For a PDF of the references and sources used in writing the book click here
References and Sources used in researching Getting the Best Care:
Chapter 1
Page 14
• And the cost can be quite high
Advance Directives | Letter Project | Stanford
Medicine
• And the cost can be quite high
End of Life Care - Dartmouth Atlas of Health Care. Dartmouthatlasorg. 2018.
• However, only 25% of us actually do
Facing Death - Facts & Figures. FRONTLINE. 2010.
Page 15
• This leads to the majority of the dying
A better way to care for the dying. The Economist. 2018.
• The growth in care has been from 700,000
NHPCO.org and HealthAffairs.org
• One estimate is that there is a need
D.B. Ruder. From Specialty to Shortage. Harvard Magazine March-April 2015.
Chapter 2
Page 26
• Both the patient and his family members
A better way to care for the dying. The Economist. 2018.
• Both the patient and his family members
Zhang B, Wright A, Huskamp H et al. Health Care Costs in the Last Week of Life. Arch Intern
Med. 2009;169(5):480.
• Studies have repeatedly shown that over
End of Life Care - Dartmouth Atlas of Health Care. Dartmouthatlasorg. 2018.
Page 28
• We have to have a goal in mind before
Krieger L. The cost of dying: Lessons learned – The Mercury News. Mercurynewscom. 2012.
Page 30
• Doctors who do have an advanced directive
Torres L, Lindstrom K. Exploring Barriers Among Primary Care Providers in Referring Patients to
Hospice. Journal of Hospice & Palliative Nursing. 2016;18(2):167-172.
Page 32
• Her dementia made her vulnerable
Fick D, Steis M, Walker J, Inouye S. Delirium superimposed on dementia is associated
with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med.
2013;8(9):500-505.
• Many health care professionals feel that
Schwartz, S Defensive medicine versus value-based care. Medical Economics. 2016
Page 33
• Research shows that the average doctor’s
Grisham S. Medscape Physician Compensation Report 2017. Medscape. 2017.
• Research shows that the average doctor’s
Tai-Seale M, McGuire T, Zhang W. Time Allocation in Primary Care Office Visits. Health Serv Res.
2007;42(5):1871-1894.
CHAPTER 3
Page 37
• There is a lot of research about the odds
Neagle J, Wachsberg K. What Are the Chances a Hospitalized Patient Will Survive In-
Hospital Arrest? hospitalistorg. 2010.
Page 38
• Some areas of the US have survival rates
Peikoff,K. CPR Survival Rates Can Differ Greatly by City. New York Times. 12/7/2015
• Research has shown that when
Nabozny M, Kruser J, Steffens N et al. Constructing High-stakes Surgical Decisions. Ann Surg.
2016;263(1):64-70.
Page 41
• Indeed, many studies have shown that when offered
Rowland K, Schumann S-A. Palliative care: Earlier is better. Hickner J, ed. The Journal of Family
Practice. 2010;59(12):695-698.
• Indeed, many studies have shown that when offered
Irwin K, Greer J, Khatib J, Temel J, Pirl W. Early palliative care and metastatic non-small cell
lung cancer.
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Page 46
• So, between 87 to 92 people out of 100
Mozaffarian D, Benjamin E, et. al. Heart Disease and Stroke Statistics—2015 Update.
Circulation. 2015;131(4):e29-e322.
• Half of those discharged will suffer
Twibell R, May A, May P. When the Heart Stops: Life-giving Updates on Cardiac Arrest. Am
Nurse Today. 2018;13(2).
• Some are released home, others require significant
Ebell M, Afonso A. Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary
resuscitation: a meta-analysis. Fam Pract. 2011;28(5):505-515.
Page 47
• Even for people who do not have a cardiac arrest
Rizzuto, D. , Melis, R. J., Et al. Effect of Chronic Diseases and Multimorbidity on Survival and
Functioning in Elderly Adults. J Am Geriatr Soc. 2017;65(5):1056-1060.
• The older you are and the more health problems
Ebell M, Afonso A. Pre-arrest predictors of failure to survive after in-hospital
cardiopulmonary resuscitation: a meta-analysis. Fam Pract. 2011;28(5):505-515.
• More than half of older patients
Chan P, Nallamothu B, et al. Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest.
