Comments on GeriPal - Geriatrics and Palliative Care Blog: Hospice care of the Geriatric patient

Your post is featured in this month's palliati...

2009-08-08T19:37:03.888-07:00

Your post is featured in this month's palliative care Grand Rounds!

http://risaden.blogspot.com/2009/08/palliative-care-grand-rounds-august.html

I have to say that this is my biggest hesitation w...

2009-08-06T16:30:11.207-07:00

I have to say that this is my biggest hesitation when initiating hospice discussions with patients who are not very near the end of life. These include heart failure patients, patients with dementia, and COPD patients. All of these may have some level of unpredictability to their disease course, but all will eventually will die from their disease. Using medications like ativan, scopolamine (great comment), benadryl should be avoided like the plague in most of these patients as they very well may hasten death or cognitive/functional decline.

Scopolamine patches are another problem. I find th...

2009-08-06T14:02:03.552-07:00

Scopolamine patches are another problem. I find them behind the ear of elders who were previously alert, eating, drinking, interacting. The family wonders why they drowsey and confused. I remove the patch and slowly they improve to prior LOC.

Nurses have long been the original inspiration and...

2009-08-03T18:19:45.727-07:00

Nurses have long been the original inspiration and foundation of hospice care. I think that NPs are in a perfect position to assist with the overall education and management of hospice patients, particularly those trained in advance illness management. I also think we need to re-look at the one size fits all role of nurses and doctors. An MD or RN behind a name who has passion about working with people at the end of life is not enough. We must start demanding training, including certifications, in our areas of expertise. Would any one of us w/o special training practice cardiology care after only a few days training and a generic list of meds associated with common symptoms? I believe nurses and docs are eager to learn, but don't know what they don't know. I think our eagerness and passion has gotten us far, but now we need to not sell ourselves short. Let's put our money where our mouth is - EOL care/advanced illness management is an area of specialty as important and valuable as cardiology, oncology, or infectious disease. If we don't start respecting that ourselves, how can we ask it of others?
-Patrice GNP, ACHPN

I agree with you! As a PCNP, I want to work on thi...

2009-08-02T17:51:10.618-07:00

I agree with you! As a PCNP, I want to work on this issue.
What do you suggest that NPs working with hospices should do to address this "one size fits all" approach to med recommendations, and to improve hospice nursing practice, especially in nursing facilities?

Agree, agree, agree! I love hospice, but I have so...

2009-07-23T19:15:49.616-07:00

Agree, agree, agree! I love hospice, but I have sometimes viewed the care as "the 5-drug-fits-all plan". Great post!

Great comment! I'm a geriatrician working par...

2009-07-19T20:04:21.966-07:00

Great comment! I'm a geriatrician working part time as a medical director at The Denver Hospice. In addition to the anti-psychotic/sinemet (or Parkinson's) combo, I also find the donepezil/oxybutynin and the tight control of glucose to be a common hospice polypharmacy errors. Geriatricians think about things like stopping the alpha blocker when the permanent foley is placed or that depression is one of the leading causes for unintentional weight loss. I agree wholeheartedly that the geri perspective augments the PC perspective.

The one-size-fits-all approach to hospice medicati...

2009-07-15T20:54:37.298-07:00

The one-size-fits-all approach to hospice medications simply does not work, particularly in the elderly. Caring is not enough, we need thinking, educated, caring providers.

Patrice---your post will warm the heart of all Ger...

2009-07-15T19:54:02.896-07:00

Patrice---your post will warm the heart of all Geriatricians! I think the case you describe is yet another example of the dangers of algorithmic care in older persons, and how important it is to individualize care. General guidelines or algorithms (such as the "comfort care packet") can be very useful. But if clinicians don't apply clinical judgement to their use, in the context of the needs of each individual patient, they risk doing more harm than good.