Hospice of Southern Illinois

Premiere Local Hospice Provider

Diabetes Management in the Hospice Patient

25% of patients over the age of 65 have diabetes and shows a test to measure insulin levels

According to the American Diabetes Association 2020 Standards of Care, 25% of patients over the age of 65 have diabetes and approximately 50% have pre-diabetes. Diabetes occurs when the body is unable to regulate sugar within the body. It is caused by a variety of reasons, but the most important is the body either cannot make insulin (Type 1) or the body becomes de-sensitized to insulin, and the body cannot make enough to compensate (Type 2). When diabetes is not controlled, there is risk for many complications including kidney disease, vision loss, and nerve pain. Blood sugar goals of 80 – 130 mg/dL in the morning and < 180 mg/dL after meals can help to slow the progression of complications. Medications for diabetes include metformin, sulfonylureas (glipizide and glyburide), and insulin. These are only a few examples of the large number of these medications available.

Complications

Kidney disease, vision loss, and nerve pain are all considered “long-term” complications of diabetes because the symptoms or body changes do not develop until there is years of damage from blood sugar levels that are not at the goals previously mentioned.

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Insomnia

There is no clear number to quantify the prevalence of insomnia. Worldwide, studies have shown anywhere from 10-60% incidence. Insomnia is classified by a few different organizations, including the international classifications for disease (ICD-10), International classification of sleep disorders (ICSD), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). All three of these organizations require difficulty either A) falling asleep, B) staying asleep or C) poor sleep quality. The biggest difference in the organizations’ definition of insomnia is the frequency of symptoms and daytime symptoms that result from lack of sleep.

There are many things that can lead to insomnia. It is important to gather a full patient history to help determine the causes. As we age, this tends to lead to a higher incidence. Other reasons can include urinary or bowel disturbances, poor sleep hygiene, medications, pain, respiratory issues, and mental health issues. When it comes to medications, different steroids such as prednisone or dexamethasone, antidepressants such as fluoxetine (Prozac) and bupropion (Wellbutrin), and diuretics such as furosemide can all contribute to insomnia. Unfortunately, we use the medications listed for a variety of symptoms in patients who have elected to obtain hospice care. Minimizing use and changing the times that we give these medications to no later than 2pm can usually decrease insomnia as a side effect. If there are other reasons for the insomnia, such as depression, anxiety, or pain, it is important to treat the condition causing the insomnia rather than jumping straight to a sleep aid.

Some non-medication practices that can help with sleep include:

  1. Keep a schedule.
  2. Don’t go to sleep unless you are tired.
  3. If it takes more than 20 minutes to fall asleep, get out of bed and do an activity for a little bit. Then try again.
  4. Limit light from the outside, hallways, phones, and other electronic devices.
  5. Only eat light snacks before bed.
  6. Avoid alcohol and caffeine before bed.

Medications are also an option for patients who do not have success with the non-medication practices. Unfortunately, the medications that can have sedating effects to cause sleep are also usually a high risk for causing falls. Because of this, the non-medication therapies for helping to manage sleep are preferred as first line.

Source: http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat,

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By: Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois

October is American Pharmacists Month and we are proud to present to you an educational blog series throughout the month by, Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care. Our series will help expand your understanding of the use of medications at the end-of-life.

Medications for Dementia

balancing comfort and medication management for the benefit of patients with dementia

According to the National Hospice and Palliative Care Organization (NHPCO), dementia is the 3rd highest reason for a referral to hospice care. Alzheimer’s disease, a form of dementia, is the 5th leading cause of death in patients >65 years old. The most common diagnostic test for dementia is the mini-mental state exam. This is a scale of 0-30, with the higher score being less cognitive impairment. Initially, dementia is characterized by patients forgetting things, becoming disoriented, or altered behaviors. This is not considered a normal part of the aging process. There is irreversible damage to the brain that will eventually cause a decline in functional status to the point where patients are no longer able to perform their activities of daily living.

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Congestive Heart Failure

            Congestive heart failure, or heart failure, is a chronic condition characterized by the inability of the heart to pump enough blood to the rest of the body. Because blood is needed to supply oxygen to the body, this can become problematic. As the amount of blood pumping decreases, our bodies have a response that, under normal circumstances, can help to maintain a good blood pressure. While these responses are good when the causes are reversible, in heart failure, these responses do more harm than good. The mechanisms usually involve increasing the heart rate or how hard the heart pumps. Similarly, to how lifting weights can make a person’s muscle bigger and stronger, the heart is a muscle that can also get bigger.  Unfortunately, when the heart gets bigger, it actually makes it more difficult to pump an adequate amount of blood and the cycle continues.

individual with congestive heart failure being supported by hospice nurse and discussing medication and treatment after listening to heart and lungs.
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Time to Talk About Morphine

            Morphine is a common medication that we use for patients that utilize hospice care. Morphine is an opioid agonist, meaning that it activates opioid receptors within the body to decrease pain. As a medication, it has been used for many years to treat both acute (short-lasting) and chronic (long-lasting) pain. Unfortunately, due the common use of morphine at the end-of-life, it has developed a “bad reputation.” Not only do some patients have fears; family members do as well. When family members are afraid, they sometimes tell their loved one to not take morphine. This can cause increased despair and confusion for the patient who wants to respect family wishes but also is very uncomfortable.

