Doctors who specialize in geriatric medicine say they're seeing Kentuckians with advanced cancer and other serious illnesses travel out of state to end their lives on their own terms.

It may mean going to Oregon, which as of last week will no longer require a person to establish residency to be eligible for medical aid in dying.

Oregon is one of 10 states, along with the District of Columbia, where the practice is legal.

Dr. Christian Furman, medical director of the Trager Institute and Smock Endowed Chair in Geriatric Medicine at the University of Louisville School of Medicine, explained most of her patients are terminally ill and in their 80s or 90s. She said doctors in Kentucky want to expand the options for these patients and their families.

"We can definitely help with a lot of the pain and symptoms, and taking care of the patient and family as they need care," Furman explained. "But there are those patients where, you know, you just can't."

A recent poll from the nonprofit Compassion & Choices found voters, nationwide and across party lines, are eight times more likely to vote for candidates who sponsor or support medical aid-in-dying legislation.

The American Medical Association is opposed to the practice, however its Code of Medical Ethics affirms that pro and con positions are in moral equilibrium and says physicians may participate in medical aid in dying without violating their ethical obligations.

Furman note it is common for terminally ill patients to refuse food or water, a sign they are ready to end their lives.

"I've never had anybody intentionally say, 'OK I'm going to stop eating and drinking, so I'll die quicker.' I have had people say, they're just ready," Furman recounted. "They've made the decision, they're ready to die, they don't want any life-prolonging treatments."

She added physicians in the state are becoming more aware of the importance of expanding end-of-life options for patients' agency, comfort and care.

"We have a palliative medicine fellowship at U of L, and we teach this in our fellowship, what medical aid in dying is," Furman stressed.

Rep. Josie Raymond, D-Louisville, introduced a bill earlier this year, which would legalize the option in Kentucky.

Most people probably never give a second thought to their visits to the dentist, but not everyone can navigate this process with ease. People with intellectual or developmental disabilities may face challenges in finding quality dental care.

Dr. Bill Milner founded Access Dental Care with those patients in mind. It's a mobile dental service that makes care more accessible by visiting places such as nursing homes, group-home day centers, PACE programs and retirement communities.

Milner said the goal is to provide a dental home for a population that is too often overlooked.

"We've had to develop our own delivery system," he explained. "It has to be rolled in, five days a week, into different facilities. We treat 15 to 18 patients a day, and then we gather everything up at the end of the day, roll it back out, put it in the truck and go home."

Sponsored by the North Carolina Dental Society, Access Dental Care serves 60 counties in the state, and visits about 160 facilities. Milner has also won this year's American Dental Association Humanitarian Award.

Milner acknowledged that efforts are being made to improve access, but said barriers still exist -- from navigating behaviors to having few providers trained to give specialized care. He said even small changes within the profession can lead to improvements.

"We're having folks roll in, in wheelchairs, into offices -- and they don't know how to transfer folks into dental chairs," he said, "and it's as simple as getting a physical therapist in to train their staff."

Another significant challenge is Medicaid funding for providers, which Milner said typically only reimburses 38 cents for every dollar of the dental bill. Nonetheless, he said, his team will continue to advocate for special-care services, with plans to open more clinics.

Milner sees it as a priority to raise awareness and encourage more dentists to work with these patients.

"We need them to speak up and continue to be advocates for oral health," he noted, "and for them to understand that infection in the mouth is infection in the body."

There is movement on this issue at the state level. In the North Carolina Legislature, Senate Bill 382 would give students the chance to work in the community at nursing homes and group homes. The bill is now in a conference committee and has bipartisan support.

The holiday season is filled with recipes passed down from years before, and feasting with family and friends. But think again before you have seconds.

The top three days for heart-related deaths are Dec. 25-26 and Jan. 1, according to a study in Circulation, a publication of the American Heart Association. Missouri dietitians and the Heart Association are reminding people to mind their heart health and overcome excuses.

Registered dietitian Ariel Johnston at The Tasty Balance in St. Louis said it's fine to enjoy favorite holiday foods - but add something, to help keep it balanced.

"Maybe you have your favorite recipes that was handed down from Grandma, and maybe it's not the most 'heart healthy.' You can still have that, but let's add some greens or salad, or your appetizers that include some fruits and veggies," she said. "You don't want to deprive yourself of those favorite things."

Winter weather can be another trigger for increased heart-attack risk, with cold temperatures restricting blood flow through already constricted blood vessels. But the research says even in a mild climate, about one-third more heart attack deaths occur in December and January than in June through September.

If it's willpower you need to keep from overindulging, the Heart Association offers tips online at heart.org.

Johnston added that so-called "yo-yo" dieting or crash diets, which are often popular following the holiday season, can be detrimental to heart health.

"A lot of the rhetoric that we hear at this time of year, as far as, like, 'This is how many pounds people gain during the holidays,' and then, you're going to start seeing all the advertising for the new diets coming up," she said. "Yes, people might lose weight and maybe improve lipid profiles a little bit. But really, they aren't sustainable."

The Heart Association also has recipes online that can help with healthier substitutions or additions to holiday meals.

Research in Georgia is getting a boost to help enhance the lives of people living with Alzheimer's disease and provide better support.

In Georgia, more than 150,000 people age 65 and older are living with Alzheimer's, and the number is only expected to rise.

Leslie Tripp Holland, senior director of marketing and communications for the Alzheimer's Association, said the state has received an additional $600,000 to advance research efforts.

"For instance, we have one researcher at Emory University," Holland explained. "Her research brings dementia awareness into the Black American churches and she is creating dementia-friendly congregations."

Right now, 19 projects are active in such areas as Atlanta, Athens and Kennesaw. Holland noted in addition to the search for a cure, many of the projects are assisting in risk mitigation, creating opportunities to spread awareness and allowing people to participate in clinical trials, ultimately helping provide increased representation in research.

Breaking down the stigmas surrounding brain health, dementia, and Alzheimer's is another significant aspect of the research being conducted in Georgia. Holland emphasized by investing in research, the state is advancing its understanding of the diseases while working toward developing effective treatments.

"We now have two FDA-approved treatments that are also approved by Medicare that clinically changed the course of the disease," Holland stressed. "We have never had that in the past."

The funding was part of a $100 million investment into research around the country by the Alzheimer's Association, the largest investment since 1980. Data show more than 6 million people in the U.S. are living with Alzheimer's, and by 2050, this number is projected to rise to nearly 13 million.


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