News Briefs – APRIL 2023
by INELDA
Aggressive End-of-Life Treatment Administered
In a study published in JAMA, the rate at which aggressive end-of-life care is administered was evaluated in 146,329 participants 66 years and older living either in nursing homes or as community-dwelling residents. Defined as “cancer-directed treatment, intensive care unit admission, more than 1 emergency department visit or more than 1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death,” the authors of the study report that aggressive EOL care is widespread, particularly in older adults with metastatic, or stage 4, cancer. The study finds that, contrary to popular belief, nursing home residents actually receive aggressive EOL care at a higher rate than their community-dwelling counterparts (63.6% compared with 58.3%), though both figures are higher than the authors’ original estimates. The study concludes by offering possible solutions to reduce the prevalence of aggressive EOL care by including multilevel interventions at different stages of treatment, as well as targeting hospital admissions in the last six months of life.
Massachusetts Approaches Legislation on Medical Aid in Dying
The Washington Post reported that nine states have issued legislation on medical aid in dying (MAiD) this session. To date, there are 10 states that allow MAiD access, as does the District of Columbia. There are bills in both houses of the state legislature in Massachusetts, and a robust lobbying effort is underway. A December 2022 decision by state justices sent the issue back to the legislative branch. Bill sponsor Rep. Jim O’Day has 60 cosponsors as well as the governor’s support. The Massachusetts Medical Society is neutral on the matter, while the Massachusetts Catholic Conference advocates for more accessibility to hospice and palliative care. Disabilities rights groups have also voiced their concerns. According to an article in CommonWealth Magazine, a poll from June 2023 showed that “77% of Massachusetts residents said a mentally sound adult with an incurable, terminal illness should have the legal option of asking a physician to prescribe aid-in-dying medication to end their suffering.”
Transgender Adults Lend Voices at End-of-Life Care Think Tank
In March 2021, transgender older adults, scholars in EOL care, and palliative care providers gathered for a two-day think tank to discuss transgender end-of-life care. The research outcomes were published [view PDF] by SAGE Journals to help identify the needs of aging transgender people. Health care systems have been ill-equipped to support this population and require a shift to where “gender-affirming care intersects with the need for gerontological nursing care.” Studies have shown that individuals are fearful of discrimination when seeking end-of-life care and that in places around the world, discriminatory beliefs and policies block access to care. The group identified four themes:
- Understanding the complexities of transgender end-of-life experiences
- Addressing end-of-life health care and advance care planning needs
- Engaging with and serving communities of transgender older adults
- Facilitating inclusion and fighting discrimination
These themes will be the basis to help move forward future research, policy, and education for nurses and clinicians serving this population.