Literature Review

Illness, and poetry, can transform usJAMA; Rafael Campo, MD, MA; 1/25... just as illness may alter our bodies and minds in unknowable ways, so can poetry subject us to the unexpected—through metaphor, imagery, and form—and thus can be indispensable as a guide to those in medicine seeking to provide empathetic care. Poetry becomes transformational, the shape-shifting text itself embodying the seemingly incomprehensible, making the father’s dementia and the speaker’s sense of grief, anger, and loss ultimately palpably human. Though perhaps readers can’t fully grasp the experience of Alzheimer disease, or losing one’s parent to its ravages, through poetry we can feel restored and heartened by its transformative power, “saying yes yes/we could live anywhere.”

Medicaid unwinding experiences in dual-eligible older adultsJAMA Health Forum; Renuka Tipirneni, MD, MSc; Wendy Furst, MA; Dominic A. Ruggiero, MPH; Dianne C. Singer, MPH; Erica Solway, PhD, MSW, MPH; Erin Beathard, MPH, MSW; Syama R. Patel, MPH; Andrei R. Stefanescu, PhD, MS; Jeffrey T. Kullgren, MD, MS, MPH; John Z. Ayanian, MD, MPP; Eric T. Roberts, PhD; 1/25This US national survey of low-income older adults found varying awareness of and experiences with the Medicaid unwinding process and identified cost-related access barriers among those who recently lost Medicaid. By 9 to 10 months into the unwinding process, few older adults reported hearing a lot about Medicaid unwinding and many reported not receiving any communication about needing to renew Medicaid eligibility. By the time of our survey, slightly less than half of respondents had completed a Medicaid renewal. Although the proportion of respondents who said they lost Medicaid in the last 6 months was relatively low, those who lost Medicaid were more likely to report cost-related difficulty getting care. These findings highlight the importance of addressing informational and navigational barriers among dual-eligible older adults to avoid disruptions in Medicaid coverage that may contribute to difficulties accessing care. 

Interoception, cardiac health, and heart failure: The potential for artificial intelligence (AI)-driven diagnosis and treatmentPhysiological Reports; Mahavir Singh, Anmol Babbarwal, Sathnur Pushpakumar, Suresh C Tyagi; 1/25"I see, I forget, I read aloud, I remember, and when I do read purposefully by writing it, I do not forget it." This phenomenon is known as "interoception" and refers to the sensing and interpretation of internal body signals, allowing the brain to communicate with various body systems. Dysfunction in interoception is associated with cardiovascular disorders. In the context of HF [heart failure], AI algorithms can analyze and interpret complex interoceptive data, providing valuable insights for diagnosis and treatment. By leveraging patient data, AI can personalize therapeutic interventions.

The role of health care stereotype threat in end-of-life planning among older sexual minority adultsInnovation in Aging; Meki Singleton; 12/24Healthcare stereotype threat (HCST), defined as “the threat of being reduced to group stereotypes within healthcare encounters”, may occur when social identities negatively impact healthcare experiences. Prior research has shown that individuals report experiencing HCST related to age, gender, weight, race/ethnicity, HIV status, and sexual orientation. Findings demonstrate that HCST may negatively impact comfort in healthcare decision-making while also potentially motivating older SM [sexual minority] adults to formally engage in ACP [advance care planning]. Research is needed to investigate the barriers and challenges to engaging in ACP among older SM adults and interventions to reduce HCST. 

Disproportionate use of aid in dying among people with ALS: Why ALS aid-in-dying requests are common while ALS is rareJournal of Aid-in-Dying Medicine; Carolyn Rennels, MD; Steven Z. Pantilat, MD FAAHPM, MHM; Ambereen K. Mehta, MD, MPH, FAAHPM; Allison Kestenbaum, MA, MPA, BCC-PCHAC, ACPE; Kelsey Noble, DO; Jessica Besbris, MD; Ali Mendelson, MD; Kara Bischoff, MD; 12/24People with amyotrophic lateral sclerosis (ALS) disproportionately use aid in dying. We explore aspects of the ALS experience that may help explain the higher rates of aid-in-dying requests in this disease relative to others. In particular, the desire to maintain control is prominent in the face of a relentlessly progressive disease that results in substantial disability. We also describe how the requirement for self-administration of aid-in-dying medications impacts people with ALS.

FTC releases second interim staff report on prescription drug middlemen: Report finds PBMs charge significant markups for cancer, HIV, and other critical specialty generic drugsFTC press release; by FTC staff; 1/14/25Staff’s latest report found that the ‘Big 3 PBMs’—Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx)—marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017-2022. The Big 3 PBMs netted such significant revenues all while patient, employer, and other health care plan sponsor payments for drugs steadily increased annually, according to the staff report. Key Findings include:

Current use and evaluation of artificial intelligence and predictive models in US hospitalsHealth Affairs; by Paige Nong, Julia Adler-Milstein, Nate C. Apathy, A. Jay Holmgren, Jordan Everson; 1/25Effective evaluation and governance of predictive models used in health care, particularly those driven by artificial intelligence (AI) and machine learning, are needed to ensure that models are fair, appropriate, valid, effective, and safe, or FAVES. We analyzed data from the 2023 American Hospital Association Annual Survey Information Technology Supplement to identify how AI and predictive models are used and evaluated for accuracy and bias in hospitals. Hospitals use AI and predictive models to predict health trajectories or risks for inpatients, identify high-risk outpatients to inform follow-up care, monitor health, recommend treatments, simplify or automate billing procedures, and facilitate scheduling. We found that 65 percent of US hospitals used predictive models, and 79 percent of those used models from their electronic health record developer.Publisher's note: It would be interesting if hospices collected and reported similar information.

Development and outcomes of a provider-driven, online continuing education program on integrative palliative care: Randomized controlled trialGlobal Advances in Integrative Medicine and Health; William Collinge, PhD, MPH; Leila Kozak, PhD; Scott Mist, PhD, MAcOM; Robert Soltysik, MS; 1/25While conventional medicine excels in emergency and acute care, complementary therapies are increasingly being integrated into efforts for symptom management and quality of life (QoL) in hospital, hospice and nursing home environments. The term “complementary” denotes a cooperative or collaborative relationship between conventional and unconventional modalities, and when such integration takes place, the terms “complementary” and “integrative” are commonly used interchangeably. Hospices have been early adaptors of such therapies with surveys in various states showing between 60-90% of hospices offering these modalities. This provider-driven CE/CME program led to significant positive changes in practitioners’ self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.

Preferred and actual location of death in adolescents and young adults with cancerJAMA Network Open; by Oreofe O. Odejide, Colin Cernik, Lauren Fisher, Lanfang Xu, Cecile A. Laurent, Nancy Cannizzaro, Julie Munneke, Robert M. Cooper, Joshua R. Lakin, Corey M. Schwartz, Mallory Casperson, Andrea Altschuler, Lori Wiener, Lawrence Kushi, Chun R. Chao, Jennifer W. Mack; 1/14/25In this cohort study of 1929 adolescent and young adult (AYA) decedents, 1226 (63.6%) had a documented discussion about their preferred location of death, with home being most frequently desired. Among these, 224 of 317 (70.7%) who wanted to die at home were able to do so, as were 164 of 172 (95.3%) who preferred a hospital death. The fact that over a quarter of AYA patients with cancer who preferred to die at home were unable to do so suggests a need for effective interventions to improve goal-concordant end-of-life care for AYA patients with cancer.

Sociodemographic disparities in the use of hospice by U.S. nursing home residents: A systematic reviewAmerican Journal of Hospice and Palliative Medicine; Christine E. DeForge, PhD, RN, CCRN; Hsin S. Ma, MPP, MA; Andrew W. Dick, PhD; Patricia W. Stone, PhD, RN, FAAN, CIC; Gregory N. Orewa, PhD; Lara Dhingra, PhD; Russell Portenoy, MD; Denise D. Quigley, PhD, MA; 1/25 Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use.

Effective solutions for caregivers of older adults: A review of systematic reviewsJournal of Applied Gerontology; Molly McHugh, Ellen Munsterman, Hannah Cho; 1/25This umbrella review aims to describe caregiver interventions tested across populations of informal caregivers of older adults and to examine the effect of caregiver interventions on depression, burden, and quality of life across intervention types and care-recipient populations. Most commonly, interventions focused on improving outcomes for caregivers of older adults with dementia. Among the included reviews, caregiver depression was most likely to be reduced by caregiver interventions, and cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) were most effective. The use of information and communication technologies to deliver caregiver interventions is increasingly common. Standardization of intervention classifications and transparent reports of intervention delivery details will strengthen research in this field.

Transition to hospice: how it impacts the mental health of caregivers of persons with dementiaAlzheimer's & Dementia; by Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris; 2024In this study, we aimed to examine caregivers’ mental health indicators and their correlation structure based on the timing of hospice transition... In the context of dementia care, our results highlight that caregivers who just entered hospice are undergoing a challenging transition that often finds them in a mentally vulnerable position. To develop and implement effective strategies for caregivers of persons with dementia, we need to understand the needs and vulnerabilities of caregivers during hospice transition and identify the best timing for the delivery of supportive tools.

The challenge of fractures in patients with chronic kidney diseaseEndocrine Practice; Andrea G Kattah, Silvia M Titan, Robert A Wermers; 12/24People with chronic kidney disease (CKD) are at increased risk of fractures in comparison to the non-CKD population and fractures are associated with high mortality and worsening quality of life. The approach for evaluation of bone disease and fracture risk in CKD is different from the approach in the general population. First, diagnosis of the type of renal osteodystrophy is not based only on assessment of bone density and traditional risk factors for osteoporosis. Second, there may be limitations of currently available fracture risk tools in the CKD population. Third, treatment choice should take into consideration the three components of the TMV classification along with the stage of kidney disease and comorbidities, but the assessment of these components has not been well established. As new medications for the treatment of osteoporosis become available, there is an urgency to establish more clear guidelines for the diagnosis, fracture risk stratification, and treatment of bone disease in CKD.