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Elderly man giving himself a breathing treatment using a mask

COPD Awareness Month: Hospice Referral Guidelines

By: Laura Mantine, MD

Chronic lung disease is the 4th most common cause of death among older adults in the United States. More than 3 million people worldwide died of COPD in 2015, representing 6% of all deaths that year. People dying from COPD frequently experience difficult and uncomfortable symptoms that lead to distress and panic. They commonly have disabling respiratory symptoms including severe breathlessness, limited tolerance for activity, and intractable coughing. They are also usually oxygen dependent, often experience anorexia with weight loss, cachexia, and ultimately become dependent on others for their activities of daily living.    

COPD and Hospice Care

Despite the symptomatic needs of individuals dying from end-stage COPD, only 30% of individuals receive hospice care before death. It is not clear why the rate of hospice use for patients with COPD is so low, but several explanations have been offered. The most important may be that few patients with severe COPD have discussed end-of-life planning with their clinician. Furthermore, many patients and clinicians do not view COPD as a terminal illness and feel it is more chronic in nature. Also, there may be a lack of awareness that patients enrolled in hospice can continue to receive treatments for COPD. Due to the fluctuating course of COPD, it is often difficult to accurately estimate a patient’s life expectancy which may contribute to low hospice utilization rates.

Hospice Eligibility Guidelines for COPD

While end-of-life-care is an appropriate topic to discuss with all patients, several factors have been suggested that should prompt a discussion with patients who have severe COPD. One factor is simply that a clinician would not be surprised if a patient with COPD were to die within the next 6-12 months. A clinician should consider hospice referral in a patient with COPD if they are dyspneic at rest or with minimal exertion, have progressed to the point where they spend most of their days at home, have experienced repeated ED visits (one or more each quarter) due to infection or episodes of respiratory failure, have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted and the patient no longer wishes to be intubated.

The major hospice eligibility guidelines for COPD are:

There are other important clinical factors that also may support a patient’s hospice eligibility. These are:

Abnormal laboratory findings may also trigger a hospice referral such as:

While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission.

How Hospice Can Help COPD Patients

COPD is a significant health issue around the world. It is ultimately a fatal disease and patients are under-referred to hospice care. Hospice, with its strong interdisciplinary approach, has been shown to improve quality of life for patients with end-stage respiratory disorders like COPD.

Please contact us if you have any questions about how our team can help COPD patients.

References:

Hospice Eligibility for Patients with COPD. Serena J. Scott, MD, Barry D. Weiss, MD, Ellyn Lee, MD, College of Medicine, University of Arizona.  https://uofazcenteronaging.com. June 2017.

When to refer patients with advanced COPD to palliative care services. Rebecca Strutt. Breathe (Sheff). 2020 Sep; 16(3): 200061.

Referral to palliative care in COPD and other chronic diseases: A population-based study. Kim Beernaert; Joachim Cohen; Luc Deliens; Dirk Devroey; Katrien Vanthomme; Koen Pardon; Lieve Van den Block. Respiratory Medicine. Volume 107. Issue 11, P1731-1739. November 1, 2013.

Graphic of multi-racial women wearing pink breast cancer awareness ribbon

Breast Cancer Awareness Month

Breast cancer is one of the most common cancers among women in the United States, second only to skin cancer. It’s a disease in which the cells in the breast grow out of control. There are several types of breast cancer, but there are two that are most common. Invasive ductal carcinoma is when the cancer cells begin in the ducts and then grow outside them into other parts of the breast tissue. Invasive lobular carcinoma is when the cancer cells begin in the lobules and then spread from there to the breast tissues that are close by. It is possible for both of these invasive cancer cells to spread to other parts of the body.

Symptoms of Breast Cancer

Symptoms of breast cancer can vary from patient to patient, and some may not experience any at all. However, some common symptoms one may experience are:

If you have concerns about any symptoms you are experiencing, see your doctor right away.

Risk Factors for Breast Cancer

There are several factors that can put a person at higher risk for developing breast cancer. Some are beyond our control, while others we can change. One of the main factors that puts a person at risk for breast cancer is being a woman. Although men can get breast cancer, women are at higher risk.

