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Deciding on hospice care for a loved one is a deeply personal and challenging decision, balancing their wishes and medical realities. Rebecca Edwards, DNP, from Renown Hospice Care, explains the signs indicating when it might be time for hospice and offers guidance on navigating this decision with compassion and clarity. Understanding Hospice Care  Before exploring the decision-making process, it’s crucial to have a clear understanding of what hospice means. Hospice care represents a shift in how we approach living with a terminal condition, emphasizing comfort, dignity, and quality of life above all else. When there is no longer a pathway to a cure, side effects of treatment outweigh the benefits, or someone is simply tired of frequent hospital visits, then it may be time for hospice. Hospice care is mainly done in the home, where most people wish to be. It's a compassionate, team approach to care that focuses on meeting the physical, emotional, and spiritual needs, supporting their families, and honoring individual preferences. 5 Critical Signs to Be Aware Of Decline in Overall Health: When a loved one's health continues to decline despite ongoing medical interventions, this may be a sign that these treatments are no longer effective.  Increasing Pain and Symptoms: When managing symptoms such as pain, nausea, fatigue or shortness of breath becomes increasingly challenging, hospice can offer specialized support and expertise in symptom management.  Frequent Hospitalizations: Repeated hospitalizations or emergency room visits can signify that the disease has progressed to a point where managing symptoms and providing comfort at home or in a hospice setting is a more appropriate approach.  Difficulty with Daily Activities: If your loved one is experiencing difficult with activity of daily living such as dressing, bathing, or mobility, it may be a sign that they require additional support and assistance. Prognosis of Six to 12 Months: Hospice Care is typically recommended for patients with a prognosis of about one year or less if the disease follows its normal course. However, it’s important to remember that every individual is unique and prognosis can vary.

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According to the Global Sepsis Alliance, 1 in 5 deaths worldwide are associated with sepsis. If not recognized early and treated promptly, sepsis is the final common pathway to death from most infectious diseases worldwide, including viruses such as COVID-19. We spoke with Jeremy Gonda, MD, a critical care physician from Renown Health’s Sepsis Committee to increase public awareness of this preventable medical emergency. What is sepsis? Sepsis is a response to infection—bacterial, viral or fungal—and can start anywhere in the body and spread into the bloodstream. The body is trying so hard to fight an infection that it begins releasing chemicals into the bloodstream that cause inflammation and the shutdown of multiple organ systems. “It carries a very poor prognosis in general unless you catch and treat it very early,” said Dr. Gonda. “Any infection can lead to sepsis. Typically your immune system takes care of the infection. It doesn’t progress, but in cases where the infection becomes severe, or the immune system doesn’t function properly, people can certainly die. So there’s, unfortunately, a very high mortality rate associated with sepsis.” According to the Centers for Disease Control and Prevention, each year at least 1.7 million adults in America develop sepsis. While you can recover from sepsis if caught early, many sepsis survivors suffer from long-term physical and psychological effects. What are the signs of sepsis? One way to spot sepsis is to use the acronym SEPSIS: S – Slurred speech and confusion E – Extreme shivering or muscle pain/fever P – Passing no urine all day S – Severe breathlessness I – “I feel like I might die” S – Skin mottled or discolored Keep in mind that sepsis symptoms can vary depending on where the infection starts. “Patients may experience urinary burning if they have a urinary tract infection or a cough and shortness of breath if they have pneumonia first,” said Dr. Gonda. “However, often symptoms are more generalized or subtle such as fevers, confusion and malaise.” How do you develop sepsis? When germs enter your body, they can cause an infection. If you don’t stop that infection, it can cause sepsis. Areas of infection that more commonly result in sepsis include: Lungs, such as pneumonia Kidney, bladder and other parts of the urinary system Digestive system Bloodstream (bacteremia) Catheter sites Wounds or burns Who is most at risk? People with compromised immune systems are at greater risk for sepsis, such as “The very young, the elderly and any people who may have conditions that suppress your immune system,” said Dr. Gonda. “For instance, if you have diabetes or if you’re an organ transplant patient who is on immunosuppressant therapy, you’re at somewhat higher risk.” Sepsis is often considered a hospital-acquired infection, but a study in The Journal of American Medical Association found that 80% of sepsis cases occur outside of a hospital. That’s why it’s especially important to remember any infection can lead to sepsis, and anyone can develop sepsis from an infection. What do I do? Timing is critical in the case of sepsis and septic shock. According to a study on septic shock patients, there is a 7.6 percent decrease in survival for each hour treatment is delayed. On the other end, if treatment is given within an hour of the first drop in blood pressure, the survival rate is 80 percent. Because sepsis can be so deadly, it’s important to seek medical attention as soon as possible. “If you’re not getting any better, if you think symptoms are progressively worsening – you should definitely be evaluated by a doctor,” said Dr. Gonda. You can help #StopSepsis by getting involved at worldsepsisday.org.

