Literature Review

Improved outcomes and cost with palliative care in the Emergency Department: Case-control studyThe Western Journal of Emergency Medicine; Brandon Chalfin, Spencer M Salazar, Regina Laico, Susan Hughes, Patrick J Macmillan; 7/25This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted ... In addition, more cases than controls had a code status of comfort care at discharge ... These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.

Behavioral symptoms in patients with dementia are associated with care partner abusive behaviorsJournal of Elder Abuse & Neglect; by Emily LeRolland, Francesca Falzarano, Karen L. Siedlecki; 8/25Abuse of older adults with dementia is an increasingly prevalent public health concern in the United States. The current study examined whether care recipient behavioral symptoms (e.g. aggressive or agitated behaviors) predicted abusive behaviors by care partners. Results indicate that most participants reported engaging in at least one abusive behavior toward their care recipient. Behavioral symptoms in care recipients were a significant predictor of abusive behavior perpetrated by the care partner, even after controlling for a large number of covariates. Care partner depressive symptoms significantly mediated the relationship between care recipient behavioral symptoms and care partner abusive behavior. Our results suggest that physician screening for depression in care partners and referral to appropriate resources may be one avenue for decreasing the risk of abuse toward care recipients. 

Clinician and caregiver perspectives on managing dementia behaviors in hospiceMedpage Today; by Elethia W. Tillman; 7/25New research reveals a gap in training and resources for managing behavioral and psychological symptoms of dementia (BPSD) in hospice settings, impacting both patient well-being and caregiver burden. Key points include:

"It may cost you your money, it costs you your life": A framework for financial hardship in dementiaGerontologist; by Krista L Harrison, Emily R Adrion, Juliana Friend, Sarah B Garrett, Madina Halim, Michael Terranova, Alissa B Sideman, Nicole D Boyd, Georges Naasan, Joni Gilissen, Pei Chen, Melissa D Aldridge, Daniel Dohan, Michael D Geschwind, Alexander K Smith, Christine S Ritchie; 7/25Care for persons with dementia costs ∼ $500 billion annually in the United States. Few qualitative studies or conceptual frameworks of the financial experiences of people impacted by dementia exist. This study examined how patients and caregivers impacted by different types of dementia and at different points in the disease journey described financial issues within a palliative care context... Even in a well-resourced population, the financial toll of dementia can be substantial. The Direct-Emotional-Logistical framework of dementia financial hardship can be used to assess financial impacts in palliative care settings.

Research Institute for Home Care and National Alliance for Care at Home ink affiliation agreement National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/20/25 The Research Institute for Home Care (the Institute) and the National Alliance for Care at Home (the Alliance) have entered into an affiliation agreement to strengthen and expand research efforts while further unifying the care at home movement. The agreement is effective immediately. ... With this affiliation, the Institute will remain an independent research organization, ... The Institute’s Board of Directors will continue to independently oversee its research agenda and initiatives. The Alliance will provide comprehensive management support for the Institute’s operations. At the launch of the affiliation, Dr. Steve Landers, CEO of the Alliance, will also serve as the President of the Institute. Jennifer Schiller, the former Executive Director of the Institute, has joined the Alliance leadership team and will continue to support Institute initiatives along with other Alliance leaders. Jennifer Sheets, Founder and CEO of Carezzi, will remain the Board Chairman of the Institute.  

Opportunities and barriers to artificial intelligence adoption in palliative/hospice care for underrepresented groups-A technology acceptance model–based reviewJournal of Hospice and Palliative Nursing; by Xu, Tuzhen; Rose, Gloria M.; 8/25Underrepresented groups (URGs) in the United States, including African Americans, Latino/Hispanic Americans, Asian Pacific Islanders, and Native Americans, face significant barriers to accessing hospice and palliative care. Factors such as language barriers, cultural perceptions, and mistrust in healthcare systems contribute to the underutilization of these services. Recent advancements in artificial intelligence (AI) offer potential solutions to these challenges by enhancing cultural sensitivity, improving communication, and personalizing care. However, barriers such as limited generalizability, biases in data, and challenges in infrastructure were noted, hindering the full adoption of AI in hospice settings.

Social relationships and end-of-life quality among older adults in the United States: The impacts of marital, kinship, and network ties The Journals of Gerontology; by Kafayat Mahmoud, Deborah Carr; 7/25We examine marital status differences in recent decedents’ end-of-life care and gender differences therein, and the role of other social ties (children, siblings, network members) in influencing the quality of end-of-life care. Divorced decedents fared poorly on multiple outcomes, being less likely than married or widowed persons to receive excellent care and to have personal care needs met. Divorced and widowed decedents were less likely to receive respectful treatment relative to married decedents. We found no significant gender differences in these patterns. Persons with more siblings and network members had superior pain management. Hospital patient advocates could also aid those who lack close kin at the end of life.