Risk Factors Beyond Our Control

How to Lower Your Risk for Breast Cancer

Hospice Care for Breast Cancer Patients

If you or someone you love has been diagnosed with breast cancer, and curative treatment is no longer an option, hospice may be right for you. Please contact us to learn more about how the Ohio Valley Hospice team can help.

Calm middle-aged woman sitting in padmasana with eyes closed. Mature female holding hands pressed together in namaste and doing breathing exercises. Meditation and yoga idea

Benefits of Yoga for Hospice Patients

We’ve all heard how good yoga is for you, but have you ever thought about the benefits of yoga for hospice patients? Yoga is defined as a spiritual discipline that is widely practiced for health and relaxation that includes breath control, simple meditation, and specific bodily postures. All of these things can be used to help hospice patients and their families navigate through an emotionally stressful time.

A brief history of yoga

Yoga is a combination of spiritual, mental, and physical practices that originated in ancient India approximately 5,000 years ago. It was originally practiced primarily to cultivate spiritual harmony and enlightenment.

It started to become more popular in the late 1800s as it spread west. New practitioners viewed it as a path to inner peace and better health. Then, we saw what is called the ‘Modern Yoga Renaissance’ in the 1920s where the physical practice of yoga dramatically changed. Prior to this point, it really only consisted of a few standing poses. Today, yoga has become a key component of holistic health.

Learn more about the history of yoga here.

What yoga looks like for hospice patients

When we think of yoga, we often think of poses like downward dog or child’s pose or even the more complex poses that turn a person into a pretzel. However, before you can learn to twist and turn and pose like that, you must focus on something you already know how to do. In fact, you do it all day, every day: breathe.

In yoga, breath control is referred to as pranayama [pränəˈyämə], and it is essential. There are several forms of pranayama that can be done from the seated position. One example of this is Adham Pranayama. It can be performed either sitting or lying down, whatever is most comfortable. The focus of Adham Pranayama is ‘belly breathing,’ or breathing deeply into your stomach.  

So how do you do it, you ask. First, place one hand on your stomach and the other on your chest. Breathe in and out. Focus on moving only your abdomen, instead of inflating your chest. It’s as simple as that. Practicing Adham Pranayama has several benefits, including reducing insomnia, providing oxygen to the body, and relieving stress.

There are many other forms of pranayama that can be done anywhere and in comfortable, seated positions. You can learn more about them here.

Why hospice patients should consider yoga

Yoga can easily be adapted to fit the needs and ability of the person doing it. Plus, it can be done anywhere- from a yoga studio to the comfort of your own home, even from your bed! Not to mention the benefits of mindful breathing. This can be an incredibly difficult time for patients and their loved ones. Taking time to truly focus on your breathing can provide a break in the stress and anxiety you may be feeling. Plus, it can be done together, helping to reduce everyone’s stress while also creating peaceful memories you’ll have forever.

World Hepatitis Day 2021: Hepatitis Can’t Wait

World Hepatitis Day is celebrated on July 28th each year to raise awareness for the global problem of viral hepatitis.

What is hepatitis?

Most often caused by a viral infection, hepatitis is an inflammation of the liver. There are five main hepatitis viruses, referred to as types A, B, C, D, and E.

Hepatitis A

  • Transmission: Mainly spread through eating contaminated food or drinking contaminated water. Often widespread in countries with a lack of safe water and poor sanitation.
  • Prevention: Treatment within a few weeks of exposure can also bring short term immunity. Risk of exposure can be greatly reduced by practicing good hygiene and sanitation and avoiding drinking water that comes from a potentially unsafe source.
  • Treatment: There is no treatment for Hepatitis A. Only causes acute hepatitis so the body is often able to clear the infection itself within a few weeks.

Hepatitis B

  • Transmission: Transmitted through contact with the blood or other bodily fluids of an infected person. Examples include transmission from a mother to child during childbirth or sharing razors or toothbrushes with infected people.
  • Prevention: Vaccination is very effective in preventing infection.
  • Treatment: Currently no real cure. Medications available that slow the replication of the virus and occasionally result in its clearance.

Hepatitis C

  • Transmission: Spread through blood-to-blood contact. Most common modes of infection include unsafe injection practices, inadequate sterilization of medical equipment, and unscreened blood and blood products.
  • Prevention: Currently no vaccination. To reduce risk of exposure, avoid sharing needles and other items such as toothbrushes or razors with an infected person.
  • Treatment: Treatment can cure this type. Involves a combination of interferon and ribavirin.

