Aging/Gerontology, Health Conditions/Diseases, Healthcare, Humanity, News, Social Work/Helping Profession/Mental Health

Rapid assessment and frailty — British Geriatrics Society

This is awesome news and more hospitals should do this! Care beds for older adults and rapid assessment and treatment. Thoughts?


Beverley Marriott is a Advanced nurse practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. There continues to be a growing emphasis on older people and emergency hospital admissions, with Frailty often used as a ‘wrap’ around term for ‘older people’. Older people with multiple complex […]

via Rapid assessment and frailty — British Geriatrics Society

Aging/Gerontology, End-of-Life, Grief/Grieving/Bereavement, Healthcare, Humanity, ICU, News, Social Work/Helping Profession/Mental Health

“Journey’s End: Death, Dying, and the End of Life”: Is out Soon!

A book that has been in the makings for almost 2.5 years……..a well thought out book that focuses on death, dying, and end of life issues with over 50 contributors mostly from Canada and the U.S.A. and a few from other countries around the world!

The book has many chapters that focus on death of spouses, parents, friends, children, friends, colleagues, clients, pets, multiple deaths, suicide, and includes resource information, training information, checklists, quotes, information on Assisted Dying around the world, Grief & Bereavement support is included, End of Life communication, planning and preparing information and more!

This is a go to book for everyone! 500 pages of information that students, professionals, lay people, and caregivers can read and use.

It has been a long journey to get to this point, but well worth it! Thank you, Julie, for your understanding when things were going on in my life-we made a great team!

The book will be printed within the next 2-3 weeks and we look forward to sharing it with you!

Julie and I are already planning book 2, so if you are interested in participating/contributing, the book will focus on death, dying, and end of life, but from cultural, ethnic, and religious perspectives.

Burial and mourning rituals with a twist as each culture, religion, and ethnicity have different and unique traditions and customs along with grief, bereavement, and end of life discussions and planning. Contact me-


Vikki and Julie

NorthernMSW & CreateWrite Enterprises

Aging/Gerontology, Education, Healthcare, Humanity, Social Work/Helping Profession/Mental Health

Change for Older Adults is Needed!

As my clients are aging, I see the challenges they face and what is lacking in the current healthcare system.  This has led me to End-of-Life issues, Palliative Care and an interest in healthcare.  I have come to see that there needs to be a shift and focus on allowing seniors to ‘age in place’ and the services must expand in order to do so.   Expansion obviously requires money from the government, both on a federal and provincial/state level.  Healthcare needs to shift to a Patient-Centered approach with professionals available to the patient in either a facility, clinic or in their home in the community.  There is also a need for case managers to oversee the patients with chronic and complex health issues while coordinating with the professionals that need to be involved in the patients overall care.

I have realized much with the work that I have been immersed into for many years now.  For one, end-of-life needs to become less taboo and society needs to realize that in the cycle of life-there must be death; to be born, one must die.  I feel that we need to let individuals die with dignity and at home if that is what they choose while having the necessary professionals and services in place.  As a society we need to lighten up, reduce stress levels and find what makes us happy in life.  Again, a shift is needed and I believe this will happen; with less focus on materials things and more focus on human relationships, quality not quantity.

I feel it is important that every professional re-evaluate their interests and find their passion, their niche population, their niche demographic.  As professionals, we should also advocate within our profession for any needed updates or changes. 

There are many of us out there working with seniors/older adults in many different ways. We are on the front lines, we see what is happening, and see what needs to change. It is our role as professionals to advocate for that change.

What are you going to do today to make that change occur? How can you force the change? Who do you speak to? Write to? 

These are all things to think about and dwell on and when the timing is right-creativity will emerge along with action!


The ten barriers to appropriate management of patients at the end of their life

In the article published in Intensive Care Medicine by Hillamn y Cardona-Morell, the main barriers that hinder an appropriate management of patients at the end of life are described.

It is becoming more common the dilemma of admitting and treat in ICU certain patients that intensive medicine no longer can offer them what they really need: accepting the death process and providing them the best care at the end of life. The medicalization of death involves sometimes futile and costly treatments without providing added value to patients or their families, and even sometimes by subtracting quality in this process.

Why is so difficult to accept the process of dying?

1. We believe in miracles: unrealistic expectations of society and of the professional about what medicine can offer, overestimating the benefits and not taking into account the possible damage of health care.

2. We deny aging and death as if they could be avoided or if not to mention, this would change the destiny.

3. As professionals we are educated and trained to treat and save lives without thinking deeply and honest about the context of the disease. We always have to do something, rather than consider that maybe we must not do anything more.

4. Medical specialization focused on the care of organs or systems leads to overestimate the real possibilities, without a holistic view of the patient, and sometimes exerts pressure to maintain the active treatment.

5. The uncertainty about the prognosis of certain pathologies and situations that justify to follow the treatment sometimes indefinitely. We need tools and predictive models to reduce uncertainty and making decisions based on evidence.

6. Economic incentives to professionals in some health systems with payments by activity, advocating to keep treatments rather than remove them.

7. Ambivalence of bioethical principles which can be interpreted in different ways depending on who prioritize them, justifying even contradictory actions.

8. Legal pressure in the process at the end of life that makes practitioners act for fear of possible claims or to violate the law.

9. Criteria and action dynamics based on the diagnosis rather than in the actual context of the patient and which leads to admission in ICU critically ill patients, but non-recoverable. Reflect and stop the process once started is hard

10. The lack of alternatives to offer palliative care helps the hospital admission and even in the own ICU, as a prelude to death, without taking into account the desire of many people to be the passed away at home.