New England Journal of Medicine. 2013;368(11):1019-1026.
CHAPTER 4
Page 51
• Rather, it acknowledges that the patient
Ebell M, Afonso A. Pre-arrest predictors of failure to survive after in-hospital
cardiopulmonary resuscitation: a meta-analysis. Fam Pract. 2011;28(5):505-515.
Page 53
• Many physicians are not comfortable
Yuen J, Reid M, Fetters M. Hospital Do-Not-Resuscitate Orders: Why They Have Failed and
How to Fix Them. J Gen Intern Med. 2011;26(7):791-797.
Page 54
• Many continue to feel physical weakness Wilemon,T. The Tennessean. Oct. 2, 2013
• These symptoms can look like the
McFarling U. Hospitals struggle to address terrifying 'ICU delirium'. STAT. 2018.
Page 55
• We have not learned how to prevent damage
Bienvenu O, Friedman L, Colantuoni E et al. Psychiatric symptoms after acute
respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med. 2017;44(1):38-47.
• These new practices are sometimes
Ely E. The ABCDEF Bundle. Crit Care Med. 2017;45(2):321-330.
Page 57
• If she were frail with multiple chronic medical
Fick D, Steis M, Walker J, Inouye S. Delirium superimposed on dementia is associated with prolonged
length of stay and poor outcomes in hospitalized older adults. J Hosp Med.
2013;8(9):500-505.
Page 59
• Doing this can help you
A better way to care for the dying. The Economist. 2018.
• In fact, he may not leave the hospital alive
A Smith et al., “Half Of Older Americans Seen In Emergency Department In Last Month Of
Life; Most Admitted To Hospital, And Many Die There,” Health Affairs 2012; 31:1277-1285,
• The doctor or hospital staff may not
A Fagerlin et al., Enough: The Failure of the Living Will. Hastings Cent Rep.
2004;34(2):30.
CHAPTER 5
Page 63
• Patients have the right to receive information
Informed Consent | American Medical Association. Ama-assnorg. 2018.
Page 64
• There is so much pressure on hospital
Atwere P, McIntyre L, Et al Informed Consent Documents Used in Critical Care Trials
Often Do Not Implement Recommendations*. Crit Care Med. 2018;46(2):e111-e117.
Page 66
• The type of biopsy at that time
Dohadwala M, Estes N. Ventricular Tachycardia with No Structural Heart Disease:
Recognition and Treatment. The Cardiology Advisor. 2016.
Page 67
• In one year alone, up to 40%
Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring Low-Value
Care in Medicare. JAMA Intern Med. 2014;174(7):1067–1076.
Page 72
• He did not want to have everyone "give up"
Gawande A. Being Mortal: Medicine And What Matters In The End. Picador USA; 2014.
• Dr. Gawande recalled, Joseph was unrealistically
Gawande A. Being Mortal: Medicine And What Matters In The End. Picador USA; 2014
Page 75
• Unfortunately, the nature of Gigi's fractures
Shaibani A, Ali S, Bhatt H. Vertebroplasty and Kyphoplasty for the Palliation of Pain.
Semin Intervent Radiol. 2007;24(4):409-418.
• This procedure is one that has been identified
Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring Low-Value
Care in Medicare. JAMA Intern Med. 2014;174(7):1067–1076.
• But most importantly, this particular procedure
McCullough BJ, Comstock BA, Deyo RA, Kreuter W, Jarvik JG. Major Medical Outcomes with
Spinal Augmentation vs Conservative Therapy. JAMA Intern Med. 2013;173(16):1514–1521.
CHAPTER 6
Page 78
• Adding to the stress is the reality
The Alzheimer’s Association https://www.alz.org/
Page 80
• Combining substituted judgment and best
Understanding Healthcare Decisions at the End of Life. National Institute on Aging. 2017.
Page 81
• In general, people live an average of four to eight
The Alzheimer’s Association https://www.alz.org/
Page 83
• We know that hospitalizations for older and
Mathews S, Arnold S, Epperson C. Hospitalization and Cognitive Decline: Can the
Nature of the Relationship Be Deciphered?. The American Journal of Geriatric Psychiatry.
