Couple die holding hands after 69 years of marriage

An Illinois couple married for 69 years have died within an hour of each other, family members tell US media.

Till death do us part: The couple first met in their native Argentina

Isaac Vatkin, 91, was holding the hand of his wife Teresa, 89, as she succumbed to Alzheimer’s disease on Saturday, the Daily Herald reported.

Isaac died 40 minutes later. Family members said they took comfort in knowing they were together at the end.

“You didn’t want to see them go,” said grandson William Vatkin, “but you couldn’t ask for anything more.”

The Vatkins sparkle on their wedding day

“Their love for each other was so strong, they simply could not live without each other,” said daughter Clara Gesklin at the couple’s joint funeral.

“They were always in love, literally to the end. To the last second,” said Rabbi Barry Schechter, who led the service at the Shalom Memorial Funeral Home in the Chicago suburb of Arlington Heights.

Staff at the local Highland Park Hospital found Mr and Mrs Vatkin unresponsive and breathing shallowly on Saturday and chose to place their beds side by side.

Family members positioned their hands so they touched.

The couple raised three children in Skokie, Illinois, and had a close relationship with their grandchildren, family members said.

Mr Vatkin had been a kosher meat distributor and Mrs Vatkin a homemaker and manicurist.

Complete Article HERE!

How virtual reality is improving end-of-life care

In the UK, terminally ill patients are being transported from the hospice to other worlds.

By

[V]irtual reality is not just for showing off the latest games and inventions. The technology has found a purpose in the healthcare industry as part of improving hospice and end-of-life care.

When someone is terminally ill, it may be inevitable that the individual will, at some point, go to a hospice or treatment center for end-of-life care or, at the least, to a respite center to give home caregivers a break.

However, in the UK under a creaking, strained, and underfunded National Health Service (NHS), sometimes these facilities may be suffering themselves from a lack of budget to make these stays as comfortable as they could otherwise be.

In addition, and perhaps most importantly, taking someone away from their home at such a stage can be a difficult transition.

To make this process a little less heartbreaking, local charity hospice Loros, which provides hospice and home care to roughly 2,500 terminally ill individuals across Leicester, Leicestershire, and Rutland, UK, has launched a new project which uses virtual reality to enhance end-of-life care.

The idea is to help those who have limited mobility to experience life outside of treatment and give them the chance to go back to places in their past which hold fond memories, as well as experience new areas beyond the hospice and home.

As shown in the video below, 70-year-old John, who is diagnosed with motor neuron disease (MND), is trying out the headset equipped with a video of Bradgate Park. This kind of technology can give patients a little more joy in their lives when perhaps it matters most.

Since being diagnosed with MND, we can get out but I can’t spend a lot of time out of the wheelchair, so being able to have these experiences through the glasses is really good,” said John. “It’s almost as good as the real thing.”

It’s a reminder that while many of us obsess over whether or not the latest mobile device will have a headphone jack or an impossibly thin shell or not, advances in technology can also provide far more important experiences.

Loros is currently working with a VR company to produce more films and hopes to commission new films that other hospice providers will be able to use in their own virtual reality services.

“Research suggests that the brain accepts the virtual world within 20 seconds after which the experience becomes all-absorbing,” Loros CEO John Knight commented. “We recognize that some of our patients are often restricted to where they can go due to their illness, so we wanted to help give them the opportunity to still enjoy life wider than their restrictions allow, through virtual reality.”

 Complete Article HERE!

Inferior End of Life Care for Ethnic-Minority Patients With Ovarian Cancer

Study findings show that “important disparities in use of end-of-life care persist among racial and ethnic minorities.”

By

[A]frican-American and Hispanic patients with ovarian cancer in Texas were more likely than Caucasian patients to suffer invasive or toxic treatment and to be admitted to the ICU in their final month of life, according to a study published in the Journal of Clinical Oncology.1

“We found being a minority was associated with receiving intensive and invasive end-of-life care among patients with ovarian cancer,” reported lead study author Jolyn S. Taylor, MD, MPH, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues. “Irrespective of other sociodemographic factors, patients of black or Hispanic racial and ethnic backgrounds were less likely to meet end-of-life quality-care metrics.”

The authors analyzed data from the Texas Cancer Registry and Medicare to assess the treatments administered to 3666 patients with ovarian cancer who died between 2000 and 2012. Seventy-seven percent of the patients were Caucasian, 15% were Hispanic, and 7% were African-American. (One percent of patients were classified as “other.”) Only patients who had received 13 months of Medicare coverage before death were included in the analysis.

Most (72%) patients had been enrolled in hospice but only 64% were still enrolled when they died, the study team noted. Median enrollment was 20 days.