Intensive Care Medicine plays an important role in promoting the open debate to define the best way to die and find appropriate solutions, without transferring them to actions that are not justified, that only mask and dilate the reality.

Accept the death and be prepared to do this is a pending matter.

Dr. Mari Cruz Martin Delgado
Head of Intensive Care Department
Hospital Universitario de Torrejón

*Re-posted with permission from Dr. Gabi Heras.

**Original can be found at:


Insensible Losses: When The Medical Community Forgets The Family

This article really makes any person or professional re-think the strategy they use to engage with patients and family. With a patient or clients permission, the family should be part of the diagnosis and assessment process along with the plan.

See part of the article below and review the link to read the rest…….

My patient, Steve, and his wife, Laura, sat in a hospital room waiting to meet the medical team. June days have balmy beginnings in North Carolina, but by noon our white coats are burdensome in the summer heat. I had been assigned to care for Steve during my internal medicine rotation. Nearing the end of my clinical year in medical school, I was increasingly eager to prove myself, to both my patients and my supervising physicians.

Steve was a vigorous man. At almost seventy years old, he was still hauling lumber and fixing faulty air conditioners. His body demanded a more energetic role than that of “patient.” Steve’s charm was evident within minutes—he pretended to be so beaten up by my routine physical exam that the only remedy for such “mistreatment” was extra pudding. But despite having the appearance and energy of a healthier person, Steve had been hospitalized for shortness of breath and low counts of all major blood cell lines.

During the medical team’s first visit to his hospital room, he and his wife showed us patience and deference. It was clear that they trusted us to know best. We ran a battery of tests, including imaging of Steve’s chest and studies of his blood. The results were concerning: a blood clot in the heart and atypical blood cells under the microscope. Signs were pointing to cancer, so we ordered a bone marrow biopsy.

The next morning, as we waited on the results of the biopsy, I went to check on Steve. Laura mentioned he was just getting over a terrible headache that had cropped up at dawn. The headache was troubling to everyone on the medical team, but that morning’s medication had controlled the pain and a neurologic exam produced no worrisome results. We reassured the couple that until the biopsy results returned, nothing else needed to be done. It turns out we were wrong…….


“12 months, 12 gestures” spreading music in Hospitals

We give one step further within the initiative “12 months, 12 gestures” and focus on a word that represents the essence of the great work we do every day as health professionals:


Because we accompany our patients and their families every day. We accompany them since they are born until they die, often in hard and complicated times. At the same time we get involved, empathize, attend, ask, thank and above all… we look.

Why not putting background music? What do you think?

We have organized a programme of concerts in collaboration with the municipal schools of music of our region: Vegadeo, Coaña, Tapia de Casariego, Castropol, Navia, La Caridad, Orchestra of the Conservatory of Western Asturias. The concerts will be weekly and will take place in the Hall of the hospital in Jarrio at 6 PM. They are directed to patients and relatives of Jarrio hospital, as well as professionals in the Area of health and public in general.

Because music, like care, is an art that influences the physiological, psychic, and spiritual aspects of people; feelings and emotions. It brings benefits to health, well-being and quality of life.

I invite you to enter the Youtube channel of “12 months, 12 gestures”, where you can see videos of the initiatives that we are doing.

As Plato said: ” Music gives soul to the universe, wings to the mind, flight to the imagination, to sadness and life comfort and joy to all things.” Welcome to the concerts of the health Area I-Jarrio (Asturias)!

A warm and musical embrace.

Delia Peñacoba Maestre
Head of Management of Care and Nursing Area I

*Original can be found at:

Re-posted with permission


My First Lesson in Humility

I remember being more confident that most of my peers. The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me. Maybe it was on account of my life-long pursuit of medicine. I felt nothing but elation at the newly branded “M” and “D” that came after my name on the hospital badge. I was no longer a volunteer, no longer a student. I was a doctor. And part of that persona was walking into the unknown with a certain amount of confidence. This was exactly where I was meant to be.

A few months into internship, I admitted an obese lady with a skin infection on her thigh. I started the appropriate antibiotics and waited. My resident noting the appearance of the skin asked me to order an X-ray. I placed the order but secretly was befuddled. Why order an X-ray? What on earth was that going to show?

I was on call and busied myself with the drudgery of being the low man on the totem pole. I admitted  5 new patients. I drew blood. I did paperwork. I spent hours in front of the computer screen looking up labs and filling out charts. I forgot one thing though.

Maybe it was because I didn’t understand my resident’s clinical reasoning. Maybe somewhere in the recesses of my mind I had written the order off as something superfluous or unnecessary. To this day, I can’t explain why I failed to follow up on the X-ray of the thigh and retrieve the results. Some things may remain unexplained.

The next morning my resident and I breathlessly ran to the patient’s room at her nurses prompting. Her blood pressure was dangerously low and her temperature was sky high. My resident looked at me in a panic and inquired about the X-ray. After we stabilized the patient, we ran down the stairs to radiology and glanced at the films. Our worst fears were confirmed upon staring up at the light box: subcutaneous gas.

The patient had necrotizing fasciitis (a severe form of skin infection) and needed immediate surgery to remove as much of the infected tissue as possible. She would likely lose her limb and possibly more.

Years later, I can’t help but wonder how much better she would have done if I had seen the film the night before, and surgery had been called immediately. The patient survived either way, but by a hair.

And I learned an important lesson that night in humility. A lesson I would be taught over and over again as I journeyed through medical education and beyond.

Disease is tougher, more resilient, and far more cunning than the minds of the medical experts who struggle to tame it.

It is only to be rivaled by the human spirit of our brave patients, who battle day in and day out to survive.

By Dr. Jordan Grumet, Internal Medicine

*Re-posted with permission

Original can be found at: