Even hospice workers fail to plan ahead, survey finds
Hospice workers may witness terminal illness and death almost daily, but that doesn’t mean they’ve documented their own end-of-life wishes, a new report finds.
A survey of nearly 900 health care workers at a nonprofit hospice in Boca Raton found that fewer than half — just 44 percent — had completed advance directives. Of the rest, 52 percent said they had not filled out the forms that specify choices about medical care. Nearly 4 percent said they weren’t sure if they had or not.
That surprised Dr. George Luck, a palliative medicine expert at the Charles E. Schmidt College of Medicine at Florida Atlantic University, who led the research.
Although the proportion is higher than the roughly one-third of Americans overall who have advance directives in place, Luck expected more from those who work with the dying.
“I expected people who work in a hospice setting, who see what happens when someone doesn’t have an advance directive, how that can be a struggle for the family, a bigger burden,” to be better prepared, Luck said. The report was in the American Journal of Medicine.
Equally surprising was that about 10 percent of hospice workers without directives said they didn’t know where to obtain the forms — which are widely available online. Another nearly 6 percent said cost was a barrier, even though the documents can be completed for free, without an attorney’s help.
“Basically,” Luck said, “you could write it on a napkin if you wanted to.”
— JoNel Aleccia, Kaiser Health News
Inflammation can have long-term effect on the brain
Chronic inflammation in middle age may be associated with an increased risk for brain shrinkage and Alzheimer’s disease later in life.
A new study, published in Neurology, looked at 1,633 people whose average age was 53 in 1987-89, measuring white blood cell count and various blood proteins that indicate inflammation. They followed the participants for 24 years.
In 2011-13, when the subjects’ average age was 77, the scientists measured their brain volume using MRI and tested their mental agility with a word-memorization task. They found that the greater the number of elevated inflammatory markers earlier in life, the smaller the volume of several parts of the brain, including those associated with Alzheimer’s disease. Higher levels of inflammation were also associated with poorer performance on the memory test.
The authors acknowledge that they had blood tests for only one point in time, and that they are assuming that brain loss occurred in the years after the inflammatory markers were assessed.
— Nicholas Bakalar, The New York Times
More evidence that heartburn meds may do harm
People who carry the stomach bacteria Helicobacter pylori are at increased risk for ulcers and stomach cancer. But even when antibiotic treatment has eliminated the bacterium, stomach cancer may still arise.
A new study suggests that one reason may be the long-term use of proton pump inhibitors, or PPIs, acid-reducing medicines sold under brand names such as Prilosec and Prevacid.
Researchers studied 63,397 people in Hong Kong successfully treated for H. pylori infection; 3,271 used PPIs and 21,179 took H2-receptor antagonists, another type of acid-controller (Tagamet, Pepcid and other brands). Over an average of 7.6 years, 153 of them developed gastric cancer.
Compared with those who used H2 blockers, those who took PPIs had more than twice the risk for cancer, and the risk increased over time. The study, published in Gut, controlled for smoking, alcohol use, obesity, statin use, hypertension and many other factors.
“Even after the eradication of H. pylori, the risk of cancer persists with PPIs,” said the lead author, Dr. Wai Keung Leung, a professor of medicine at the University of Hong Kong. “But the absolute risk is not high, and I don’t want to discourage people from taking these drugs when necessary.”
— Nicholas Bakalar, The New York Times