“In the final 30 days of life, 381 (10%) had more than one ER visit, 505 (14%) more than one hospital admission, 593 (16%) ICU admission, 848 (23%) invasive care, and 418 (11%) life-extending care,” the authors reported.

Ten percent (357 patients) received chemotherapy during the final 2 weeks of life.

Ethnic and racial disparities in end-of-life care remained statistically significant in multivariate analyses adjusting for year and age at death, tumor stage, comorbidity index, income and education level, and location of residence. Race and ethnicity correlated more strongly with outcomes than income, education, or geography.

“Several outcomes differed for minorities compared to white patients,” the authors concluded. “Hispanic and black patients were less likely to enroll and die in hospice (black odds ratio [OR] 0.66; 95% CI: 0.50-0.88; P = .004; Hispanic OR 0.76; 95% CI: 0.61-0.94; P = .01.”

Hispanic patients were also more frequently admitted to the ICU (OR 1.37; 95% CI: 1.05-1.78; P = .02), while African-American patients more frequently received multiple ER visits or underwent life-extending procedures (ORs 2.20 and 2.13, respectively; P < .001 for each).

The findings show that “important disparities in use of end-of-life care persist among racial and ethnic minorities,” the authors concluded.

Complete Article HERE!

Where you live may determine how you die, study suggests

By JoNel Aleccia

[A]mericans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests.

Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country.

In 2013, nearly two-thirds of Oregonians who died did so at home, compared with fewer than 40 percent of people elsewhere in the US, according to the report published Wednesday in the New England Journal of Medicine. Previous research had shown that more than 85 percent of Americans say they’d prefer to die at home.

“Obviously, if you’ve spent decades trying to improve your end-of-life care, it’s pretty rewarding to see that something changes,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, who co-led the study.

The review analyzed Medicare fee-for-service claims data from 2000, 2005, and 2013, and it compared end-of-life care in Oregon and Washington — a nearby state with similar demographics and attitudes toward end-of-life care — with the rest of the US, excluding those two states.

It found that in 2013, ICU use in the last 30 days of life was about 18 percent in Oregon, compared with 23 percent in Washington and 28.5 percent in the rest of the US. Nearly three-quarters of patients in Oregon hospitalized in the last month of life were discharged to home, compared with slightly fewer than two-thirds in Washington state and a little more than half — 54.2 percent — in the rest of the US.

More than 40 percent of patients in Oregon were enrolled in home hospice in 2013, compared with about 30 percent in Washington and fewer than 20 percent in the rest of the US, the analysis found.

Oregon, which enacted the nation’s first death-with-dignity law and led the way on implementing portable medical orders for treatment at the end of life, may be reaping the results of those and other efforts, said Tolle’s coauthor, Dr. Joan Teno, a professor of medicine, gerontology, and geriatrics at the University of Washington in Seattle.

“When you look at the patterns, it’s very different than the rest of the United States,” she said. “It’s even different than a borderline state.”

Pat Duty, 64, who ran a Portland floor-covering business with her husband, Jimmy, for years, said Oregon’s palliative care culture helped guide treatment decisions after his 2013 diagnosis of lung cancer and dementia. Jimmy Duty wanted limited medical interventions; he had a do-not-resuscitate order, plus a request to avoid the ICU.

“He was very clear that quality of life was his first choice,” Pat Duty recalled. “We knew we needed to discuss these things while he could make decisions for himself. We wanted to give him the dignity and grace he deserved for his final couple of years.” He died in October 2015 at age 74.

Creating such a culture is much harder than it looks, Tolle and Teno argued. Oregon has successfully integrated awareness of end-of-life care at all levels, from state government and emergency care to individual decisions made by patients and their doctors.

“If patients’ goals are not linked to actionable care plans that are supported by local health care systems and state regulations, many patients who wish to remain at home will die intubated for all the reasons the current system fails them,” they wrote.

Across the US, there’s been a push to promote ways to indicate end-of-life treatment preferences, including advance directives, which provide guidance for future care, and Physician Orders for Life-Sustaining Treatment, or POLST, portable medical orders authorizing current care. Twenty-two states now have POLST programs and others are working on or considering them, said Tolle, who co-led the creation of POLST in the early 1990s.

But the researchers warned that, while POLST efforts are important, simply filling out the forms is not enough.

“We were highlighting that there’s no simple answer,” Tolle said. “You can’t just do one thing and think that you will change the culture of end-of-life care. It is a whole lot of work.”

Dr. Scott Halpern, a medical ethics and health policy expert at the Perelman School of Medicine at the University of Pennsylvania, has been a chief critic of POLST efforts, contending that there’s little evidence that the medical orders improve quality of life near death.

The new analysis by Tolle and Teno doesn’t fill the gap, he said. But he agreed with the authors’ contention that a focus on single interventions ignores the complexity of end-of-life decisions.

