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The role of care homes in end of life care. Briefing 2: place and cause of death for permanent and temporary residents of care homes
- Author:
- NATIONAL END OF LIFE CARE INTELLIGENCE NETWORK
- Publisher:
- Public Health England
- Publication year:
- 2017
- Pagination:
- 14
- Place of publication:
- London
This briefing paper describes recent trends in the demographics of people who receive end of life care in a care home, presenting data on the place and cause of death for permanent and temporary residents of care homes. It also provides analyses of variation by geographical region. It reports that nearly two thirds (62 per cent) of people who died in care homes have dementia or Alzheimer’s disease as an underlying or contributory cause of death. It is the second of two briefings produced by National End of Life Care Intelligence Network to describe the important role that care homes play in the care of people at the end of life. (Edited publisher abstract)
The influence of thoughts of death and suicidal ideation on the course of depression in older depressed patients
- Authors:
- BOGERS Ista C.H.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(8), 2017, pp.882-891.
- Publisher:
- Wiley
Objective: Thoughts of death are not regularly included in diagnostic instruments and rarely examined separately from thoughts of suicide. This exploratory study examined whether thoughts of death and thoughts of suicide affect the course of late-life depressive disorders. Methods: In 378 depressed older persons, thoughts of death and thoughts of suicide were assessed using questions from the Composite International Diagnostic Interview. After 2 years, the presence of a DSM-IV-TR diagnosis of minor or major depression or dysthymia was assessed with the Composite International Diagnostic Interview. The Inventory of Depressive Symptomatology was administered every 6 months up till 3-year follow-up. Results: Multinomial logistic regression showed that thoughts of death as well as thoughts of suicide predicted double depression at follow-up (OR = 2.14 [95% CI: 1.04–4.40] and OR = 6.47 [95% CI: 2.22–3.02], respectively), compared with patients without these thoughts. Results became non-significant when adjusted for baseline depression severity (OR = 1.17 [95% CI: 0.52–2.63] and OR = 2.57 [95% CI: 0.79–8.84], respectively). Mixed linear models showed that severity of depression was lowest in the reference group, while symptoms decreased more over time in those with either thoughts of death or suicide. Conclusions: Patients with thoughts of death or with thoughts of suicide were more severely depressed at baseline and follow-up, with the highest risk of being depressed at follow-up for patients with thoughts of suicide. These associations could be explained by baseline depression severity. The results suggest that thoughts of death and thoughts of suicide are important risk markers in predicting the course of depression. (Publisher abstract)
Factors determining the balance between the wish to die and the wish to live in older adults
- Authors:
- BONNEWYN Anke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(6), 2017, pp.685-691.
- Publisher:
- Wiley
Background: The “Internal Struggle Hypothesis” (Kovacs and Beck, 1977) suggests that suicidal persons may have both a wish to live (WTL) and a wish to die (WTD). The current study investigates whether the three-group typology – “WTL”, “ambivalent (AMB)”, and “WTD” – is determined by common correlates of suicidality and whether these groups can be ordinally ranked. Methods: The sample comprised 113 older inpatients. Discriminant analysis was used to create two functions (combining social, psychiatric, psychological, and somatic variables) to predict the assignment of older inpatients into the groups WTL, AMB, and WTD. Results: The functions “Subjective Well-being” and “Social Support” allowed us to assign patients into these three distinct groups with good accuracy (66.1%). “Subjective Well-being” contrasted the groups WTD and WTL and “Social Support” discriminated between the groups WTD and AMB. “Social Support” was highest in the AMB group. Conclusions: The results suggest a simultaneous presence of a WTL and a WTD in older inpatients, and also that the balance between them is determined by “Subjective Well-being” and “Social Support”. Unexpectedly, the AMB group showed the highest scores on “Social Support”. The authors hypothesise that higher social support might function as an important determinant of a remaining WTL when a WTD is present because of a lower sense of well-being. The study suggests that the groups WTL–AMB–WTD can not situated on a one-dimensional continuum. (Edited publisher abstract)
Preparedness for death: how caregivers of elders with dementia define and perceive its value
- Authors:
- HOVLAND-SCAFE Cynthia A., KRAMER Betty J.
- Journal article citation:
- Gerontologist, 57(6), 2017, pp.1093-1102.
