Dreams and Visions at the End of Life

Sometimes pleasant, other times troubling or horrifying, we’ve all experienced dreams that shake us and stay with us in our waking hours.  A quick google search for “dream analysis” will come up with countless websites dedicated to decoding imagery or themes from dreams, but just as many people out there will tell you that dreams are your mind processing the day’s events, that they have no real meaning beyond that.

But what about the dreams of the dying, or the deathbed phenomena?  Is it possible that the vivid dreams or visions that many people experience during their final days and weeks of life play a role in achieving peaceful deaths?  Could they have therapeutic implications?  A recent NYTimes article explores this topic, and highlights work being done in the field.

Dr. Christopher Kerr of Hospice Buffalo is leading a team of clinicians and researchers to help gain an understanding of dreams’ importance and the role they play in patient’s final days of life.

Read the article here: http://www.nytimes.com/2016/02/02/health/dreams-dying-deathbed-interpretation-delirium.html

And check out Dr. Kerr’s TED talk here: https://www.youtube.com/watch?v=rbnBe-vXGQM

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Carol Marak launches new blog series, “A Baby Boomer’s Aging-Alone Plan”

Carol Marak, aging advocate and editor of http://www.SeniorCare.com, has started a new blog series as part of Huffington Post’s Post 50 blog.  Marak will chronicle her process of developing a plan for how she will care for herself as she ages.  We’re excited to follow her journey.  Check it out!

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The Road Taken

Tara Cortes, PhD, RN, FAAN, Executive Director, Hartford Institute for Geriatric Nursing

by Tara Cortes, PhD, RN, FAAN, Executive Director, Hartford Institute for Geriatric Nursing

What do we think of when we hear the word dementia? It usually creates a profound image associated with stigma. Often we associate it with fear and loss. Usually we associate with getting old. People who are young might perceive dementia differently that people who are in their 60s and 70s. Those who live with or have loved ones who suffer with dementia might have yet another perception of what it means. Different societies perceive aging and memory loss differently. In some cultures aging people are revered regardless of their cognitive or physical abilities. In other cultures aging people who become confused or forgetful are shuttered and often isolated.
Recently I spoke at the International Dementia Conference in Birmingham, England and heard short remarks delivered by Baroness Sally Greengross OBE, Chief Executive/ President of the International Longevity Centre in UK. She spoke about dementia as a journey. It helped me to reflect on dementia as another road in life that some people take. This reminded me of Robert Frost’s A Road Not Taken:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same…

It struck me how much more gentle it was to look at dementia through the lens of a journey than the lens of a disease. It is a road now traveled by more and more people and there are signposts and detours along the way. There are other people that join a person who is on that road. Some ride along for a little while and some longer. Most important, are the signposts and rest stops on that road that provide direction and respite to the journeymen. These signposts provide support, understanding and wisdom that make the journey meaningful and enrichening. These respite stops provide the comfort and the peace to the person on the journey and his or her companions. The road has many bumps that may require one to slow down. But there is an end. The goal is to embrace the journey while it lasts and seek ways to find new experiences along the way.

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Fighting against fear…


By Alyssa Coppa

Cancer is a word I began to hear and fear at a young age. I first heard this word when I was 3 years old and my grandmother, who I refer to as Nonna, was diagnosed with Stage 4 breast cancer. We immediately booked a flight to Italy to see her. It was the first and last time I was able to see my Nonna. A few years later, my grandfather, Nonno Antonio, was diagnosed with stomach cancer. A short week later he passed away during surgery. During this time, my cousin, who was only three years older than me age was battling a rare type of brain tumor. After two years of fighting hard, she passed away as well. All of the pain cancer was causing the various members of my family was heartbreaking. It felt as if cancer was taking away all of the people I loved. I contribute all of these losses I experienced at a young age as motivators to enter the field of oncology and help in the fight against the many types of cancer.

In nursing school, oncology is briefly touched upon. The more common types of cancer are taught along with the most frequent treatments including chemotherapy and radiation therapy. During the month of September, I was given the opportunity to shadow Dr. Giuliante, a Head and Neck/Melanoma/Sarcoma (HMS) Nurse Practitioner at Memorial Sloan Kettering (MSK) and vital member of the Hartford Institute of Geriatric Nursing family. This was the perfect opportunity to explore the oncology field in more depth and actually see if this is a field I can see myself entering when I become a registered nurse.

The experience was incredible! From the moment I arrived at MSK, to when I left, I was overcome with various emotions. Sadness filled me when some clients were told that their current treatment plan was not working or producing the results the health care team had hoped. Some of these individuals had young children that they would not be able to see graduate high school or college. However, despite these distressing moments, the strength and courage I encountered with many of the patients that were seen by the HMS team was inspiring. It makes the common things we stress about in life seem miniscule. In addition, the MSK staff including the nurses, nurse practitioners, and medical oncologists, were all incredible. The care they provided was some of the best care I have ever seen thus far in my career.

