Archive for April 2016

Hospice Care Shown To Reduce Symptoms in Older Adults

Posted on Apr 27, 2016

Senior woman potting flowers

There have been multiple studies that attempt to quantify the positive effects hospice care has on patients in the last weeks and months of their lives. While some have focused on the amount of time a patient may enjoy in hospice care, a study conducted by Yale researchers has been used to show how quality of life is impacted by hopsice through decreased symptoms. The Precipitating Events Project, PEP, enrolled 754 adults over the age of 70, who lived in the community, rather than an in-patient facility or nursing home, and were not disabled. These participants were interviewed monthly until their death about their health. The results of this study have allowed for a number of subsequent studies into what impacts a person's life and health in the months before death. Here, we focus on a study recently published in the American Journal of Medicine, which tracked the monthly occurrence of symptoms in these individuals and how those symptoms changed after enrollment in hospice care. 

The results of this study show two things. First, for most individuals, hospice care was reserved for a time when the number and prevelence of symptoms that restrict daily activity increased sharply. For example, the mean number of activity limiting symptoms rose from one to three over a three month period immediately prior to hospice enrollment. The prevelence of any activity limiting symptom rose from about 25-percent to over 50-percent in the same time period. 

Second, the data shows that following hospice enrollment, these same metrics decreased sharply and nearly returned to the levels of four months prior to enrollment. Over the first 90 days in hospice care, the number of symptoms fell to less than two. In the same period, the prevelence of symptoms dropped more than 20-percent. It should be noted that patients typically required up to a month to begin seeing significant reductions in their acitivity limiting symptoms. 

The first takeaway is not surprising. Families and patients typically wait to enroll in hospice until the quality of life of the patient has been significant affected. The Hospice Medicare benefit also doesn't allow for enrollment until a patient receives a diagnosis with a life expectancy of 6 months or less. 

Even so, the mean time from admission in hospice care to death was only about 15 days. This means that many patients both don't receive the full benefit of hospice care, and spend an unnecessary amount of time battling limiting symptoms before enrolling in hospice. 

The second takeaway is made even more meaningful when you examine the specific symptoms that hospice helps to reduce. The most common symptoms affected by hospice for participants in this study were fatigue, depression, anxiety, and arm or leg weakness. Each of these directly contributes to a patient's quality of life, and, as they improve, introduce opportunities to enjoy activities they otherwise would have missed out on. 

In addition to these findings, the PEP data has been instrumental in other research, including disability trajectories in the last year of life, and the prevelence of dyspnea in older adults in the last year of life. 

If you or a loved one are in need of hospice or palliative care, or if you'd like to research these care options, please contact us at Cura-HPC by calling 1-800-797-3839. 

Two Categories of Advancement in Early Alzheimer's Detection

Posted on Apr 22, 2016

Doctor studying brain scan

Alzheimer's disease leads to cognitive decline and mental deterioration that significantly impacts an individual's personal life, and health. While there's not currently a cure for Alzheimer's, a great deal of research is being conducted to get closer to finding one. In the meantime, treatment and management of this disease improves greatly when it's caught in its early stages. Recent breakthroughs in testing have allowed for earlier diagnoses. Here are the details of two of these advances. 


Also referred to as their full name, biological markers, these genes or molecules represent a tremendous opportunity in Alzheimer's research because of their unique ability to detect when something is wrong within a human system. By studying biomarkers, experts are able to discern when physiological damage or a disease is present within an individual, and can even categorize the specific issue. Biomarker research has concluded that it would be possible to detect Alzheimer's disease in its earliest stages, and potentially before any other type of detection currently available. To date, however, specific biomarkers for Alzheimer's haven't been identified or clinically validated. Research is headed in this direction by studying brain imaging and cerebral spinal fluid protein, while also utilizing genetic risk profiling. 

Brain Imaging

Because of the nature of Alzheimer's disease and its affect on the brain, brain imaging is another promising option for early detection. This would be the MRI, CT, or PET scans that have become common to perform when diagnosing any type of disorder to issue that's related to the brain. As Alzheimer's develops, amyloid plaque begins to build up in the brain, which shows up in brain imaging scans. Amyloid plaque can also be an indication of other disorders. Research seems to be farther along with brain imaging and closer to being able to implement more early detection testing in real world applications. There are even new brain imaging processes in the works that will help doctors identify Alzheimer's specifically without the use of radiation, and at a fraction of the cost of other brain scans. One such technique called arterial spin labeling, or ASL-MRI, requires about 20 additional minutes than a typical MRI, and is able to pinpoint changes in blood flow and increases in blood sugars that would be a symptom of Alzheimer's disease. 

Alzheimer's patients are among the individuals we commonly treat under hospice and palliative care at Cura-HPC. To learn more about our care options, contact us at 1-800-797-3839. 

