Monthly Archives: September 2014

Hospice Care and Alzheimer’s

For Americans age 65 and older, Alzheimer’s is the fifth leading cause of death.

Because Alzheimer’s generally develops over a period of time, a patient with an early diagnosis of Alzheimer’s may not qualify for hospice care. But when a patient reaches the later stages of Alzheimer’s and a doctor determines that a patient has six months or less to live, hospice care can play an important role for patients and their families.

Today’s Geriatric Medicine, in an article posted on its website, points out that “hospice is underutilized for advanced dementia patients.” The main reason? “End-of-life prognostication presents a significant barrier to hospice usage.” In other words, it may be harder for a doctor to make the “six months or less” assessment with an Alzheimer’s patient.

The article quotes geriatric care manager Joan Wright who says, “Emotions remain within the dementia patient long after other aspects of that person are lost. Hospice responds to those emotions, and the dementia patient responds in turn. Ensuring a peaceful environment and a dignified death is what hospice does best for dementia patients.”

In her recent book about Alzheimer’s, Slow Dancing With A Stranger, Meryl Comer mentions the early misdiagnoses of her husband’s Alzheimer’s. They ranged from Lyme disease to anemia to Mad Cow disease. (Her husband is currently in hospice care at home.)

Regarding his Alzheimer’s, she writes, “”The man I live with is not the man I fell in love with and married. He has slowly been robbed of what we all take for granted—the ability to navigate the mundane activities of daily living: bathing, shaving, dressing, feeding, and using the bathroom.”

In the book, she expresses distress that not only is there no cure for Alzheimer’s, there are no disease-modifying drugs or treatments.

Research to find cures and treatments for Alzheimer’s is continuing. Some of the funding for that research is collected via events like the Walk To End Alzheimer’s, set for Saturday, September 27, at St. Charles Community College in St. Peters. The Hope Hospice team will participate. If you’d like to help, click HERE for more information.

For questions about hospice care in metro St. Louis, call us at Hope Hospice at 314-984-9800.




How To Choose A Hospice

A recent item posted on the New Old Age blog on the New York Times website offers guidance on selecting a hospice. Naomi Naierman of the American Hospice Foundation was interviewed and shared her thoughts.

“You have to become a very savvy consumer about what is likely to be the most important health care decision you make in your life,” she says.

She advises asking direct questions to hospice representatives. She says, “How receptive a hospice is to these questions is the first signal of their quality.”

“Hospices in some communities come and go. You want to be sure you’re not signing up with one that’s been around a few months or even a year.” (Hope Hospice is beginning its 8th year of operation in metro St. Louis.)

To those who might presume that all hospices are alike, she adds, “There’s a set of services that’s standard, but how much, what the intensity is — that varies a lot. Consumers need to know that.”

Regarding respite care, Naierman suggests, “It’s also a good question to ask: What kind of respite care do you offer, under what circumstances?”

Paula Span, who conducted the interview and wrote the piece, mentions, “It will be difficult for patients or families to undertake this research if they’ve waited until a few days before death. It sounds like another argument for enrolling in hospice early.”

Among the comments posted by readers, this one sums up the feelings of many survivors: “I am glad we called in hospice early, because [my husband] spent the last few months of his life in his own home, in familiar surroundings, cared for by family with support from hospice staff.”

At Hope Hospice we welcome your questions about hospice care, even if your need may be weeks, months or years away. Call us at 314-984-9800.

Hope Hospice serves patients and families in St. Louis city and county and in St. Charles, Jefferson and Franklin counties.

Anticipatory Grief

Following the death of a loved one, a friend or an associate, we tend to suffer grief in varying degrees and for varying periods of time.

Grief that precedes an anticipated death can have many of the elements of grief that occurs after a death, including depression. Added to this grief is the uncertainty of a future without the presence of the person whose passing is awaited.

An article posted on the National Cancer Institute’s cancer information database states that anticipatory grief may not always occur. The article also points out that grief before a death does not shorten the time of grief following the passing.

Anticipatory grief, the article suggests, can give the family more time to get used to the reality of the loss. Facing this stark reality can lead family members to complete unfinished business with the dying person, such as saying goodbye and expressing love that may have not always been readily shared. Try to make your loved one’s remaining time meaningful.

For caregivers, the emotions of anticipatory grief may be combined with the stress and exhaustion that come from attending to the dying patient. Share your feelings with other family members and your support group, including your hospice team members.

Remember that while you are experiencing anticipatory grief, the dying person is also faced with a multitude of feelings as she or he becomes aware that life will soon be ending. Just as family members experience anticipatory grief in various ways and to different degrees, so, too, do those who are facing death. Your hospice chaplain or your family’s religious leader can provide counsel.

For answers to your specific questions regarding grief before and after the passing of a loved one, call Hope Hospice in metro St. Louis at 314-984-9800.