Skip to main content

Addressing Unmet Palliative and Geriatric Needs of Zombies



Considerable evidence indicates that zombies do not receive optimal palliative or geriatric care.  High prevalence of untreated pain, depression, decreased socialization, and impaired sleep and mobility, as well as lack of access to proper medical care are universal issues facing this population of undead. It is therefore not surprising that zombies and their loved ones often express dissatisfaction with after-life care, which may play a role in zombies' seeming unquenchable desire to eat the brains of the living. In the following post we will address some of the most common issues facing zombies, and some potential palliative and geriatric solutions to providing truly Zombie Centered Health Care (ZCHC).

Hospice Care
One of the most surprising issues facing zombies is the lack of coordinated health care focused on the care of the dead. Many zombies may benefit from an interprofessional team based service like hospice. However, the hospice benefit is limited to those with less than 6 months to live, effectively ruling out zombies as they are already dead. One proposal by some zombie advocates is to create an open access policy for hospice that includes the undead to ensure that they receive the same type of care that has been shown to improve care and family satisfaction in the living.

Pain
A growing amount of evidence is revealing that opioid use in zombies is quiet uncommon despite high rates of traumatic injuries. There are several possible reasons why zombies may be at risk for the under-treatment of pain. A common belief is that zombies feel and experience less pain as they generally do not report pain to their health care providers. A similar situation arises for those with dementia, however current evidence reveals that pain sensitivity and the perceptual processing of pain remain largely intact even with advanced dementia. It is therefore likely that in zombies, it is not a reduction in the actual experience of pain that leads to underreporting but, rather, an inadequate assessment of pain due to poor patient recall and communication of painful symptoms. We therefore recommend an adaption of the faces of pain scale as shown below:

Faces of Pain - Zombie Version

Gait Issues 
While the gait speed of zombies has not previously been estimated, we can use the speed of the Grim Reaper as a rough estimate for the maximum speed of a zombie. In a BMJ article, Death’s maximum speed was estimated to be less than 3 km/hour, which is around the speed I have estimated zombies to shuffle at in most of the publicly available films. This speed in older adults is associated an elevated mortality risk, which remains true for zombies, as they have a 100% mortality rate. Interestingly, zombies pose a paradox as they have a slow and shuffling gait reminiscent of a Parkinsonian gait, but an exceeding low risk of falls as revealed through an informal yet systematic review of all available zombie clips available to the public viewing.

Delirium 
Zombies are clearly delirious as evident by an acute change in mental status, inattention, decreased level of consciousness, and disorganized thinking. In addition, day/night reversal and perseveration (for braaiiins) is virtually pathognomonic for their condition. However, after researching hours of zombie behavior, another clear finding is that insomnia is a very large issue for zombies. I have yet to see a film of zombie behavior that shows one in sleep. While this is merely a hypothesis generating finding, there is a strong correlation between insomnia and the delirium seen in zombies (a 1:1 ratio). Given this, it may be reasonable during any zombie apocalypse to attempt interventions that produce a phase-shifting effect on circadian rhythms, such as the use of bright light therapy or melatonin, to decrease the rate of zombie related behaviors.

Depression
Diagnosing depression is as difficult a task in zombies as it is for those with advance illnesses. DSM V criteria for the diagnosis of depression exclude symptoms like psychomotor retardation that are due to the direct physiological effects of a general medical condition, like death.   Furthermore, symptoms like guilt may be a normal reaction to lifestyle choices, such as eating your family members brains.

Prognosis
The median life expectancy for zombies is zero days.  This grim statistic underscores the importance of discussing prognosis with zombies, as it is for anyone with a serious illness.  A study by Smith and colleagues revealed that most zombies want to know their prognosis.  Unfortunately, upon my review, no zombie movie has ever demonstrated a health care provider, or for that matter any of the living, telling a zombie his or her prognosis.

Advance Care Planning 
The subject of advance care planning pertains to end-of-life decisions, which may seem unimportant for zombies as they are past the end of life. However, understanding the values and preferences of zombies around “dead-decisions” is just as important as asking the living about end-of-life decisions. Given the high rates of traumatic injuries, having stated values of what is most important to zombies in their deaths, what brings them enjoyment while being dead, and what are the biggest worries and concerns would appear to be just as important to the undead as to the living.

by: Eric Widera (@ewidera)

Comments

Dave said…
Shared with http://caregiversnewsbasket.blogspot.com/
Unknown said…
Thank you so much for the timely information on the Zombie Care issues.
Tim Haskett said…
Thanks, Eric, for this interesting discussion. Perhaps zombies represent folks who did not receive good palliative care before their death and are out looking to seek revenge on a health care system that failed to meet their needs! In this light, palliative care would be considered a preventive measure.
Marie said…
Eric,
Thank you for your timely and comprehensive review of this understudied population--it is dead on. Clearly the zombie needs are gravely unmet. While the timing of this post was a dead giveaway, I suspect others will be dying to jump into the fray. Meanwhile I have two questions:
While your focus was on issues in geriatrics ever consider studying associations between symptoms in young zombies and the mummy-daddy dyad?
Could you share more about your methods? Did you use qualitative decomposition or did you succumb to the more generic immersion/submersion in the data approach. Personally, I'm fatally attracted to the former. Thanks again for raising the zombie issue; and reminding us that for many, there's more to life than "being mortal".
Eric Widera said…
You all are killing me! As I'm dead tired now I'll just leave you with a zombie joke:

A lawyer
A doctor
And a zombie walk into a bar...

Three zombies walk out.
Anne Johnson, LCSW said…
I was disappointed to see the "medicine-centric" focus on the needs of the undead. Where, I ask, is the interdisciplinary approach to the care of the zombie family system?

Social workers face special challenges in advance care planning. How to prove to Social Security that someone is undead, yet technically dead?

I'm hoping that the writer will consider applying for a multi-year grant so that all team members can have a voice. Or at least we can have a family meeting.

Popular posts from this blog

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Advance Care Planning before Major Surgery: A Podcast with Vicky Tang

This week's podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang.  Vicky is an assistant professor and researcher here at UCSF.  We talk about her local and national efforts focused on this intersection, including:
Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. Prehab clinics and how ACP fits into these clinicsThe Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgeryHow frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and check out some of those links.  For those who want to take a deeper dive into how GeriPal and surgery fit together, check out these other podcasts: Zara Cooper on Trauma Surgery, Geriatrics, and Palliative Car…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …