Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

ContextAdvance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process.ObjectivesTo gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process.MethodsThis was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory.ResultsFamily members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns.ConclusionThis study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns.     

Continence Care for Older People

Surveys of incontinence among the elderly in Japan have shown that about 10% of Japanese men and 40–50% of Japanese women have some degree of incontinence. Unfortunately many of those with incontinence seem to think that there is nothing that can be done about it. They give up because they think incontinence is a part of aging. Incontinence is not simply a part of aging, continence can be regained. However, an assessment to find the causes of an individual's incontinence and his/her possibility of improvement must first be accomplished. Causes of incontinence include bladder functional disorder, intelligence disorder, mobility and dexterity problems, and environment problems. Incontinence is categorized into several types, based upon the particular cause of the incontinence. Bladder functional disorder has been identified as the cause of three types of incontinence: urge incontinence, stress incontinence, and overflow incontinence. Urge incontinence is recognized as the involuntary loss of urine associated with an abrupt and strong desire to void. Urge incontinence often is associated with urinary frequency and is a symptom of bladder muscle irritability. Both urge incontinence and urinary frequency can be controlled by medication that relaxes the bladder muscle. Stress incontinence has been defined as the involuntary loss of urine secondary to increased abdominal pressure. The most common cause of stress incontinence is a weak pelvic floor muscle. Therefore, pelvic floor muscle exercises are useful for the prevention and improvement of stress incontinence. Overflow incontinence has been recognized as the involuntary loss of urine due to over‐distension of the bladder. In order to control overflow incontinence, it is necessary to determine whether the bladder distention is due to enlargement of the prostate gland or is a side‐effect of medication. Functional incontinence has been shown often to be secondary to an intelligence disorder, or to mobility and/or dexterity problems. Regardless of the cause of the incontinence, an appropriate environment is needed in which to treat the incontinence. Treatment and care for the incontinent individual needs to be done by a multidisciplinary team in accordance with the type of incontinence being experienced.     

Primary Care End-of-Life Planning for Older: Adults with Chronic Illness

Care of patients with chronic illness such as congestive heart failure and chronic obstructive pulmonary disease accounts for a large part of primary care practice. End-of-life planning is an important part of the care of these patients and should begin early in the progression of the disease. This case outlines the development of a comprehensive end-of-life plan in early, worsening, and end-stage disease.     

Nurse-Assisted Suicide: Not an Answer in End-of-Life Care

Published documents were used to identify women's and children's exposure experiences following two mass disasters and two terrorist attacks that occurred in the United States. Research reports, clinical needs assessments, and a case study were analyzed to determine the type and severity of women's and children's exposure. Research reports were given priority if pre-event/post-event data were reported, if the study reported was longitudinal in design, and if samples were representative of the populations from which they were drawn. Clinical needs assessments were included because these documents provide evidence of need for services by disaster victims. The case study selected was unique in the literature reviewed. The results showed that both the women's and children's severity of exposure was related to posttraumatic stress disorder (PTSD), depression, separation anxiety, and generalized anxiety. In studies that made gender comparisons, data collected from women and girls showed more negative mental health outcomes than data collected from men and boys. Implications for clinical practice and traumatic event policy are addressed. Longitudinal, prospective studies of potentially traumatic events (PTE) are needed to better understand the longer term plight of children, especially girls.     

End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be effective, health care professionals who provide hospital care will need to respond to its patient-centered purpose. Health services will also be called upon to train health care professionals to work with dying people in a more participatory way and to assist them to develop the clinical processes that support shared decision making. Health professionals who manage clinical workplaces become central in reshaping this practice environment by promoting patient-centered care policy objectives and restructuring health service systems to routinely incorporate patient and family preferences about care at key points in the patient's care episode.     

Mental Health Nurses Supporting the Routine Assessment of Anxiety of Older People in Primary Care Settings: Insights from an Australian Study

Anxiety in older age is a worldwide problem and co-associated with other mental health problems, physical health conditions, disability, reduced quality of life and increased healthcare utilisation. Yet the symptoms of anxiety are often unrecognised in older people, challenging early diagnosis and increasing the risk of older people developing more chronic and disabling illness. This article reports on research led by mental health nurses and a primary care nurse that supported primary care practitioners to undertake a routine assessment of anxiety in older people in Australia. The Geriatric Anxiety Inventory-Short Form was incorporated into the annual, in-depth 75?years and older, health assessment that is undertaken in primary care settings and funded by Australia’s Medicare. An initial feasibility study demonstrated good acceptance levels of the routine assessment by the primary care practitioners. These findings suggest fertile ground for the everyday use of the routine assessment in primary care settings in Australia, with transferability internationally in low-, middle- and high-income global communities. Mental health nurses can play a key role in supporting primary care nurses to recognise and respond to anxiety in older people. Illness prevention and health promotion activities are low cost and have the potential to make a difference worldwide to the health of people across the lifespan.     