4 Common Mistakes Made When Planning For End of Life Care

Posted on Apr 14, 2016

Couple discussing advance directives

For most of us, researching hospice care, and other care options for ourselves or aging, or ill relatives, only happens when there's an immediate need. Too often, creating a care plan for ourselves is neglected and forgotten until it's the situation becomes dire. Recent research has revealed, however, that those that create a definitive plan for their care near the end of their life also spend less time in the hospital, and receive fewer intensive treatments. Overall, the quality of life for those with advanced directives in place is generally better than those that have no plan in place. Despite this knowledge, less than 30 percent of Americans have put their treatment wishes in writing. It's important for adults at any age to begin to take their end of life care options into consideration. When you do, here are some common mistakes to avoid. 

The Wrong Proxy

One reason why it's important to have a detailed care plan in writing is that you may be incapacitated or unable to speak when you need medical care. In that case, having a plan will help guide your treatment, but you'll also need to choose a healthcare proxy who can ensure your wishes are carried out and make any decisions that aren't explicit in your plan. This proxy can be a friend, relative, or anyone you trust, but it should be chosen carefully. You'll need someone who is strong enough to stand up to those who may oppose your wishes, whether that's your physician or your family. It's typically easier if your proxy agrees with the choices you've made, or at least respects your decisions. And, the current age and health of your prospective proxy should also be taken into consideration to ensure they're physically and mentally able to handle the job when you need them. 

Bogged Down in Details

As soon as you begin to consider your treatment options, you'll likely realize that there is an endless number of potential decisions and scenarios to consider. Trying to make individual choices based on certain outcomes is a waste of time, and it's unlikely that you'll cover all the possibilities anyway. Instead, start from the end and answer broader questions. For example, what details are important to you about your death. That includes where you'd like to be, who you'd like to be around, how aggressive your treatments should be leading up to that day, and similar considerations. Once you've answered that question, decisions on smaller details will fall into place as well. 

Not Involving Your Doctor

There's a good chance that your doctor knows more about your illness and overall health than even you do. Not only that, but in most cases, your doctor will be the one expected to provide the treatments that are important to you, or to oversee your care in some fashion. If you don't involve your doctor in your care plans, it increases the risk that your wishes won't be carried out properly. Only about 25 percent of individuals who have an advanced directive in place involved their physician in creating it, or even informed their doctor that paperwork existed. By meeting with your doctor when you're creating these documents, you'll have more information about the care choices you're considering, and your doctor will know what the plan is, and what to do when this scenario occurs. 

Not Communicating With Loved Ones

Just as you need to have your doctor's involvement in your advanced planning, you also need the involvement of your loved ones. A recent survey revealed that nearly everyone would agree that it's important to discuss end of life care plans with their family, less than a third of these individuals had actually had these conversations. This lack of communication can lead to disagreements, fights, and your wishes not being followed correctly. Gather those closest to you, ideally all at once, and explain to them what choices you've made, and give each of them a copy of your advance directive. This way, they all have the same information and can work together to help you get the treatment you want. 

In addition to this advice, it's important that you revisit your care options documents periodically. As you age, and as your situations changes, and the situations of those around you, you'll want to update and revise your decisions. 

For help gathering information about hospice and palliative care, and making informed decisions about your end of life treatment, contact us at Cura-HPC. 

Associations Found Between Diet and Cancer Risks

Posted on Apr 07, 2016

Woman eating salad

Many of the patients we provide hospice and palliative care for are battling cancer. While there are multiple causes of cancer, one recent study found how your diet directly influences your risk of certain types of cancer. Completed by a PhD student at NYU, research discovered certain foods that could triple the risk of developing prostate cancer, and other foods that help reduce the risk of developing breast cancer by two-thirds. Here's an overview of the study and its findings. 

Researchers in the health field have found repeatedly that health risks like heart disease, weight gain, and others can be directly tied to the over-consumption of refined, processed carbohydrates. Additionally, this study at NYU found that these unhealthy carbs also greatly increase the risk of prostate cancer. 

To reach this conclusion, data from 3100 individuals was collected by conducting questionnaires about each individual's eating habits. The food sources the individuals consumed were divided between glycemic index (GI) and glycemic load (GL). 

GI is a measure of a carbohydrates quality, as determined by its impact on blood sugar levels compared to another food for a point of reference. 

GL is a measure of both the quality and the quantity of carbs found in a specific food. 

With these categories lined out for each individual's diet, researchers were able to find correlations between cancer rates, and the intake of carbs. Specifically, regular foods with a high GL led to an 88 percent higher risk of prostate cancer. 

Meanwhile, regular consumption of foods with a low GI was found to be associated with a 67 percent lower risk of breast cancer. 

This second, positive distinction stemmed from the discovery that females in the study with higher proportion of their total diet made up of carbs also had a lower occurrence of breast cancer. Those whose diets included the largest quantity of carbs also included the largest quantity of quality carbs like fruits, vegetables, whole grains and legumes.

This led to the conclusion that the type of carbs consumed is more important than the sheer volume. While eating a diet filled with healthy carbs can help to lower the risk of many health issues, consuming unhealthy carbs like pizza, burgers, and processed lunch foods has the opposite effect.

Changing your diet now could very well help you avoid cancer. 

If you or a loved one are already battling this debilitating disease and want to explore care options, contact us at Cura-HPC at (800)797-3839.