2014;22(5):465-480
CHAPTER 7
Page 91
• The decline may be due to the stress
Fick D, Steis M, Waller J, Inouye S. Delirium superimposed on dementia is associated
with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med.
2013;8(9):500-505.
Page 93
• The sedation required for this procedure
Crosby G, Culley D, Marcantonio E. Delirium: A Cognitive Cost of the Comfort of Procedural Sedation
in Elderly Patients?. Mayo Clin Proc. 2010;85(1):12-14.
• Indeed, it can lead to nausea, infection
12. Melville N. Feeding Tube Use Declines in Advanced Dementia. Medscape.
2018.
• Indeed, it can lead to nausea, infection
Mitchell S, Mor V, Gozalo P, Servadio J, Teno J. Tube Feeding in US Nursing Home Residents With
Advanced Dementia, 2000-2014. JAMA. 2016;316(7):769..
Page 94
• The doctors who specialize in the care of older patients
Flaschner E, Katz D. American Geriatrics Society Position Statement on Feeding Tubes
in Advanced Dementia. J Am Geriatr Soc. 2015;63(7):1490-1491.
• But it is clear when looking at statistics that show
Bynum J. Our Parents Ourselves: Healthcare For An Aging Population. Dartmouth Atlas;
2016:38-39. Available at:
http://www.dartmouthatlas.org/downloads/reports/Our_Parents_Ourselves_021716.pdf.
• Combine limited mobility with diarrhea
Finucane T, Christmas C. Tube Feeding and Pressure Ulcers. Arch Intern Med. 2012;172(9):701.
Page 97
• These risks are why many experts are recommending that older patients Mathews S, Arnold S,
Epperson C. Hospitalization and Cognitive Decline: Can the Nature of the Relationship Be
Deciphered? The American Journal of Geriatric Psychiatry. 2014;22(5):465-480
• These risks are why many experts are recommending that older patients Rauch J. The Hospital Is
No Place for the Elderly. The Atlantic. 2013.
Page 99
• Discomfort and risks of adverse drug reactions
Dufour AB, Shaffer ML, D’Agata EMC, Habtemariam D, Mitchell SL. Survival After
Suspected Urinary Tract Infection in Individuals with Advanced Dementia. Journal of the
American Geriatrics Society. 2015;63(12):2472-2477.
CHAPTER 8
Page 100
• The suffering caused by serious chronic
Piotrowski M. Palliativedoctorsorg. 2018. Page 101
• Patients receiving this holistic approach
O'Connor N, Moyer M. The Impact of Inpatient Palliative Care Consultations on 30-
Day Hospital Readmissions. J Palliat Med. 2015;18(11):956-961.
Page 103
• Studies are showing that for patients who are nearing
Zhang B, Wright A. Health Care Costs in the Last Week of Life. Arch Intern Med.
2009;169(5):480.
• Patients who had the benefit of palliative care
Detering K, Hancock A. The impact of advance care planning on end of life care in elderly patients:
randomised controlled trial. BMJ. 2010;340(mar23 1):c1345-c1345.
• Patients who had the benefit of palliative care
Ersek M, Miller S. Association between aggressive care and bereaved families’ evaluation of
end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs
facilities. Cancer. 2017;123(16):3186-3194.
• Patients who had the benefit of palliative care
Temel J, Greer J. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung
Cancer. New England Journal of Medicine. 2010;363(8):733-742.
• Family members of palliative care patients also
Rosenstein D. Depression and end-of-life care for patients with cancer. PubMed Central
(PMC). 2011.
• Instead of watching their loved one struggle
Rosenstein D. Depression and end-of-life care for patients with cancer. PubMed Central
(PMC). 2011.
• When palliative care is received early in a disease process
Temel J, Greer J. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung
Cancer. New England Journal of Medicine. 2010;363(8):733-742.
Page 104
• For people coming into hospice care, nearly
National Hospice and Palliative Care Organization. 2018.
• In addition to that, many physicians
Friedman B, Harwood M. Barriers and Enablers to Hospice Referrals: An Expert Overview. J
Palliat Med. 2002;5(1):73-84.
• He shows in his practice that people can receive
Ely W. What happens when a patient says, 'Doc, help me die'. CNN. 2018. Available at:
https://www.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-
opinion/index.html.