During my first day shadowing Dr. Giuliante at MSK, each client we encountered was extremely complex. I often associated cancer with only one part of the body. For instance, I once thought lung cancer affected only the client’s lungs and colon cancer only affected the colon. How wrong I was! Cancer often affects multiple parts of one’s body whether it is directly or indirectly. When assessing and addressing the various problems a patient is enduring, often solving one problem leads to another problem developing or becoming more apparent. The patience and intelligence the health care team at MSK had was fascinating. In addition, every member of the team worked very effectively with each other. The collaboration seen among the team was something I have read as “the future of health care”, but is already being practiced at MSK!

This opportunity confirmed for me that working in oncology is the right path for me. I want to help in the fight against cancer by providing comfort and care to those as an oncology nurse and one day nurse practitioner. After this experience, I no longer associate the word fear when I hear the word cancer. Instead, I associate strength, determination and courage with cancer. These are all the traits portrayed by the clients I encountered at MSK.

Alyssa Palma Coppa

Alyssa Coppa is a nursing student in the third sequence of the accelerated baccalaureate program at NYU College of Nursing. She is a member of the Hartford Institute Geriatric Undergraduate Scholars Program and the Geriatric Student Interest Group. Her first degree is in Biology with a minor in Psychology. She plans on becoming an Adult Acute Care Nurse Practitioner specializing in geriatrics.

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Move your Body!

Maryanne M. Giuliante, DNP, RN, GNP, ANP-C

Maryanne M. Giuliante, DNP, RN, GNP, ANP-C

It is well known that exercising is good for all of us, but this article in today’s NY Times reveals that exercising is not just healthy for our physical being. It may also prevent cognitive deterioration, such as Alzheimer’s Diseases. As a Geriatric Nurse Practitioner, I am often asked what one can do to stave off these type of dreaded diseases, which rob patients of their cognitive abilities. This article suggests that there IS something. And the best part? It benefits not just the brain, but the body too! For patients to reap the benefit of this relatively easy intervention, the amount of exercise suggested is “briskly walking for 20 or 25 minutes several times a week”. We can all do that, right?

What are the challenges that you can anticipate in trying to integrate this intervention into your daily routine? Of course, any alteration in our day-to-day activities is somewhat difficult to first adopt, but often comes easier over time. Can you find a way to break these barriers down, in the name of better health?

Before beginning a new exercise routine, we should first check with our health care provider to ensure that it is done in the safest way possible.


Older Adults: Putting Wheels on Their Home!

RV’ing appears to be the new “in thing.” As adults grow older, their need to be tied to their traditional home decreases. Along with this new-found freedom come creative ideas to spend time and money. Many older adults are being found at campgrounds throughout the United States. Offering a sense of freedom while still maintaining many of the comforts of home, an RV (recreational vehicle) is becoming more popular among older adults.

Several years ago, my parents (who are in their late 60’s) decided to buy an RV. They even named it!! The name of their RV is a combination of all of their grandkids names: Joseph, Gabriella, Daniella, Ariana, and Sophia were combined to create “Jogada Arso,” a name which they proudly display on the side of their RV. They have traveled all over the country and have met so many wonderful friends this way. My mom, who cannot stand the thought of dirt, unsanitary conditions, and other people’s messes, has wholeheartedly embraced the idea of creating a kind of “home on wheels.” They can pack it up and roam without a destination in mind. How lovely to have this freedom!

As older adults are living longer, RV’ing provides a method of becoming mobile while still recognizing that many (like my parents) are set in their ways!

maryannes parents

– Dr. Maryanne Giuliante, DNP, RN, GNP, ANP-C


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Exciting news from the Hartford Institute!

Tara Cortes, PhD, RN, FAAN, Executive Director of the Hartford Institute for Geriatric Nursing at NYU College of Nursing, was recently awarded a 3-year, $2.55 million Health Resources and Services Administration (HRSA) grant through the newly launched Geriatrics Workforce Enhancement Program (GWEP). HIGN was one of 44 organizations in 29 states awarded a total of $35.7 million in awards.
Partnering HIGN with the Montefiore Health System and Regional Aid for Interim Needs, Inc. (RAIN), a community services organization in the Bronx, GWEP aims to improve the quality of healthcare for older Americans by: 
  • Changing clinical training environments into integrated geriatrics and primary care delivery systems. 
  • Training providers who can assess and address the needs of older adults and their families or caregivers at the individual, community, and population levels. 
  • Delivering community-based programs that will provide patients, families, and caregivers with the knowledge and skills to improve health outcomes and the quality of care for older adults. 
The HIGN grant, entitled the “Community/Clinical Primary Care of Older Adults program (CC-PCOA)”, will build the geriatric capacity of the primary care workforce in clinical and community settings to address gaps in health care for older adults and maximize patient and family engagement. Specifically, this project will create a paradigm shift from the traditional perception of primary care as a visit to a doctor to one where primary care is provided by professionals and lay people throughout a continuum of locations extending from the doctor to services in the community where care plans can be enhanced to attain better health outcomes through non – traditional interventions. Using the National Prevention Strategy’s goal of increasing the number of Americans who are healthy at every stage of life through a multidisciplinary approach, this program will provide an interprofessional, multi-modal educational intervention aimed at creating a culture which values the health of our aging population.
Visit the Geriatrics Workforce Enhancement Program webpage to learn more: http://bhpr.hrsa.gov/grants/geriatricsalliedhealth/gwep.html
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