End of life: Expert care and support, not physician-hastened death.

In legal physician-hastened death, a physician prescribes medication with the primary intent of causing the death of a willing terminally ill patient. This practice differs radically from palliative sedation, intended to relieve a patient's suffering rather than cause a patient's death. In this position paper, we argue that the practice of physician-hastened death is contrary to the interests of patients, their families, and the sound ethical practice of medicine. Therefore, the American Academy of Neurology should advise its members against this practice, as it had done until 2018.

Utilization of rehabilitation therapies by nursing home residents with MS at admission.

OBJECTIVE: To identify factors associated with the utilization of physical and occupational therapies by nursing home residents with multiple sclerosis (MS) at admission to the facility. DESIGN: The study analyzed 27,264 admission assessments for residents with MS recorded in the national Minimum Data Set (MDS) between June, 1998 and June, 2003. A multiple linear regression model was employed to analyze the MDS data. The total number of minutes of physical and occupational therapies provided are the dependent variables. Independent variables are demographic characteristics, payment source, behavioral symptoms, and a range of health-related characteristics. RESULTS: The use of physical and occupational therapies by residents with MS at admission to the nursing facility was significantly associated with payment source, controlling for other independent variables. CONCLUSIONS: When reimbursement is available these therapies are more likely to be prescribed or requested. Since provision of these rehabilitative services diminishes disability and handicap, expanded Medicaid coverage may reduce long term health care costs and also improve the quality of life.

Racial analyses of longer-stay nursing home residents with multiple sclerosis.

OBJECTIVES: Compare profiles of African Americans with multiple sclerosis (MS) to White residents with MS one year after admission to a nursing facility. METHODS: We used all admission assessments recorded in the national Minimum Data Set (MDS) from 1999 to 2001 as well as all MDS annual assessments recorded from 2000 to 2002. We matched admission assessments with first annual assessment for 3632 White residents with MS and 461 African-American residents with MS. RESULTS: African Americans with MS were admitted at a significantly younger age and with more aid to daily living (ADL) dependence and cognitive dysfunction than Whites with MS one year after admission. Despite significantly poorer physical performance, cognitive function, and more medical comorbidities, African Americans with MS did not receive significantly more therapies or medications than White residents with MS after one year in the facility. CONCLUSIONS: Basic differences in MS expression and progression in African Americans appear to have to do with both genetic and environmental factors. Further study will help to clarify the reasons for these differences.

Nursing home residents with multiple sclerosis and dementia compared to other multiple sclerosis residents.

Cognitive impairment may be a significant symptom in multiple sclerosis (MS), affecting about one half of MS patients in study samples similar to the general MS population. An interesting question is what role dementia, of any aetiology, plays in the cognitive ability of people with MS. The objective of this research is to learn more about nursing home residents with MS and dementia, identifying how they differ from other residents with MS. We developed profiles of MS residents with dementia using the Minimum Data Set and compared these profiles to other residents with MS. Nursing home residents with MS and dementia are admitted to nursing facilities at an older age and seem less likely to have physical impairments but more mood and behaviour problems than other MS residents at admission. A cortical variant of MS may be more prevalent than previously suspected and may be a factor responsible leading to nursing home admission in this subgroup of patients. Further clinical analysis of this subgroup would be necessary to support this contention.

Nursing home residents with multiple sclerosis: comparisons of African American residents to white residents at admission.

This research profiles African American residents with multiple sclerosis (MS) at admission to the nursing facility and compares them to profiles of white residents with MS using the Minimum Data Set (MDS). We analysed MDS admission assessments for 1367 African Americans with MS and 9294 whites with MS. African American residents with MS were significantly younger at admission than white residents with MS, with almost one half of these African Americans 50 years or younger compared to only one quarter of these whites. African American residents with MS were significantly more physically disabled and cognitively impaired at admission than white residents with MS. Although there were significant racial differences in disability, there were no significant racial differences among these MS residents in the use of various therapies provided by qualified therapists. These observed racial differences among MS residents in disease manifestations, severity, progression and disability are due to multiple variables and point out the need for more research. By combining discoveries from genetics, immunology, epidemiology and virology we can gain a better understanding of the complex pathophysiology of MS and develop more effective treatments and preventive measures. Our findings also indicate potential racial disparities in the use of MS-related care, illustrating that a greater outreach effort may be needed to evaluate and treat African Americans with MS.

Analyses of nursing home residents with multiple sclerosis at admission and one year after admission.

This research compares profiles of residents with multiple sclerosis (MS) at admission to the nursing facility with profiles of these same residents one year later using the Minimum Data Set (MDS) to determine how their health and care received changed after one year in the facility. We matched MDS admission assessments with their first annual assessment for 1309 residents with MS. These residents with MS demonstrated deterioration in cognitive performance, communication skills, motor performance and bladder/bowel continence after one year in the facility. However, the proportion of residents with urinary tract infections and the proportion of residents with pressure ulcers declined after one year. A significantly larger proportion of these MS residents had a diagnosis of depression one year after admission, with significantly increased use of antipsychotic and antidepressant medications but little and declining use of psychological therapy after one year in the facility. In addition, there was a significant decline after one year in the use of physical, occupational, and speech therapies. These longer stay residents with MS may benefit from support services directed toward mental health and increased use of physical, occupational and psychological therapies provided in the nursing facility.