Religious observance and perceptions of end‐of‐life care

This study examines the impact of the level of religious observance on the attitudes toward end‐of‐life (EOL) decisions and euthanasia of Jews in Israel—where euthanasia is illegal—as compared to Jews living in the USA, in the states where euthanasia is legal. A self‐reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.     

Self‐care agency,lifestyle, and physical condition predict future frailty in community‐dwelling older people

The purpose of this 2 year longitudinal study was to identify the relationship between self‐care agency, lifestyle, physical condition, and frailty among community‐dwelling older people in a rural area of Japan. The participants were 133 older individuals aged 65 years or above. Data collection was conducted via face‐to‐face interviews using self‐administered questionnaires. Background information, such as age, sex, current employment status, family structure, medication use, comorbidities, and knee and lower back pain, were assessed. The definition of frailty was based on the Frailty Checklist. Self‐care agency, lifestyle habits, and locomotive syndrome were assessed using specific assessment scores. Logistic regression analysis showed that locomotive syndrome, knee and lower back pain, and stroke are risk factors for frailty. Among the factors associated with frailty, current employment, regular exercise, and self‐care agency were recognized as preventive factors of depression, decreased cognitive function, and being housebound. Our findings suggest that enhancing self‐care agency, regular exercise, and self‐management skills for chronic illness and disability may decrease the progression of frailty among older people.     

Experiences with advance care planning: older people and family members' perspective

jeong s.y.‐s., higgins i. & mcmillan m. (2011) Experiences with advance care planning: older people and family members’ perspective. International Journal of Older People Nursing 6 , 176–186 doi: 10.1111/j.1748‐3743.2009.00201.x Aims and objectives. The aim of this study is to report the findings of a case study that explored the phenomenon of advance care planning and advanced care directives in residential care settings in Australia. In particular, this study focuses on the experiences of residents’ and family members’. Background. Understanding the phenomenon of advance care planning and advanced care directives is vital to end of life decision making. There are few studies that report the experiences of older people and family members in relation to advance care planning and advanced care directives. Methods. A case‐study research was conducted and data was collected over 7 months involving participant observation, field notes, semi‐structured interviews and document analysis. Findings. The participants’ early experiences with advance care planning were expressed in unpleasant, hostile and negative ways. However, those emotions and concerns were transformed to more stable, amenable and positive attitudes and feelings as issues were resolved. The factors that enhanced or inhibited the transition were described. Conclusion. Older people and families view the end of life with broader psychosocial and spiritual meanings shaped by a lifetime of experiences. Advance care planning led to a different level of appreciation of personal entity and transcendence. However, advance care planning demands concerted action and support by everyone involved.     

Needs for end‐of‐life care by home care nurses among non‐cancer patients in Korea and Japan

The purpose of this study was to undertake a comprehensive assessment of each stage of the end‐of‐life process and the home care nursing needs of non‐cancer patients. The total number of eligible patients was 117 in Korea and 121 in Japan, aged ≥ 40, receiving continuous home care nursing throughout the beginning, stable, and at final death stages and ultimately dying at home. The need for the ‘management of physical symptoms’ increased as patients progressed through the end‐of‐life stages to death. In both countries, the needs for ‘loss and grief care’ and ‘coordination among care team members’ were significantly higher in the stable stage than in the beginning or final death stages. Further research is needed to develop tailored nursing care programmes that meet the specific needs of patients in each stage of the end‐of‐life care at home.