimize complex medication regimens while honoring patients’ psychosocial, cultural, and spiritual needs. ...

Harmonizing federal and Florida laws on prescribing controlled substances through telehealth JD Supra; by Jeremy Burnette, Martin Dix, and John Hood; 3/24/25 Practitioners who want to prescribe controlled substances via telehealth to patients in Florida must meet the requirements of both federal and state law. The federal Drug Enforcement Administration (DEA) and the Florida legislature have recently amended the applicable federal regulations and state laws, respectively, to allow the prescribing of controlled substances via telehealth[*] without conducting an in-person evaluation under certain circumstances. There are key differences between federal and state law, so practitioners prescribing controlled substances via telehealth to patients in Florida should be aware of the particular requirements of each. [Continue reading ...]