The purpose of this project is to explore the historical context and current state of prison hospice programs in the US. This objective was accomplished through an extensive review and synthesis of the relevant literature pertaining to prison hospice programs in the US. The historical increase of the incarceration rate beginning in America during the 1980’s has led to the development of more elderly prisoners than ever before in the US. As prisoners age in the US correctional system, they experience faster-than-average health decline. Mass incarceration has placed incredible strain on the correctional system to provide healthcare to the medically complex elderly inmate population. This project proposes that some of this systematic strain may be alleviated through the action of prison hospice programs. Prison hospices replace unnecessary industrial medical interventions with personalized comfort care measures and the unique service of inmate volunteers. This approach to medical care at the end of life has become the standard of care for the free population but is slower to emerge in the prison context. This project asserts that the dying US inmate population should be offered the right to a dignified death through equitable access to hospice services.

Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed with mild, moderate or severe dementia. The virtual experience consisting of a set of instructions, headphones and different materials, is a quick, effective and efficient way to mimic having some of the stressors those living with Alzheimer's, or other types of dementia, may experience in their day-to-day lives. The purpose of this study was to analyze the effect on caregivers’ emotions and attitudes toward dementia, before and after the virtual experience using a qualitative approach. It is hypothesized that the intervention will educate and instill empathy in the caregivers, overall, improving the delivery of their care in the future. Participants were asked open ended questions before and after the intervention using the virtual experience and four themes emerged: (1) Being more patient, (2) Slowing down, (3) Empathy and (4) Being positive. The findings suggest further education about the disease process is needed to help caregivers understand the actions of dementia related behaviors. Also, education about different strategies to handle some negative behaviors associated with Alzheimer’s or other types of dementia can be done to improve the situation. Overall, the findings showed an increase in empathy and positive words or phrases from the participants, suggesting the simulation experience was an applicable and ethical intervention.

Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed with mild, moderate or severe dementia. The virtual experience consisting of a set of instructions, headphones and different materials, is a quick, effective and efficient way to mimic having some of the stressors those living with Alzheimer's, or other types of dementia, may experience in their day-to-day lives. The purpose of this study was to analyze the effect on caregivers’ emotions and attitudes toward dementia, before and after the virtual experience using a qualitative approach. It is hypothesized that the intervention will educate and instill empathy in the caregivers, overall, improving the delivery of their care in the future. Participants were asked open ended questions before and after the intervention using the virtual experience and four themes emerged: (1) Being more patient, (2) Slowing down, (3) Empathy and (4) Being positive. The findings suggest further education about the disease process is needed to help caregivers understand the actions of dementia related behaviors. Also, education about different strategies to handle some negative behaviors associated with Alzheimer’s or other types of dementia can be done to improve the situation. Overall, the findings showed an increase in empathy and positive words or phrases from the participants, suggesting the simulation experience was an applicable and ethical intervention.

BACKGROUND: Delirium is often not recognized by clinicians at hospice facilities, leading to the lack of beneficial interventions. The aim of this study is to find a baseline of how many patients show signs of delirium, dementia, or both, determine whether clinicians are recognizing these signs, and observe how dementia and delirium are being treated for these patients.

DESIGN: Patient charts were reviewed to obtain demographic information, medications, and patients' progress throughout stay including pharmacologic and non-pharmacologic interventions and results. Patients were then interviewed using the short portable mental status questionnaire.

SETTING: The prevalence and management of dementia and delirium was evaluated in 10 Hospice of the Valley inpatient settings.

RESULTS: Out of the 159 participants (mean age = 77.72 years), 93 (58.5%) presented with moderate to severe cognitive impairment, but only 38 participants (23.9%) had a formal diagnosis of dementia. Out of the 93 participants with significant cognitive impairment, 60 participants (65.6%) were treated with benzodiazepines and 82 (88.2%) were treated with opioids. Fifty-nine (63.4%) participants with cognitive impairment had documented non pharmacological interventions such as repositioning and reorientation, but only 22 (23.7%) participants received more meaningful non-pharmacological interventions such as hand massages, targeted videos, and favorite music.

CONCLUSIONS: The current study found a high prevalence of moderate to severe cognitive impairment without a diagnosis of dementia. A likely cause is the high frequency of opioids and benzodiazepines prescribed, causing drug-induced sedation and delirium which significantly impairs cognitive abilities. Safer alternatives, such as non-opioid pain medications, should be considered within the hospice population, especially given that age is a risk factor for delirium. A tool would be helpful to encourage staff to identify and document use of non-pharmacological interventions.