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Becoming a parent for the first time means lots of new unknowns – from learning to breastfeed and swaddle to buckling your newborn into the car seat for the first time. But when it comes to putting them to bed safely, it’s important to remember it really can mean life or death. It’s something we’re taught before our little one is even here: the correct way to put your baby to bed safely. Sadly though, the number of infant deaths continues to climb. The main culprit of sleep-related infant death continues to be all the items parents leave in the crib with their babies. According to the Center for Disease Control and Prevention, there are about 3,500 sleep-related deaths among babies each year. “The best advice is ‘bare is best.’ Keep your infant’s sleep space clutter free – no blankets, bumpers, toys or pillows,” said Karen Wagner, Pediatric Nurse Practitioner. Follow the ABCs for Safe Sleep Remembering the ABCs is an easy way to remember how to put your little one to bed safely. A: Alone No blankets, toys or pillows. “We do recommend using a sleep sack as a blanket alternative,” said Karen. “It prevents the risk of suffocation and keeps your baby warm.” Keep in mind, the greatest risk for suffocation happens when babies are under 1 year of age, so it’s best to save the toys, blankets and pillows for their “big kid bed,” or around 18 months old. B: Back The slogan “back is best” is another good reminder. Keeping your baby on their back until they’re old enough to rollover helps reduce the risk of Sudden Infant Death Syndrome (SIDS). C: Crib It is best to have your baby sleep alone in their crib. While co-sleeping may be enticing, especially after a late-night feed, it increases the risks of possible suffocation. However, “having your child in your room, in their own crib or bassinet, is protective for SIDS,” Karen said. “In fact, we think co-rooming reduces SIDS risk by almost 50 percent.” Co-rooming allows parents to keep new babies in close reach and helps parents oversee their baby’s sleep, just in case something happens.

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November is National Alzheimer’s Disease Awareness Month. At Renown Health, we know that Alzheimer's safety for your loved one is a priority, as the symptoms can sometimes lead to unsafe situations. We asked Dr. Jonathan Artz – a neurology physician with Renown Health and an assistant professor of clinical neurology at the University of Nevada, Reno School of Medicine – for tips on keeping loved ones safe and secure.  According to the Alzheimer’s Association, Alzheimer’s disease affects safety in various ways, specifically due to body and brain adjustments. These changes can include: Judgment, including forgetfulness  Sense of place – getting lost on the way home  Behavior – being suspicious or fearful  Body difficulty – losing balance Sensing ability – noticeable sensitivity in hearing, seeing or temperature  Dr. Artz gives us four major tips to ensure your loved one’s safety as you both navigate this disease together.  Watch for Wandering  Those experiencing Alzheimer’s disease tend to wander and get lost. Try the following tips to reduce the risk of wandering:  Get your loved one an ID bracelet and have them wear it at all times. You can also enroll your loved one in “Wandering Support.”  Install door chimes so you know when exterior doors are open.  Ask neighbors to call you if they see your loved one out alone. Go with your loved one when they insist on leaving the house. Don’t argue or yell. Instead, use distraction or gentle hints to get them to return home.  Discourage Driving  Driving can be unsafe for someone with this disease. With this in mind, ask a doctor whether it’s safe for your loved one to drive. For example, on a case-by-case basis, there are certain situations where doctors are required to report individuals with particular cognitive impairments, wherein a form of a driving assessment will be recommended.  Limit access to the car. Keep the keys with you or lock them away.  Ask an authority figure, such as an insurance agent or a doctor, to tell them not to drive.  Adult-Proof Your Abode  A simple living space is a safe living space. This means reducing clutter and removing any issues that may pose a safety concern. You may also want to get advice from an occupational therapist (home safety expert). Keep in mind that some changes may not be needed right away. Focus on major safety concerns first.  Try the following tips:  Add lighting (or glow-in-the-dark tape) to brighten dark areas, including stairways and halls.  Use color contrast or texture indicators for dials, knobs and appliance controls.  Remind your loved one not to carry items while walking to avoid a fall.  Remove sharp objects from drawers and countertops.  Avoid using small throw rugs or doormats, as they are easy to trip on.  Move frequently used items so that they are easy to reach.  Lock away alcohol and tobacco products, as they are not recommended for dementia patients.  Install handrails in the shower, tub and near the toilet. Bathroom falls are especially common.  Adjust the setting on your hot water heater so water does not scald. Those with Alzheimer’s can lose their sensitivity to temperature.  Move and lock up hazardous chemicals and cleaning supplies, such as bleach and insecticides.  Disable and remove guns or any weapons. Supervise any medication taken by your loved one.  Promote a Positive & Healthy Lifestyle  Continually emphasize the strengths of your loved one by promoting participation in meaningful activities, wellness visits and healthy habits to help them improve their well-being. Here are some ways to keep them physically and mentally active:   Maintain regular vision and hearing screenings and make necessary adaptations.  Establish a routine for daily activities.  Encourage participation in self-care and leisure activities.  Work with your loved one’s doctor to establish a healthy diet.  Ensure proper hydration. It may help to set reminders for your loved one to drink fluids.  Encourage regular exercise. Exercise delivers oxygen to the brain, improving brain health. Promote good sleep habits. Good quality sleep can increase overall brain health and has been associated with improving memory, attention and concentration.  Resources and support are available with the Renown Memory Disorders Program. Providers within this program are specifically dedicated to treating several different memory-related disorders. Memory Disorders Resources & Support.

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At 85, James Domingos is still enjoying life as a cowboy, thanks to a transcatheter aortic valve replacement. Always rolling with the punches when it comes to life, 85-year-old James Domingos faced his health issues with the same grit. For many years, he roped cattle for friends and rounded up horses for the Bureau of Land Management. In recent years, a pacemaker controlled the rhythm of his heart, but didn’t slow him down. “We used to be able to take walks for 15 minutes in one direction and take the dog,” says Domingos’ wife, Joy. “Then it got to be less and less.” Tests at Renown Health revealed a heart valve was nearly closed. His heart doctor, Jake Ichino, MD, FACC, FSCAI, suggested a transcatheter aortic valve replacement, known as TAVR, which repairs a heart valve without removing the damaged valve. The procedure is recommended for patients who are at high risk for open heart surgery.

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