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Announcing Pharmacy Residency Program’s 5th Year

Hospice of Southern Illinois is pleased to introduce and welcome the full-time, on-staff, PGY-2 (post-graduate, year 2) Pharmacy Resident, Dr. Timothy Cruz, PharmD. Setting us apart from other hospice programs, we are announcing our 5th year with a PGY-2 Pain and Palliative Care Pharmacy Residency Program. In collaboration with the SIUE School of Pharmacy, we remain the only accredited PGY-2 Pain and Palliative Care Pharmacy Residency Program fully funded by a hospice, in the United States. Our patients, families, and entire organization directly benefits from this very unique program. It is 1 of 26 in the country and the only accredited one, fully funded by a hospice.

Dr. Cruz is an integral member of our interdisciplinary team focusing on each patient’s goals of care. Our goal remains to deliver the highest quality end-of-life care to the patients and families we serve. He leads with our mission and core values of excellence, integrity, respect, diversity and dignity. Dr. Cruz shares our commitment to this program and quality of life for individuals with a life-limiting illness.

“I feel very fortunate to have the opportunity to work with such a kind and loving team at Hospice of Southern Illinois. This year will allow me to grow as a pain and palliative care pharmacist and care for patients to the best of my ability.”

[Read more…]

Adapting your home to keep loved ones safe

protecting your loved ones safety and comfort at home

We want to empower caregivers to adapt your home to keep loved ones safe. Additionally, adapting your home helps simplify everyday living. Caregivers are working hard to do what’s best for their loved ones; however, they already have a lot of responsibilities in their day-to-day lives. Implementing these home safety tips can also ensure a more comfortable environment for aging adults. Further, they can eliminate common stressors some caregivers encounter. Here are a few quick tips to help keep loved ones in the comfort of their home, all the while staying safe.

  • Organize and label items in each room to make things easy to find
  • Remove old and unused items to eliminate clutter
  • Clear walkways and heavily traveled paths
  • Remove tripping hazards, including throw rugs
  • Utilize assistance equipment like walkers or wheelchairs
  • Keep a flashlight handy for emergencies
  • Cap unused outlets
  • Install grab bars and hand rails in the home and bathroom
  • Keep medications locked up
  • Place nightlights in dimly light areas
  • As always, wash your hands often to stop the spread of germs
keep loved ones n the comfort of their home, all the while staying safe

Have you already taken all of these steps regarding adapting your home? You are on the right track! If you haven’t, implement as many as you can. We understand caregivers experience many challenges during the progression of an illness. Our person-centered approach, in addition to your loved one’s safety, also focuses on their physical, emotional, social, and spiritual well-being. This allows you to treasure more of life’s moments that mean the most. We are ready and available to provide caregiver support if your loved one has a life-limiting illness. Get help now and schedule a telehealth call with our team, 1-800-233-1708.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat,

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In One Word, Hospice of Southern Illinois is a Blessing

Simply the Word Blessing

Dear Friend,

      I never thought I would be in hospice care but last December I was given two weeks to live.  I had been in and out of the hospital most every month during 2019 and my body was not tolerating cancer treatment.  When my wife, Louise and I  first met with the nurse from Hospice of Southern Illinois, I politely declined their services.  The nurse was nice and explained everything to me but I wasn’t ready.  I had seven different doctors and I went to several appointments a week.  How could I just stop going to all of them?  You see, I literally thought hospice care meant that you went home, a volunteer came and sat with you and waited for you to die.  Boy, was I wrong.

” If I had to describe my experience with Hospice of Southern Illinois in one word, it would simply be the word blessing.“

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Hospice of Southern Illinois Granted One Special Gift

One Special Gift – A St. Louis Wish

Have you ever reflected on what makes you happy? Maybe there is one activity that would make a difference in your life or provide joy during a solemn time. Everyone has something that touches their heart. Recently in 2019, a new St. Louis attraction, St. Louis Aquarium – Downtown at Union Station, grabbed the attention of one of our patients. Hospice of Southern Illinois’ nurse and the social worker asked how we could fulfill a wish for the Duvall family. 

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Quality of Life Matters

Rise to the Challenges of COVID-19 Together

August 3, 2020 – During these uncertain times, Hospice of Southern Illinois is still here as we always have been. We are the ones behind the masks. Our team is here to support you through these uncharted waters. COVID-19 has greatly changed the landscape of healthcare. Adaptation is on the forefront. One goal remains, ensuring that your comfort, peace and dignity remain intact during the end-of-life journey. We will rise to the challenges that are ahead. And, we will continue to do what we do best, enhancing the quality of life for people touched by a life-limiting illness.  

We Are Still Here

The pandemic has shaped how clinicians offer support and compassion. However, it doesn’t change the philosophy of our care.  A person’s quality-of-life matters more now than ever before because of the additional barriers people are experiencing. Hospice of Southern Illinois is leading the way. You and your family can count on us. We will help you plan for the future. The circle of care will provide support and relief you didn’t even know was possible. Count on our experience to show the love and compassion every person deserves through the end-of-life. 

The mission of Hospice of Southern Illinois is to enhance the quality of life for individuals and their loved ones touched by a terminal illness. We stand behind our mission as we make changes and grow to better serve those who need us. Not all hospices are the same. Ask for Hospice of Southern Illinois by name. www.hospice.org/ourcare

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