Hepatitis D

  • Treatment: Passed through contact with infected blood.
  • Prevention: Only occurs in people who are already infected with the hepatitis B virus. Therefore, can be prevented by getting the hepatitis B vaccine.
  • Treatment: Consists of interferon but is not very effective.

Hepatitis E

  • Transmission: Like hepatitis A, mainly transmitted through eating contaminated food or drinking contaminated water.
  • Prevention: Vaccine exists but is not widely available. To reduce the risk of exposure, practice good hygiene and sanitation and avoid drinking water that comes from a potentially unsafe source.
  • Treatment: No treatment, but people usually recover on their own. However, it can be fatal in some cases.

For more information on the different types of hepatitis, visit the website for the World Hepatitis Alliance.

Hospice for Hepatitis Patients

Hepatitis C is one of the most common causes of cirrhosis of the liver. When the liver becomes damaged by a virus, it will begin to scar. Once the damage becomes serious enough that the liver can no longer heal itself, it is called cirrhosis. Cirrhosis is a degenerative disease that can ultimately lead to liver failure when the liver is losing or has lost all function. Although there are treatment options to help manage the condition, there is currently no known cure.

So how do you know it could be time to consider hospice care for an end-stage liver disease patient? Keeping in mind that only a doctor can make a clinical determination, the signs below may indicate the patient may benefit from hospice services:

  • Symptoms become difficult to manage
  • Sudden or progressive loss of functional independence
  • Weight loss or reduced appetite
  • Restlessness
  • Altered mood or behavior
  • Majority of time is spent in bed
  • Confusion
  • Abdominal distention
  • Bowel dysfunction
  • Difficulty breathing
  • Itchy skin

If you would like more information on how Ohio Valley Hospice can help patients with end-stage liver disease, please contact us.

LGBTQ Aging

A 2020 Gallup study observed Americans’ identification as lesbian, gay, bisexual, or transgender (LGBT), by generation. The findings report that only 1.3% of the Traditionalist generation (born before 1946) and 2.0% of Baby Boomers (born 1946-1964) identify as LGBT. This number increases dramatically over the generations, reaching 15.9% for Generation Z (born 1997-2002). The question is – does the higher percentage of younger Americans reflect a true shift in sexual orientation? Or is it simply reflecting a greater willingness to identify as LGBT?

Although those who make up the younger generations were born into a world where huge progress has been made in the gay rights movement, the older generations of the LGBTQ community experienced much less accepting times. It wasn’t until 1961 that Illinois became the first state in the United States to get rid of its sodomy law. It then took another ten years before 20 more states followed their lead. So even though Traditionalists and Baby Boomers were around to witness the progress that has been made, many may still have the mindset that society will not accept them for who they are.

It is this fear of discrimination that may play a part in their hesitation to seek the help and support they need as they near the end of their life. As a result, the LGBTQ community has been historically underserved by hospice. A 2011 study reported that 20% of LGBTQ seniors that were surveyed did not even reveal their sexual orientation to their primary physician for fear of discrimination. Beyond hospice services for the patient, their grieving partner often misses out on bereavement support as they care for their partner in their final months and days.

Resources for the Aging LGBTQ Community

Hospices are now working harder than ever to understand the specific needs of the aging LGBTQ community and to do all they can to accommodate those needs. The National Resource Center on LGBT Aging is a resource center focused on improving the quality of services and support offered to lesbian, gay, bisexual, and/or transgender older adults. Their website includes resources that cover a variety of topics, including end of life decisions. You can also use the interactive map to find resources in your area.

No one should miss out on the benefits of hospice care for any reason, especially for fear of discrimination.

Happy Pride Month!

June is…

June is Alzheimer’s and Brain Awareness Month. This month-long celebration provides the opportunity to focus on raising awareness for the 50 million people worldwide living with Alzheimer’s and other dementias.

Alzheimer’s Disease

Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Schedule an appointment with your doctor if you notice any of these ten signs and symptoms:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

Visit the website for the Alzheimer’s Association for more information on these signs and symptoms to be on the lookout for.

Take Action

There are several ways to get involved in Alzheimer’s and Brain Awareness Month! On June 20th, join the cause by celebrating ‘The Longest Day’ through a fundraising activity of your choice! There are a variety of ways to get involved, including virtually and in-person.

So put on your purple gear, share your story of why you go purple, and join the fight to #EndAlz!

Soak Up the Sun…Safely

Summer is just around the corner, which mean barbeques, swimming, and SUN! And while most of us enjoy getting outside and soaking up a little Vitamin D, it is important to remember to be safe when heading outside into the sun. Per the American Academy of Dermatology Association, skin cancer is the most common cancer in the United States, and unprotected UV exposure is the most preventable risk factor for skin cancer.

With that being said, it is important to follow these three steps to protect your skin:

  • Seek shade: Remember, the sun’s rays are the strongest between 10AM and 2PM
  • Wear sun-protective clothing: Sunglasses and hats are key!
  • Apply sunscreen: Use a broad-spectrum, water-resistant sunscreen with at least SPF 30

Signs of Skin Cancer

Finding skin cancer early, before it has spread, makes it much easier to treat. If you know what to look for, you can often spot warning signs early on. Doctors recommend checking your own skin about once a month using a full-length mirror in a well-lit room. You can also use a hand mirror to check areas that are harder to see.

Melanoma is one of the deadliest forms of skin cancer, while basal and squamous cell skin cancers are more common but are usually very treatable. The American Cancer Society’s website discusses these types of skin cancers and what to look out for.

Melanoma

Use the “ABCDE” rule to look for some of the common signs of melanoma:

  • Asymmetry – one part of a mole or birthmark doesn’t match the other
  • Border – the edges are irregular, ragged, notched, or blurred
  • Color – the color is not the same all over and may include shades of brown or black, sometimes with patches of pink, red, white, or blue
  • Diameter – the spot is larger than ¼ inch across (although melanomas can sometimes be smaller than this)
  • Evolving – the mole is changing in size, shape, or color

Basal Cell Carcinomas

These types of skin cancers typically grow on parts of the body that get the most sun, such as the face, head, and neck. However, they can still show up anywhere. Here is what you should look for:

  • Flat, firm, pale, or yellow areas (similar to a scar)
  • Raised reddish patches, might be itchy
  • Small shiny, pearly bumps that are pink or red
  • Pink growths with raised edges and a lower area in the center, which might have abnormal blood vessels spreading out like the spokes of a wheel
  • Open sores that may have oozing or crusted areas and do not heal, or heal and then come back

Squamous Cell Carcinomas

Similarly to basal cell carcinomas, these typically grow on the parts of the body that get the most sun but can appear anywhere. You should look for:

  • Rough or scaly red patches, which may crust or bleed
  • Raised growths or lumps, sometimes with a lower area in the center
  • Open sores that may have oozing or crusted areas and do not heal, or heal and then come back
  • Wart-like growths

Talk to Your Doctor

Although these are good examples of what to look for, some skin cancers may look different than these descriptions. It is important to talk to your doctor about anything you are concerned about, such as new spots and other skin changes.

Better Hearing and Speech Month Facts

Each year, Better Hearing and Speech Month in May provides an opportunity to raise awareness about communication disorders and other hearing and speech problems. The event also serves as a reminder to people to get their hearing checked. Early identification and intervention is very important, and getting your hearing checked is the first step!

According to the CDC’s website, the World Health Organization’s first World Report on Hearing found that:

  • Noise is acknowledged as an important public health issue and a top environmental risk faced by the world today
  • Over 50% of people aged 12-35 years listen to music via personal audio devices at volumes that pose a risk to their hearing
  • Keeping the volume below 60% is a general rule of thumb for safety
  • You should consider using noise cancelling earphones or headphones rather than turning the volume up
  • Listening through personal audio devices should not exceed 80dB for adults or 75 dB for sensitive users, such as children, for 40 hours per week

Building Connections

“Building Connections” is the theme for 2021! You can find a variety of resources, broken down by week, on the American Speech-Language-Hearing Association’s website. Week 4’s focus is “Summer Skill Building, Hearing Protection for School-Aged Children.” Below are some examples of the resources available. Be sure to check out the ASHA’s website for more!

Early Identification

And remember to get your hearing checked as a first step in addressing any potential issues. Early identification is important!

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