“Good end-of-life care involves physicians eliciting patients’ values, hopes and fears and making treatment decisions that align,” Halpern said.

The new analysis, which was funded by a grant from the Robert Wood Johnson Foundation, underscores that families and patients outside of Oregon must be vigilant to ensure they receive the care they want, Tolle said.

“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,” she said.

Complete Article HERE!

Is there really life after death?

Brain activity is recorded 10 MINUTES after patient dies in an ‘unexplained’ case

Scientists from from the University of Western Ontario in Canada studied the extraordinary case of a patient continuing to release delta wave bursts after they were declared dead. We normally get these delta waves during a deep sleep

By Phoebe Weston

[L]ife may continue even after death – just in sleep mode.

Doctors have found scientific evidence that people’s brains can continue to work after they are clinically dead.

A patient showed persistent brain activity for ten minutes after their heart stopped and experienced brain waves we normally get during deep sleep.

Doctors in a Canadian intensive care unit described the case as extraordinary and unexplained.

Researchers from the University of Western Ontario in Canada assessed electric impulses in the brain in relation to the beating of someone’s heart after life-sustaining therapy was removed.

Brain inactivity preceded the heart stopping in three of the four cases.

However, in one of the cases, the patient’s brain continued to work after their heart stopped.

‘In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and arterial blood pressure (ABP),’ the researchers said

There was significant differences in electrical activity in the brain between the 30-minute period before and the 5-minute period after the heart stopped.

‘It is difficult to posit a physiological basis for this EEG [brain] activity given that it occurs after a prolonged loss of circulation’, according to the paper which was published in the National Centre for Biotechnology Information.

Across the four patients recordings of their brain were very different – suggesting we all experience death in unique ways.

The experiment raises difficult questions about when someone is dead and therefore when it is medically and ethically correct to use them for organ donation.

As many as a fifth of people who survive cardiac arrests report having had an other-worldly experience while being ‘clinically’ dead.

However, scientists say it’s far too early to be talking about what this could mean for the post-death experience – especially considering it was only seen in one patient, according to Science Alert.

In 2013, a similar phenomenon was investigated on experiments on rats whose hearts had stopped.

In one of the cases, single delta wave bursts persisted after the heart had stopped and the patient was clinically dead. The experiment raises difficult questions about when someone is dead and therefore when it is medically and ethically correct to use them for organ donation

The research, which was published in the journal Proceedings of the National Academy of Sciences revealed rats had a burst of brain activity one minute after decapitation.

The pattern of activity was similar to that seen when the animals were fully conscious – except signals were up to eight times stronger.

The researchers said that the discovery that the brain is highly active in the seconds after the heart stops suggests that the phenomenon has a physical, rather than spiritual nature.

It has been argued that the dying brain is incapable of such complex activity and so near-death experiences must have their origins in the soul.

It suggests something happens at the brink of death that pushes the conscious brain to a high level of arousal, potentially triggering the visions and sensations associated with near-death experiences (NDEs).

As many as a fifth of people who survive cardiac arrests report having had an other-worldly experience while being ‘clinically’ dead.

Typically NDEs involve travelling through a tunnel towards an intense light, being separated from the body, encountering long-departed loved ones or angels and undergoing some kind of judgment of ‘life review.

Some emerge from NDEs as transformed individuals with a completely altered outlook on life, or a new belief in religion.

But many scientists believe near-death-experiences are nothing more than hallucinations induced by the effect of the brain shutting down.

Complete Article HERE!

New research identifies a ‘sea of despair’ among white, working-class Americans

Princeton economists Angus Deaton and Anne Case continue to report on sickness and early death among white, middle-aged, working-class Americans.

Sickness and early death in the white working class could be rooted in poor job prospects for less-educated young people as they first enter the labor market, a situation that compounds over time through family dysfunction, social isolation, addiction, obesity and other pathologies, according to a study published Thursday by two prominent economists.

Anne Case and Angus Deaton garnered national headlines in 2015 when they reported that the death rate of midlife non-Hispanic white Americans had risen steadily since 1999 in contrast with the death rates of blacks, Hispanics and Europeans. Their new study extends the data by two years and shows that whatever is driving the mortality spike is not easing up.

VIDEO: Here’s what you need to know about the life expectancy drop

The two Princeton professors say the trend affects whites of both sexes and is happening nearly everywhere in the country. Education level is significant: People with a college degree report better health and happiness than those with only some college, who in turn are doing much better than those who never went.

Offering what they call a tentative but “plausible” explanation, they write that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a “cumulative disadvantage” over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease and suicide.

“Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline,” they conclude.

The study comes as Congress debates how to dismantle parts of the Affordable Care Act. Case and Deaton report that poor health is becoming more common for each new generation of middle-aged, less-educated white Americans. And they are going downhill faster.

