Hospice use not rising with end-of-life planning


A record 72 percent of elderly people had created advance directives in 2010 to guide their end-of-life care. That’s up from 47 percent in 2000, according to research from the University of Michigan (UM) and the Veterans Affairs Ann Arbor Healthcare System.

“Given the aging population, there’s been a great push to encourage more people to complete advance directives with the idea that this may increase hospice care and reduce hospitalization for patients during the last six months of life,” said the study’s lead author, palliative care specialist Maria Silveira, MD.

However, the study—which was published in the Journal of the American Geriatrics Society—found that hospitalization rates and deaths in hospitals remained the same.

“We found that while there’s an upward trend in creating these documents, it didn’t have much bearing at all on hospitalization rates over the decade,” Dr. Silveira said.

About the study

Data came from the UM’s Health and Retirement Study, a long-term research project involving more than 26,000 U.S. adults over age 50. The study collects information about a variety of topics, including health insurance, physical health and health care expenditures.

The sample for the study on advance directives included 6,122 people age 60 and older who died between 2000 and 2010, the most recent data available for the biennial study.

Based on responses to surveys completed by proxies (such as family or friends of the deceased), researchers learned that 6,005 people in the sample had prepared one or both of the following documents to guide their end-of-life care:

  • A living will. This is a legal document that spells out what kind of medical treatment you want near the end of life.
  • A durable power of attorney for health care. Also a legal document, this lets you name the person you want (a proxy) making medical decisions for you if you can’t make them yourself.

According to background information in the study, conventional wisdom has held that advance directives would result in spending less money on unwanted, aggressive treatment at the end of life and that people would be less likely to die in hospitals.

However, of the sample group for this study:

  • 38 percent died in the hospital
  • 27 percent died in their homes
  • 23 percent died in long-term care facilities
  • 8 percent died in hospice facilities

The findings suggest that several things are going on, said Dr. Silveira. One is that a piece of paper cannot control the likelihood of a person being hospitalized before death. A more direct and detailed conversation with family members or proxies may be needed for that to happen.

However, a second finding is that the increase in advance directives suggests that people are less timid about broaching the subject with loved ones, she said.

The take-home message
People with advance directives are more likely to have their wishes for treatment respected, according to the study’s authors. But the documents may not be enough in some cases.

“It may be that conversations in which individuals are given the choice not to be hospitalized and are provided with the appropriate support to safely and comfortably stay home are much more likely to affect hospitalization rates than advance directives are,” the study concluded.

The National Institutes of Health’s new NIHSeniorHealth site offers information about preparing for end-of-life treatment, as well as definitions of different types of care and legal directives.


Yakima Chronic Disease Classes

Juanita Silva of Memorial Community Health appeared on KIT 1280 on April 22, 2014 to discuss Memorial’s chronic disease classes. Memorial is starting its next round of classes May 6 to help individuals who suffer from chronic illness. The “My Health, My Life” classes are designed to teach simple techniques for living a healthy life by managing your symptoms. The six-week program teaches key skills for improving your health, despite your illness.

As rates of obesity, diabetes and other chronic diseases continue to rise in our community, we must pursue avenues of prevention and management to affect meaningful change in how these conditions impact people’s lives.

Louise Adams is seeing this firsthand. Louise was invited to attend a class to offer support for a friend and found that she learned as much about her own health habits. Louise shared her experience on KIT 1280 as well, encouraging others to sign up for the classes.

Who should take these classes?
Anyone living with a chronic illness that impacts the quality of their life can attend. We see people with any number of disorders:
• arthritis, diabetes, asthma, depression, obesity, heart disease, cancer and debilitating, chronic pain.

You also don’t need to be ill to attend the class – caregivers and family supporters are also welcome.

What are some of the things the class teaches?
• Healthy eating
• Weight management
• Getting a good night sleep
• Preventing falls and improving balance
• Managing your chronic disease
• Communicating with your doctor
• Managing your medications
• Pain management
• Managing difficult emotions
• Problem solving
• Goal setting

The classes are held in Memorial’s classrooms in the basement. They are 2-1/2 hours each, once a week for six weeks. The next class starts Tuesday, May 6.

For more information, call Juanita at 225-3178

Walk this way—With your whole family!

(Courtesy of the American Heart Association)

Getting your kids to trade screen time for physical activity may be the most challenging — and the most important — item on your to-do list. Walking is a great start, but there are other ways to get your whole family moving together. Be a good role model. You don’t have to be perfect all the time, but if your kids see you getting physically active and trying to eat right, they’ll notice your efforts.