Conducting Focus Groups Cross-Culturally: Experiences with Pacific Northwest Indian People

Many disciplines have used focus groups in research and the use has increased in the past 15 years (Smith, 1995). Procedural concerns have been explored, such as the selection of the participants, the location, and the size of the group, but little attention has been given to the consideration of cultural influences. The purpose of this paper is to focus attention on the impact of culture in conducting focus groups. Experiences from 15 focus groups conducted in two qualitative research studies with two Washington state Indian tribes over a 5 year period are presented and illustrate the importance of culture in conducting focus groups. Communication patterns, roles, relationships, and traditions were found to be important elements that must be considered in conducting focus groups cross-culturally. While some strategies discovered were found to be helpful, additional research is needed.     

End-of-Life Care: Challenges and Opportunities for Health Care Professionals

The failings of the American Health Care System in meeting the comprehensive needs of the seriously and terminally ill have led to both professional and public efforts to improve end-of-life care. Following a discussion of the shortcomings of end-of-life in America, this article describes the goals and philosophy of palliative care, while highlighting current innovative programs in end-of-life needs and insure quality of life for patients and families experiencing incurable, progressive illness. Health care professionals are called to respond to the challenges and opportunities of end-of-life care as individual health care providers, as members of professions, and as members of interdisciplinary teams committed to improving the care of the dying in America. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com?<?Website: http://www.haworthpressinc.com>]     

Preferences for End-of-Life Care and Decision Making Among Older and Seriously Ill Inpatients: A Cross-Sectional Study

ContextOlder and seriously ill Australians are often admitted to hospital in the last year of their life. The extent to which these individuals have considered important aspects of end-of-life (EOL) care, including location in which care is provided, goals of care, and involvement of others in decision making, is unclear.ObjectivesTo determine, in a sample of older and seriously ill Australian inpatients, preferences regarding location in which they receive EOL care and reasons for their choice; who is involved in EOL decisions; disclosure of life expectancy; goals of care; and voluntary-assisted dying.MethodsCross-sectional face-to-face survey interviews conducted with 186 (80% consent) inpatients in a tertiary referral center aged 80 years and older; or aged 55 years and older with progressive chronic disease(s); or with physician-estimated life expectancy of less than 12 months.ResultsHome care was preferred (69%), given the perceived availability of family/friends, familiarity of environment, and likelihood of having wishes respected. If unable to make decisions themselves, inpatients wanted family to decide care alone (31%) or with a doctor (49%). Of those who had not discussed life expectancy, 23% wished to. Most (76%) preferred care that maintained quality of life and relieved symptoms. There was some agreement for being sedated at the EOL (63%) and able to access medication to end life (43%).ConclusionMost inpatients would prefer EOL care that maintains quality and relieves suffering compared with life extension and to receive this care at home. Family involvement in resolution and documentation of EOL decisions should be prioritized.     

The Role of Rehabilitation Professionals in Care Transitions for Older Adults: A Scoping Review

Abstract

Aim: To identify existing theories and conceptual models that inform care transition interventions and to explore whether the role of rehabilitation professionals is explicitly stated or implied in these theories and models.

Methods: We searched multiple databases and included articles published from 2000 to 2018, with distinct mention of care transitions of older adults (>65 years) from one care setting to another.

Result: Two theories (Middle Range Theory and System of Care Philosophy), and six conceptual models (Coleman’s Model, 4Cs of Transitional Model, Quality Cost Model of Advanced Practice Nurses Transitional Care, Health Belief Model, Care Transition Framework, Ideal Transition in Care) were identified in 13 of the 21 articles; however, only one conceptual model in an opinion paper illustrated the role of a physiotherapist in care transition.

Conclusion: Most of the models, frameworks and theories that inform care transition interventions did not explicitly consider the role of RPs.     

广东茂名市残疾老年人居家康复的影响因素

目的研究居家康复的影响因素。方法设计问卷调查表,选取广东茂名市基本符合居家康复的老年残疾人350 人,采用入户调查和电话问卷调查形式进行调查。结果和结论残疾老年人居家康复受残疾人自身经济能力、养老费用比例、家庭平均收入状况、社会保障机制、康复疗效、政策宣传等因素影响,其中经济因素影响最为显著。     

Perceptions of Professional Responsibility When Caring for Older People in Home Care in Sweden

ABSTRACT

Older people in Sweden are increasingly being cared for in the own home, where professional caregivers play an important role. This study aimed to describe perceptions of caring responsibility in the context of older people’s homes from the perspective of professional caregivers from caring professions. Fourteen interviews were conducted with professional caregivers from different professions. The result show how professional caregivers perceive responsibility as limitless, constrained by time, moral, overseeing, meaningful and lonesome. Responsibility seems to affect caregivers to a large extent when the burden is high. Professional caregivers’ perceptions of responsibility, and the potential consequences of a perceived strained work situation therefore need to be addressed. The findings also indicate a need for professional support and guidance when it is difficult to distinguish between professional and personal responsibility.