Page 105
• The mutual empathy and connection the patient
Ely W. What happens when a patient says, 'Doc, help me die'. CNN. 2018. Available at:
https://www.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-
opinion/index.html.
• Allen Kellehear says in his book, A Social History of Dying
Kellehear A. A Social History of Dying. Cambridge University Press; 2007.
Page 108
• This robs not only the dying person
Temel J, Greer J. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung
Cancer. New England Journal of Medicine. 2010;363(8):733-742.
Page 109
• We spend over three times more on people
Smith A, McCarthy E. Half Of Older Americans Seen In Emergency Department In Last
Month Of Life; Most Admitted To Hospital, And Many Die There. Health Affairs. 2012;31(6):1277-1285.
• However, the fact is that generally, increased
Zhang, B Health Care Costs in the Last Week of Life. Arch Intern Med. 2009;169(5):480.
Page 111
• We know that nearly 20% of frail patients
Roeper B. Innovative Care Model to Improve Clinical Quality and Safety of Transitional Care:
Early Outcomes. Managed Care magazine. 2018.
• Nursing home residents are tested far too often
Nace D, Drinka P. Clinical Uncertainties in the Approach to Long Term Care Residents
With Possible Urinary Tract Infection. J Am Med Dir Assoc. 2014;15(2):133-139.
• Nursing home residents are tested far too often
Dufour AB, Shaffer ML, D’Agata EMC, Habtemariam D, Mitchell SL. Survival After
Suspected Urinary Tract Infection in Individuals with Advanced Dementia. Journal of the
American Geriatrics Society.
2015;63(12):2472-2477.
Page 112
• Also, the increased use of antibiotics in long-term care
Nace D, Drinka P. Clinical Uncertainties in the Approach to Long Term Care Residents With Possible
Urinary Tract Infection. J Am Med Dir Assoc. 2014;15(2):133-139.
CHAPTER 9
Page 114
• This waste is using limited
Mathur A. Health expenditures and personal bankruptcies. Health (Irvine Calif).
2012;04(12):1305-1316.
• Having a primary care provider is a vital resource
Boccuti C, Swoop C. Medicare Patients’ Access to Physicians: A Synthesis of the Evidence.
The Henry J Kaiser Family Foundation. 2013.
• Having a primary care provider is a vital resource
Lin C, Barnato A. Physician Follow-Up Visits After Acute Care Hospitalization for Elderly
Medicare Beneficiaries Discharged to Noninstitutional Settings. J Am Geriatr Soc.
2011;59(10):1947-1954.
Page 115
• Frailty is a vulnerability to physical stress
Frailty in Older People. Lancet. 2013;381(9868):752-762.
• Not only are they subject
Rauch J. The Hospital Is No Place for the Elderly. The Atlantic. 2013.
• Not only are they subject
Lum H, Studenski S. Early Hospital Readmission is a Predictor of One-Year Mortality in
Community- Dwelling Older Medicare Beneficiaries. J Gen Intern Med. 2012;27(11):1467-
1474.
Page 117
• If her hands are restrained
McPherson J, Wagner C. Delirium in the Cardiovascular ICU. Crit Care Med. 2013;41(2):405-413.
• If her hands are restrained
Piao J, Jin Y. Triggers and nursing influences on delirium in intensive care units.
Nurs Crit Care. 2016;23(1):8-15.
Page 118
• It is common for delirium to be misdiagnosed
Lorenzl S, Füsgen I, Noachtar S. Acute Confusional States in the Elderly—Diagnosis and Treatment.
Deutsches Ärzteblatt International. 2012;109(21):391-400.
• Up to 87% of patients over the age of sixty-five
Fong T, Tulebaev S, Et al. Delirium in elderly adults: diagnosis, prevention and treatment.
Nature Reviews Neurology. 2009;5(4):210-220.
• Fifty percent of patients having hip
Marcantonio E. Delirium in Hospitalized Older Adults. New England Journal of
Medicine. 2017;377(15):1456-1466.
• However, things can be done
Fong T, Tulebaev S, Et al. Delirium in elderly adults: diagnosis, prevention and treatment.
Nature Reviews Neurology. 2009;5(4):210-220.