Get the whole family moving. Don’t just send your kids out to play. Plan times for everyone to get moving together. Take walks, ride bikes, go swimming, garden or just play hide-and-seek. Everyone will benefit from the exercise and the time together.

Break it up. The American Heart Association recommends 150 minutes a week of exercise, but if that sounds overwhelming, try three 10-minute workout sessions a day. Don’t make exercise a punishment. Forcing your child to go out and play may increase resentment and resistance. Try using physical activity to counter something your child doesn’t want to do. For example, let your kids ride bikes for 30 minutes before starting homework after school. Your child will beg for 20 more minutes outside just to put off the homework!

Build confidence and find an activity they love.

Some kids are embarrassed to participate in sports because they don’t think they’re good enough. Find time to practice together and boost their confidence. Try swimming, dancing, cycling, skateboarding, yoga, walking or jumping rope. Encourage your child to explore multiple activities to find one they really enjoy.

Get your kids active while doing housework. Put a sticky note on all the items that need cleaning or tidying (like the kitchen table, the sofa, the bed). Ask your child to collect each sticky note after they clean the item. Make it a friendly competition to see who collects the most stickies. You could even offer a prize (like a Frisbee or jump rope from the dollar store) for the winner. Your kids will be physically active, helping with household chores and having fun!

Be realistic. Setting realistic goals and limits are key to adopting any new behavior. Small steps and gradual changes can make a big difference in your health over time, so start small and build up. The more active your family gets, the more inspired you may feel to tackle other areas. Need tips for dealing with a picky eater? We’ve got ‘em. Want to learn how to make fast food healthier when you’re on the go? We can help. On a budget and need quick ideas for healthy foods that are under $1? Check out this list.

And remember: Something is always better than nothing! Physical activity is anything that makes you move your body and burns calories, even raking leaves, walking the dog or climbing stairs

Stress, sneeze, repeat: Study links stress to allergy flare-ups

People who regularly feel stressed out tend to have more frequent flare-ups of their allergies than allergy sufferers under less strain, according to a study in Annals of Allergy, Asthma & Immunology.

Plus, the study found that the more flare-ups the people had, the more their mood worsened. The worse their mood, the more they felt stressed—and the more their allergy symptoms flared.

It’s a perfect storm of stressing and sneezing.

“Stress can cause several negative effects on the body, including causing more symptoms for allergy sufferers,” said lead study author Amber Patterson, MD. “Our study also found that those with more frequent allergy flare-ups also have a greater negative mood, which may be leading to these flares.”

About the study

The research involved 179 university employees in Ohio who were initially part of a 12-week-long study looking at the potential health benefits of mindfulness.

Part of the study involved completing an online diary each night at bedtime during two separate two-week periods. Diary details included any allergy symptoms, stressful events, stress levels and mood.

To help researchers calculate a daily stressful event score, the people also documented whether or not they had experienced a stressful scenario that day involving friends, spouses or partners, work, or coworkers. In addition, they rated their own stress level by answering the question: “Overall, how stressful were your relations with your friends/spouse/family/coworkers today?”

Researchers collected saliva samples of each person four times a day to measure levels of cortisol, a hormone that indicates stress.

Sixty-nine people reported at least one allergy flare-up, and most had more than four during the total 28 days of diary entries. These same people also reported feeling more frazzled than those without allergy symptoms. Their allergies tended to flare up more during periods of stress, although generally not on the same day as a stressful event.

The study’s findings suggest that persistent stress over a period of time has more of an effect on allergy flares than any single day of high stress, the authors wrote.

Researchers also found a link between feeling upset or irritable and frequent allergy symptoms. Whether allergy symptoms led to the negative mood or the negative mood triggered the allergy symptoms—or even a bit of both—the study wasn’t able to answer.

The study’s findings are limited by relying on the people’s self-reports, which could mean that allergy symptoms weren’t accurately recorded. It’s also possible that allergy medications may have had an effect on people’s moods. But, the authors wrote, “if [the people] regularly used antihistamines during this study without reporting it, then the effects of stress on symptom flares could be greater than reported.”

Another possible limitation was that the study took place from September to May, so people with summer allergies would not have had symptoms.

The take-home message
Stress doesn’t cause allergies. But some allergy sufferers may benefit from stress awareness and coping strategies—from asking for help with overloaded schedules to carving out time to relax and have fun.

“While alleviating stress won’t cure allergies, it might help decrease episodes of intense symptoms,” Dr. Patterson said.

How can you tell what’s causing your allergies? What’s the difference between being allergic to pollen and being allergic to foods? Find the answers at the Allergies health topic center.