In a teleconference with reporters this week, Case said the new research found a “sea of despair” across America. A striking feature is the rise in physical pain. The pattern does not follow short-term economic cycles but reflects a long-term disintegration of job prospects.

“You used to be able to get a really good job with a high school diploma. A job with on-the-job training, a job with benefits. You could expect to move up,” she said.

The nation’s obesity epidemic may be another sign of stress and physical pain, she continued: “People may want to soothe the beast. They may do that with alcohol, they may do that with drugs, they may do that with food.”

Similarly, Deaton cited suicide as an action that could be triggered not by a single event but by a cumulative series of disappointments: “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.”

The economists say that there is no obvious solution but that a starting point would be limiting the overuse of opioids, which killed more than 30,000 Americans in 2015.

The two will present their study on Friday at the Brookings Institution.

“Their paper documents some facts. What is the story behind those facts is a matter of speculation,” said Adriana Lleras-Muney, a University of California at Los Angeles economics professor, who will also speak at Brookings.

She noted that less-educated white Americans tend to be strikingly pessimistic when interviewed about their prospects.

“It’s just a background of continuous decline. You’re worse off than your parents,” Lleras-Muney said. “Whereas for Hispanics, or immigrants like myself” — she is from Colombia — “or blacks, yes, circumstances are bad, but they’ve been getting better.”

David Cutler, an economics professor at Harvard who also will be discussing the paper at Brookings, said the declining health of white, working-class Americans suggests that Republican plans to replace the Affordable Care Act are akin to bleeding a sick patient. As he put it, “Treat the fever by causing an even bigger fever.”

Whites continue to have longer life expectancy than African Americans and lower death rates, but that gap has narrowed since the late 1990s. The picture may have shifted again around the Great Recession, however: Graphs accompanying the new paper suggest that death rates for blacks with only a high school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites.

White men continue to die at higher rates than white women in every age group. But because women started with lower death rates, the recent mortality increase reflects a greater change in their likelihood of dying early. The numbers reported by Case and Deaton suggest that white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely.

Case and Deaton play down geography as a factor in the epidemic. Yet they note that white mortality rates fell in the biggest cities, were constant in big-city suburbs and rose in all other areas. The Washington Post’s analysis published last year highlighted the same geographical signature, with a break in death rates between the two most urban classifications (big cities and big-city suburbs) and the four less urban classifications, which The Post described as an urban-rural divide.

Last week, the Centers for Disease Control and Prevention published a report on U.S. suicides by level of urbanization between 1999 and 2015, a period in which 600,000 Americans took their own lives. The report showed rising rates in each of the six urbanization classifications but found “a geographic disparity” in which rates increased as urbanization decreased. That urban-rural divide appears to have widened, particularly in recent years, the CDC reported.

Complete Article HERE!

For first time, chimpanzee observed performing funeral rites for dead as mother cleans the body of ‘Thomas’

By Sarah Knapton

[A] chimpanzee has been filmed using tools to apparently clean the corpse of its adopted offspring, the first hint that animals other than humans may have mortuary practices.

The female, Noel, was seen at the Chimfunshi Wildlife Orphanage Trust in Zambia using a stem of grass to remove debris from the teeth of a nine-year-old male, Thomas, which she had looked after since the death of its mother four years earlier.

She was one of a number of chimps that surrounded the body for around 20 minutes, gently touching and sniffing Thomas despite offers of food to lure them away. Noel stayed on its own to clean the teeth of its adopted son, even when the others had left.

Dr. Edwin van Leeuwen, of St. Andrews University, lead author of the study, published in the journal Scientific Reports, said: “Noel approached Thomas’s body, sat down close to his head, turned her upper body sideways to select a hard piece of grass, put the grass in her mouth, and opened Thomas’ mouth with both of her hands.

Chimpanzees gather around the body of Thomas, a nine-year-old who died of pneumonia.

“Then she wrapped her fingers around Thomas’s chin and jaw, and used her thumbs to explore his teeth. After three seconds, she took the grass out of her mouth with her right hand, while maintaining focused grip on Thomas’s mouth with her left hand, and started to meticulously poke the grass in the same dental area as where her thumbs had been.

“This behaviour has never been reported in chimpanzees or any other non-human animal species. Chimpanzees may form long-lasting social bonds and like humans, may handle corpses in a socially meaningful way.”

Nina, Noel’s adolescent daughter, stayed at its mother’s side and observed the cleaning efforts.

The researchers say Noel might have been trying to understand how Thomas had died. She was seen tasting the debris she picked from his teeth. A post mortem found Thomas had most likely died from a combination of a viral and bacterial lung infection.

Complete Article HERE!