Page 121
• In this era of modern anesthesia, it is possible
Zywiel M, Prabhu A. The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After
Joint Arthroplasty: A Systematic Review. Clinical Orthopaedics and
Related Research®. 2013;472(5):1453-1466.
• Having post-operative delirium puts patients
Sieber F, Zakriya K. et al. Sedation Depth During Spinal Anesthesia and the Development of
Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair. Mayo Clin Proc.
2010;85(1):18-26.
Page 123
• And according to that research, one year
Sieber F, Zakriya K. et al. Sedation Depth During Spinal Anesthesia and the Development of
Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair. Mayo Clin Proc.
2010;85(1):18-26.
• Fragile patients with multiple medical problems
Devore E, Fong T. Prediction of Long-Term Cognitive Decline Following Delirium in
Older Adults. Innov Aging. 2017;1(suppl_1):1326-1326. 60. Delirium in elderly adults: diagnosis,
prevention and treatment. Nature Reviews Neurology. 2009;5(4):210-220.
Page 126
• Within a week of being admitted to a hospital
Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor. Patient Safety
and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research
and Quality (US); 2008 Apr. Chapter 12.
• Within a week of being admitted to a hospital
Mallah Z, Nassar N. The Effectiveness of a Pressure Ulcer Intervention Program on the Prevalence of
Hospital Acquired Pressure Ulcers: Controlled Before and After Study.
Applied Nursing Research. 2015;28(2):106-113.
Page 127
• This tissue damage can become severe
Sullivan, N Schoelles KM. Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy. Ann
Intern Med. 2013;158(5_Part_2):410.
• If he (the patient) has a bedsore
Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor. Patient Safety
and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research
and Quality (US); 2008 Apr. Chapter 12.
• Medicare and Medicaid penalize hospitals
Levine J. Does The Term "Never Event" Apply to Pressure Injuries? | WoundSource.
Woundsourcecom. 2018.
• The most important aspects of prevention
Schmitt, S Andries, M et al. Wound, Ostomy and Continence Nurses Society Position Statement on
Avoidable Versus Unavoidable Pressure Ulcers. Journal of Wound, Ostomy and Continence Nursing.
2009;36(4):378-381.
Page 128
• Even if there was not a severe injury
Schmid A, Wells C. Prevalence, predictors, and outcomes of poststroke falls in acute hospital
setting. The Journal of Rehabilitation Research and Development. 2010;47(6):553.
• Risks of falling may increase
Schmid A, Wells C. Prevalence, predictors, and outcomes of poststroke falls in acute hospital
setting. The Journal of Rehabilitation Research and Development. 2010;47(6):553.
Page 130
• Twenty-five percent of Medicare patients
Szabo L. Never Too Late To Operate? Surgery Near End Of Life Is Common, Costly. Kaiser
Health News. 2018.
• Surgeons acknowledge the risks to frail
Nabozny M, Kruser J. Constructing High-stakes Surgical Decisions. Ann Surg. 2016;263(1):64-
70.
Page 132
• If you believe that, your loved one
Graham J. Slowing Down Hospital Discharge Requires Fast Action. Kaiser Health News.
2018.
• If you feel that, your loved one
Fast appeals in a hospital | Medicare.gov. Medicaregov. 2018. Available at:
https://www.medicare.gov/claims-and-appeals/right-to-fast-appeal/hospital/fast-appeals-in-
hospitals.html.
CHAPTER 10
Page 134
• It is common for family members
Mendoza M. Guilt and Grief: Placing a Loved One in a Nursing Facility. Psychology Today. 2017.
Available at: https://www.psychologytoday.com/us/blog/understanding- grief/201705/guilt-and-grief-
placing-loved-one-in-nursing-facility.
Page 138
• So often older people have lost
Gleeson M, Timmins F. The use of touch to enhance nursing care of older person in long-term
mental health care facilities. J Psychiatr Ment Health Nurs. 2004;11(5):541-545.
• We know that infants need physical
Ardiel E, Rankin C. The importance of touch in development. Paediatr Child Health.
2010;15(3):153-156.
Page 139
• When nursing home residents go to the ER
Burke RE, Rooks SP, Et al. Identifying Potentially Preventable Emergency Department Visits by
Nursing Home Residents in the United States. J Am Med Dir Assoc. 2015;16(5):395-
399.
