Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide. While their short-term efficacy in managing acid-related disorders is well established, their long-term use—especially in older adults and hospice patients—raises important concerns about safety, necessity, and alignment with patient-centered goals of care. As palliative and hospice
In an era where genetic testing is accessible to nearly anyone with an internet connection, palliative care clinicians are increasingly encountering patients—and family members—who are anxious about their APOE4 status. Popular genetic platforms like 23andMe often alert users to their APOE4 allele status, sparking fears that a diagnosis
As the population ages and chronic disease burdens deepen, palliative care and hospice teams are increasingly faced with the intersecting trajectories of metabolic and neurodegenerative disease. Among the most clinically significant—and often overlooked—intersections is the strong association between Type 2 diabetes and Alzheimer's disease. Understanding this
Helping Families Navigate the Complex Terrain of Dementia with Compassion and Clarity “How long do we have?” It’s the question every family asks when dementia becomes part of their reality—and it’s one of the most challenging to answer. For years, many of us in hospice and palliative
In the world of palliative care, providers frequently navigate the complexities of neurocognitive decline. Subtle shifts in memory, behavior, and function often raise the question: is this dementia, delirium, or simply the “normal aging brain”? Among the many tools available, the Clock Drawing Test (CDT) remains one of the most
Palliative medicine, once seen as a niche field, has now become an essential component of healthcare, focusing on providing relief from the symptoms, pain, and stress of serious illnesses. As the global population ages and the burden of chronic diseases continues to rise, palliative care has gained prominence, emphasizing holistic,
In the nuanced world of post-cardiac care, one key metric often serves as the bridge between clinical recovery and functional reintegration: the Metabolic Equivalent of Task (MET). This standardized measure of energy expenditure empowers healthcare providers to assess the intensity of physical activities, customize rehabilitation protocols, and predict patient outcomes
Opioids remain the cornerstone of symptom relief in hospice and palliative care, especially for pain and dyspnea. However, navigating reported "allergies" to opioids—particularly morphine and codeine—can pose significant challenges. In an already complex clinical landscape, these allergy labels can lead to under-treatment of distressing symptoms, unnecessary
As palliative care continues to evolve with an emphasis on quality of life, comfort, and symptom control, the incorporation of precision medicine tools like pharmacogenomics (PGx) offers promising benefits. Pharmacogenomics, the study of how a patient’s genetic makeup influences their response to medications, can serve as a powerful ally
In palliative medicine, attention to genitourinary symptoms is often overshadowed by more pressing issues such as pain, dyspnea, or existential distress. Yet lower urinary tract dysfunction—particularly the confusing coexistence of overactive bladder (OAB) symptoms and urinary retention—is both common and under-recognized, especially in older adults with complex comorbidities.
March is Kidney Awareness Month, a time often focused on prevention, early detection, and life-sustaining treatments like dialysis. These conversations are important—and incomplete. Missing too often is space for an equally valid, deeply human decision: the decision to stop dialysis. For many people living with advanced kidney disease, dialysis
March is Kidney Awareness Month, a time often focused on prevention, early detection, and life-sustaining treatments like dialysis. These conversations are important—and incomplete. Missing too often is space for an equally valid, deeply human decision: the decision to stop dialysis. For many people living with advanced kidney disease, dialysis
We spend a great deal of time helping patients in maintaining stability—physically, emotionally, and socially. For individuals living with dementia, stability is more than a comfort; it is a lifeline. Disrupting it—especially through relocation—can carry significant clinical and emotional risks. Whether moving from home to a facility,
In palliative and hospice medicine, opioids remain the cornerstone of pain and symptom management. Morphine, codeine, hydromorphone, oxycodone, and other agents provide profound relief from pain, dyspnea, and certain distressing symptoms at the end of life. Yet, many patients arrive with their medical record littered with “opioid allergy” labels. These
As the hospice community deepens its commitment to equity and trauma-informed care, clinicians are increasingly caring for individuals who have experienced incarceration. These patients bring with them a lifetime of medical, psychological, and existential burdens shaped not only by disease, but by the enduring imprint of trauma, stigma, and institutionalization.
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that track controlled substance prescribing and dispensing. While they were originally designed as a tool to combat the opioid epidemic, PDMPs are now an expected part of safe, compliant medical practice in nearly every setting—including palliative care and hospice. For
For patients, caregivers, and clinicians walking the palliative and hospice journey In palliative care and hospice, we are often surrounded by urgency—symptoms to manage, decisions to make, emotions to hold, lives to honor. And yet, amid all of this motion, one of the most therapeutic interventions available to us
Smiling is one of the most basic human expressions, universally recognized and deeply tied to emotion, social connection, and quality of life. In the palliative and hospice setting, providers often witness the gradual fading of a patient’s ability to smile. While at first glance this may seem like a
Introduction For many people—especially women, older adults, and those with chronic health conditions—recurrent urinary tract infections (UTIs) can feel like an endless cycle. Antibiotics may clear the infection temporarily, but the relief is often short-lived. Over time, repeated antibiotic exposure can lead to resistance, side effects, and a
When we think of aging, most people imagine wrinkles, thinning hair, or skin changes. Yet the most insidious change is less visible: the gradual loss of muscle mass, strength, and function known as sarcopenia. Beginning as early as age 30, we lose 3–8% of muscle mass per decade, accelerating
Sleep disturbance is one of the most pervasive and distressing symptoms in patients living with advanced illness. Families worry when their loved one is awake at night, clinicians search for safe non-opioid strategies to settle nighttime agitation, and patients often ask for something “natural” to help them sleep. For many
The holidays arrive every year whether we feel ready or not. They come with lights and music, rituals and expectations—tables set the way they’ve always been set, recipes made the way they’ve always been made. And yet, for many, something essential is missing. A chair is empty.
My late husband, Bob, was a hospice and palliative medicine physician. Early in our relationship, as we shared family histories, I told him about my brother David. When David was 13 (I was 18), he was in an accident and remained in a coma for 21 days. For years I
If you are a healthcare professional and feel put upon, underappreciated, overlooked, and taken for granted by administration, it is entirely valid. Many administrators on both the provider and payer side of healthcare fail to recognize that without the talent, the show simply cannot go on. Unlike Broadway and Hollywood,