Journal of palliative medicine
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To describe acetylcholinesterase inhibitor (AChEI) and memantine use among persons over the age of 65 admitted to hospice with a primary diagnosis of dementia and identify patient and hospice program characteristics associated with the use of these agents. ⋯ A notable number of hospice enrollees with a primary diagnosis of dementia were prescribed AChEI and/or NMDA receptor antagonist therapy. Studies are needed to better define the role of these agents as well as the impact of medication discontinuation in persons with end-stage dementia.
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Comparative Study
Health literacy not race predicts end-of-life care preferences.
Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life. ⋯ Health literacy and not race was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. In addition, after viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to race and health literacy. These findings suggest that clinical practice and research relating to end-of-life preferences may need to focus on a patient education model incorporating the use of decision aids such as video to ensure informed decision-making.
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Serious illness can cause economic devastation for families. Locally run patient day care programs, or programs for training caregivers for future caregiving employment, could provide a measure of economic resilience. We sought to gather pilot data on the circumstances of informal caregivers and the desirability of such programs. ⋯ Most ICs in this survey faced financial and personal hardships. A large majority reported that they would use day care or hired home care for their patients if it existed, and also reported interest in becoming certified, paid caregivers. These data suggest that an economic resilience option for families based on IC training in palliative care might work at Hospice Africa Uganda.