Page 140
• Research has shown that over half of emergency department
Wang HE, Shah MN, Allman RM, Kilgore M. Emergency Department Visits by Nursing Home Residents in
the United States. Journal of the American Geriatrics Society.
2011;59(10):1864-1872.
Page 141
• All too often, advance directives
Span P. The Trouble With Advance Directives. Nytimescom. 2018. Available
at: https://www.nytimes.com/2015/03/17/health/the-trouble-with-advance- directives.html.
Page 142
• DNH orders are most effective in slowing
Cohen A, Knobf M, Fried T. Do-Not-Hospitalize Orders in Nursing Homes: “Call the Family
Instead of Calling the Ambulance”. J Am Geriatr Soc. 2017;65(7):1573-1577.
CHAPTER 11
Page 144
• “Polypharmacy” is a term used to describe
Bushardt R. Polypharmacy: Misleading, but manageable. Clin Interv Aging. 2008;Volume 3:383-
389.
Page 145
• It is easy to see how someone
Cooper A, Dore D. Predictors of High-Risk Prescribing Among Elderly Medicare Advantage
Beneficiaries.
American Journal of Managed Care. 2014.
Page 146
• Antipsychotics are approved to treat
Christian R, Saavedra L. Tables of FDA-Approved Indications for First- and Second-
Generation Antipsychotics. Ncbinlmnihgov. 2011.
• However, the use of antipsychotic drugs
Cioltan H, Alshehri S. Variation in use of antipsychotic medications in nursing homes in the
United States: A systematic review. BMC Geriatr. 2017;17(1).
Page 147
• The recommendations include using nondrug
Verduin M. The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to
Treat Agitation or Psychosis in Patients With Dementia. J Psychiatr Pract. 2017;23(2):160-161.
• There can be dramatic complications
Howland, RH. Potential Adverse Effects of Discontinuing Psychotropic Drugs--Part 3: Antipsychotic,
Dopaminergic, and Mood-Stabilizing Drugs. Journal of Psychosocial Nursing and Mental Health
Services. 2010;48(8):11-14.
Page 148
• These medications can cause
Ham A, van Dijk S. Beta-blocker use and fall risk in older individuals: Original results from
two studies with meta-analysis. Br J Clin Pharmacol. 2017;83(10):2292-2302.
• These medications can cause
Ham A, Swart K, Enneman A, Et al. Medication-Related Fall Incidents in an Older, Ambulant
Population: The B-PROOF Study. Drugs Aging. 2014;31(12):917-927.
CHAPTER 12
Page 154
• Frequently, ICU doctors and nurses
Peter Whoriskey Warehouses for the Dying.The Washington Post December 13, 2014
Page 156
• Instead, if we encourage family members
Angel, Karen Newsday Consider Options Before Allowing a Feeding Tube Jan 4, 2013
https://www.newsday.com/opinion/oped/consider-options-before-allowing-a-feeding-tube-karen-
angel-1.4407678
CHAPTER 13
Page 168
• In the US in 2015
Rates of Motor Vehicle Crashes, Injuries and Death in Relation to Age 2014-2015 AAA Foundation
for Traffic Safety http://aaafoundation.org/wp-
content/uploads/2017/11/CrashesInjuriesDeathsInRelationToAge2014-2015Brief.pdf
Page 172
• South Pacific Island tradition of Hoʻoponopono
Hilgenkamp, K, Pescaia C. Traditional Hawaiian Healing and Western Influences.
California Journal of Health Promotion. 2003. Available at:
http://www.cjhp.org/Volume1_2003/Issue/34-39-hilgenkamp.pdf.
APPENDIX 2
Page 186
• If you only have a Will
https://www.thebalance.com/what-happens-to-assets-left-out-of-your-trust-3505437.
APPENDIX 3
Page 194
• Every year over 30,000 people
Cortez M. Flu Is Causing 1 in 10 American Deaths and Climbing. Bloombergcom. 2018.
• And because the vaccine
Vaccine Effectiveness - How Well Does the Flu Vaccine Work? | Seasonal Influenza (Flu) | CDC.
Cdcgov.
2017.
Page 195
• The pneumococcal vaccines
Cdcgov. 2018. Available at: https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-
schedule-easy- read.pdf.
• The CDC recommends that everyone over age fifty
Cdcgov. 2018. Available at: https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-
schedule-easy- read.pdf.
Page 196
• A healthy person at age eighty- five
Salzman B, Beldowski K, Paz A. Cancer Screening in Older Patients. Aafporg. 2016.
This is a resource used for the information in the Screening Tests section of Appendix 3
APPENDIX 4
Page 201
• Over 650,000 people every year are dealing
The Kidney Project University of California San Fransisco
https://pharm.ucsf.edu/kidney/need/statistics
Page 202
• That is the average life expectancy for someone who
United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in
the United States. National Institutes of Health, National Institute of Diabetes and Digestive and
Kidney Diseases, Bethesda, MD, 2017.
• Yet, over 90% say they have not discussed it
Mandel, E., Bernacki, R. and Block, S. (2016). Serious Illness Conversations in ESRD. Clinical
Journal of the American Society of Nephrology, 12(5), pp.854-863.
Page 203
• Here are some key facts
Pooja Singh, Michael J. Germain, Lewis Cohen, Mark Unruh; The elderly patient on dialysis:
geriatric considerations, Nephrology Dialysis Transplantation, Volume 29, Issue 5, 1 May 2014,
Pages 990–996.
Kurella Tamura, M. and Covinsky, K. et al. (2009). Functional Status of Elderly Adults before and
after Initiation of Dialysis. New England Journal of Medicine, 361(16), pp.1539-1547.
Mandel, E., Bernacki, R. and Block, S. (2016). Serious Illness Conversations in ESRD. Clinical
Journal of the American Society of Nephrology, 12(5), pp.854-863.
Johansen KL, Delgado C, Bao Y, Tamura MK. Frailty and Dialysis Initiation. Seminars in dialysis.
2013;26(6):690-696. doi:10.1111/sdi.12126.
Page 204
• Being on dialysis is a big adjustment
Worth, T. (2014). The Challenge of Dialysis at the End of Life. [online] Renal and Urology News.
APPENDIX 5
Page 205
• Always use medications as prescribed
American Society of Consultant Pharmacists. Ascpcom. 2018. Available at:
https://www.ascp.com/.
Ham A, van Dijk S. Beta-blocker use and fall risk in older individuals: Original results from two
studies with meta-analysis. Br J Clin Pharmacol. 2017;83(10):2292-2302.
APPENDIX 6
Page 208
• An estimated 40% of the people with Janet's
Lee S, Smith A, Widera E. ePrognosis - Mitchell Index. Eprognosisucsfedu. 2012. Charlson M.
Charlson Comorbidity Index (CCI) - MDCalc. Mdcalccom. 2018.
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• Frailty is a vulnerability to physical stress
Fried L, Ferrucci L. Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications
for Improved Targeting and Care. The Journals of Gerontology Series A: Biological Sciences and
Medical Sciences. 2004;59(3):M255-M263.
• Not only are they subject to risks
Rauch J. The Hospital Is No Place for the Elderly. The Atlantic. 2013.
• Not only are they subject to risks
Lum H, Studenski S. Early Hospital Readmission is a Predictor of One-Year Mortality in Community-
Dwelling Older Medicare Beneficiaries. J Gen Intern Med. 2012;27(11):1467-
1474.
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• Up to 87% of patients over
Fong T, Tulebaev S, Et al. Delirium in elderly adults: diagnosis, prevention and treatment.
Nature Reviews Neurology. 2009;5(4):210-220.
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These doctors who specialize in the care of patients
Flaschner E, Katz D. American Geriatrics Society Position Statement on Feeding Tubes in Advanced
Dementia. J Am Geriatr Soc. 2015;63(7):1490-1491.
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• Patients who have the benefit of palliative care
Ersek M, Miller S. Association between aggressive care and bereaved families’ evaluation of
end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs
facilities. Cancer. 2017;123(16):3186-3194.
• Patients who have the benefit of palliative care
Temel J, Greer J. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung
Cancer. New England Journal of Medicine. 2010;363(8):733-742.
• Family members of palliative-care
ELY W. What happens when a patient says, 'Doc, help me die'. CNN. 2018. Available at:
https://www.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-
opinion/index.html
