Seniors are completing advance directives in record numbers, but this is not having the expected effect of shifting people from hospitals to hospices in their last days, say researchers from the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System.
About 47% of elderly people had completed a living will as of 2000, and that increased to 72% by 2010, according to data from the Health and Retirement Study. This is a national survey done by the University of Michigan Institute for Social Research, on behalf of the National Institute of Aging.
However, during that same period, hospitalization rates increased in the last two years of life, the investigators found.
The proportion of people dying in the hospital decreased from 45% to 35%, but the researchers determined this had little to do with advance directives. This could be because directives focus more on the type of care rather than the setting where it is provided, they surmised.
“These are really devices that ensure people’s preferences get respected, not devices that can control whether a person chooses to be hospitalized before death,” said Maria Silveira, M.D., MA, MPH.
Among those who have completed a living will, most have both explained their treatment preferences and appointed a surrogate to make care decisions for them, according to the findings in the Journal of the American Geriatrics Society.
Diabetes-wound link
Diabetes is the co-morbid condition most strongly associated with the development of pressure ulcers in senior living residents, according to an analysis of existing research.
Investigator Yuta Kurashige, M.D., Ph.D., identified seven studies that have been done on this topic. The smallest involved 827 residents in the United Kingdom, and the largest involved more than 14,600 in the United States.
Six of the seven studies found that diabetes mellitus is associated with pressure ulcer development, according to Kurashige, of the Hachioji Medical Center at Tokyo Medical University.
Some of the studies found that Parkinson’s disease, hip fracture and peripheral vascular disease also are correlated with pressure ulcer development, but other studies indicated that these conditions are not associated with PUs, Kurashige found. His findings are published in the International Journal of Clinical Dermatology & Research.
Alzheimer’s test
A new blood test reveals with 90% accuracy which people will develop Alzheimer’s disease or mild dementia within three years, according to study results in Nature Medicine.
The study involved 525 seniors. An analysis of 10 lipids predicted the cognitive conditions, the researchers discovered. They say this could improve interventions and drug development.
Further testing is needed before the test could be offered to the public. Without any proven preventive therapy, screening for dementia might be pointless, prior research has suggested.
Enhance care
Stroke survivors have “enormous” palliative care needs, and healthcare providers should ensure they can provide these services, according to a scientific statement released by the American Heart Association/American Stroke Association.
In the first statement outlining palliative care guidelines for stroke survivors in the United States, members of the writing group emphasized the need for care coordination among different types of providers and clinicians. Nurses and therapists are two members of a care team that also should include primary care providers, neurologists and other specialists, families and the patients themselves, according to the statement.
High-quality palliative care should be patient- and family-focused to aid in the complex decision-making that characterizes stroke care, the guidance states.
Specifically, the care should involve “effective, sensitive discussions” about physical and mental losses and, potentially, dying.