Black and white older adults’ end-of-life experiences: Does hospice use mitigate racial disparities? The Journals of Gerontology; by Clifford Ross, Brina Ratangee, Emily Schuler, Zheng Lian, Benmun Damul, Deborah Carr, Lucie Kalousová; 7/25Racial disparities in end-of-life care are well documented, but less is known about how these inequalities shape assessments of death quality. Proxies for Black decedents reported higher perceived death quality than those for White decedents, despite evidence of greater structural disadvantage. However, perceived care concordance was significantly lower among Black decedents. Hospice care was associated with improved perceived death quality for Black decedents but not for Whites. When accounting for socioeconomic and death experience controls, hospice care did not moderate perceived care concordance.

Caregiver-reported barriers and facilitators to hospice enrollment for persons with dementia: A systematic review of qualitative evidencePalliative Medicine; by Oonjee Oh, Connie M Ulrich, Lauren Massimo, George Demiris; 7/25Despite the increasing prevalence of dementia, persons with dementia often receive suboptimal care near the end of life. Dementia caregivers experience intrapersonal, interpersonal, emotional, logistical, and physical challenges in ensuring quality end-of-life support for their loved one (e.g. limited understanding of end-stage dementia, gatekeeping providers, and family conflicts). The unique needs of caregivers caring for a seriously ill family member with dementia are not being fully addressed by the current available services and policies.

Palliative delays associated with increased length of stay in older traumatic brain injury patientsThe Journal of Trauma & Acute Care Surgery; by Sarah A Hatfield, Parima Safe, Cleo Siderides, Anjile An, Cassandra V Villegas, Nicole Goulet, Robert J Winchell, Elizabeth Gorman; 7/25Trauma Quality Improvement Program guidelines recommend early goals of care discussions (≤72 hours) for older patients with severe injuries. Patients (55 years or older) with moderate to severe TBI [traumatic brain injury] ... were retrospectively identified at a level I trauma center (2020-2022). Conclusions: Delayed PI [palliative intervention] is associated with increased LOS [length of stay] in older TBI patients, with no survival difference compared with early PI. Palliative interventions should be introduced early to reduce morbidity in patients with potential poor prognosis.

End-of-life course and subspecialty palliative care involvement for children on mechanical circulatory support: Five-center retrospective cohort study from the United States, 2015–2020Pediatric Critical Care Medicine ; by Vazquez Colon, Zasha; Robinson, Lorelei; Lopez-Colon, Dalia; Joong, Anna; Waldman, Elisha; Delgado-Corcoran, Claudia; May, Lindsay J.; Cousino, Melissa K.; Peng, David M.; Lukich, Stevan; Blume, Elizabeth D.; Machado, Desiree S.; M. Moynihan, Katie; 7/25Objectives: To characterize end-of-life (EOL) care and subspecialty palliative care (SPC) involvement in children with heart disease supported on mechanical circulatory support (MCS), including ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO). Most pediatric deaths after MCS occur soon after discontinuation of devices while receiving invasive therapies in ICUs. SPC teams were involved in less than half of the cases, with only 21% being consulted early. SPC was associated with more ACP [advance care planning] and less CPR at EOL.

End-of-life care planning among older Vietnamese and Filipino Americans: A qualitative analysisJournal of Gerontological Social Work; Carson M. De Fries, My Ngoc To, Peiyuan Zhang, Emerson Ea, Fei Sun, Bei Wu, Sue E. Levkoff, Kaipeng Wang; 7/25Racial and ethnic disparities in end-of-life (EOL) care planning persist, particularly due to limited knowledge of culturally sensitive practices among older Vietnamese and Filipino Americans – two of the largest Southeast Asian American subgroups. Thematic analysis ... revealed a shared belief in the importance of EOL care planning in both groups, driven by the desire to honor personal wishes, reduce burden on family, and minimize conflict. Participants also expressed distrust in healthcare systems and emphasized the influence of family dynamics on EOL decisions. Notable differences emerged: Vietnamese participants more often described cultural practices that encouraged open conversations about death, while Filipino participants cited cultural taboos that hindered such discussions.

Ethics of overtreatment and undertreatment in older adults with cancerBMC Medical Ethics; by Clark DuMontier, William Dale, Anna C. Revette, Jane Roberts, Ameya Sanyal, Neha Perumal, Eric C. Blackstone, Hajime Uno, Mary I. Whitehead, Lewis Mustian, Tammy T. Hshieh, Jane A. Driver, Gregory A. Abel; 7/25This modified Delphi study convened a panel of experts in biomedical ethics and reached consensus that the principles of beneficence, non-maleficence, and autonomy are related to our previously proposed definitions of over- and undertreatment in older adults with cancer. The panel also reached consensus that, in most cases, it is unethical to make a treatment recommendation without (1) formal assessment of patient frailty (e.g., via a geriatric assessment) and (2) the opportunity for a patient to share their values, goals, and/or preferences. The panel did not reach consensus regarding the relationship between justice and over-/undertreatment; however, the panel concluded that justice applies to undertreatment when an oncologist withholds potentially beneficial cancer treatment in an older patient based on their age alone.