GeriPal

by: Eric Widera ( @ewidera ) If you had to guess what long acting opioid is most commonly started on in nursing home patients, which one would you guess?     A new study released last week in JAGS shocked me.   The answer to this question was a fentanyl patch.   Even more shocking, many of those started on this medication were never prescribed any opioids prior to being started on a patch.   Ok, before I get ahead of myself, let me describe the study.   The authors used nursing home data from 22,253 Medicare-enrolled long-stay residents (meaning that they had to have a stay of greater than 90 days).  They combined the Minimum Data Set (MDS) with Medicare enrollment, hospital claims, and prescription drug transaction data from January to December of 2011 to determine the prevalence of new initiation of a long-acting opioid prescriptions.   They excluded residents who were comatose, who did not initiate a long-acting opioid after nursing home admission, or who had less than 3

by: Bridget Blitz, LCSW, ACHP-SW Her name was Faith, at least for the purposes of this reflection.  The night before she died, Faith knew that she was going to die and told the hospital nurses that she was would be dying soon.  She was able to articulate her needs, see her family and quietly die the next morning.  In her mid-fifties, Faith encountered a long journey with breast cancer that lead to metastasis in other areas of her body, including her bones.  Long before the hospitalization, Faith cried while anticipating a bad result from an MRI that turned out to be more positive than negative at that time with little progression of her cancer.   She had an uneven course after that with more illness progression.  Unfortunately, her disease proved to be quite strong and deadly. Our society seemed to ignore and then to glamorize breast cancer.  Pink ribbons, moving stories of beautiful, bald young women with small children and fund-raising walks do not capture the full extent of l