- Publisher:
- Oxford University Press
Purpose: The purpose of this study is to ascertain how bereaved caregivers of a family member who died from a dementia-related diagnosis (a) define preparedness and (b) perceive its value. Design and Methods: Purposive criterion sampling was employed to identify 30 bereaved caregivers of family members aged 65 and older who died with a dementia-related diagnosis. In-depth, qualitative interviews were conducted over a 12-month period, and qualitative content analysis was used to analyse the data. Results: Only one third (n = 10) of caregivers interviewed were prepared for the death, and the majority who were prepared were enrolled in hospice. Five primary themes revealed ways that caregivers define various domains of preparedness: (i) accepting reality; (ii) knowing death is near; (iii) getting your “house in order”; (iv) saying “what you need to say”; and (v) giving “permission” to die. The majority (87%) believed that it is important for caregivers to be prepared, and the value of preparedness was exemplified in five domains reflecting the benefits of being prepared. Implications: The results support further attention to the development and testing of interventions to address the unmet needs of caregivers of family members with dementia to help prepare them for the death in a variety of contexts (Publisher abstract)
Premature and preventable deaths in frail, older people: a new perspective
- Authors:
- HITCHEN Tatiana, et al
- Journal article citation:
- Ageing and Society, 37(8), 2017, pp.1531-1542.
- Publisher:
- Cambridge University Press
The concept and potential implications of a premature death of an older person are under-recognised and misunderstood by society. Clinical, forensic and public health practitioners need to redress this gap to prepare society better for a future where an increasing proportion of the population are vulnerable older people. Reliable and valid information is paramount for understanding how many older people have premature, preventable deaths, with implications for aged care services, health-care expenditure, quality and safety, and human rights. The authors' aim is to: (a) provide discourse on the limitations and challenges to the use of the concepts ‘premature’ and ‘preventable’ deaths, examining the situation for nursing home residents; and (b) propose the use of a novel classification system of ‘treated’, ‘un-treated’ and ‘untreatable’ causes of death that is more sophisticated and reflects the demographic reality of our ageing population. Accepting that preventable, premature deaths may happen to older people and adopting a new classification is a novel approach that has considerable benefits for health and life care of older persons. Improved assessment of the quality of care provided, including identification of health or life care practices that are unsafe or deleterious, can be identified and addressed. (Edited publisher abstract)
Exploring the utilization of end-of-life documentation among an online sample of sexual- and gender-minority individuals in the United States
- Authors:
- MARSACK Jessica, STEPHENSON Rob
- Journal article citation:
- Journal of Gay and Lesbian Social Services, 29(3), 2017, pp.273-279.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons often receive end-of-life care incongruent with wishes. Evidence with heterosexual samples supports associations among end-of-life documentation (do not resuscitate [DNR] orders, durable power of attorney for health care orders [DPOAH], living wills [LW]), and care consistent with wishes. However, little is known about the knowledge, attitudes, and willingness regarding utilisation of these documents among LGBTQ persons. Of 107 participants, most had heard of each document (95% DNR, 91% DPOAH, 97% LW), but had not procured them (26% DNR, 50% DPOAH, 51% LW). Answers above 4 on a 5-point Likert scale indicated willingness to pursue these documents and belief documents would be enforced. However, approximately one-third of respondents believed documents would be enforced more for heterosexual persons than themselves. This result indicates sexuality or gender minority-related stigma may be a barrier to document utilisation. Future research, policies, and guidelines should address these concerns. (Edited publisher abstract)
Effects on life satisfaction of older adults after child and spouse bereavement
- Authors:
- BRATT Anna Sofia, STENSTROM Ulf, RENNEMARK Mikael
- Journal article citation:
- Aging and Mental Health, 21(6), 2017, pp.602-608.
- Publisher:
- Taylor and Francis
Background: Few studies have compared the impact of different familial losses on life satisfaction (LS). Furthermore, there is a lack of research on the effect of having lost both a child and a spouse among older adults. Sample: A random sample of 1402 individuals, 817 women and 585 men, aged 60–96 years from the Blekinge part of the Swedish National Study of Aging and Care (SNAC-B) participated in this cross-sectional study. Aims: The first aim was to compare the effects of child or spouse or both child and spouse bereavement on LS and, the second aim, to investigate if there were gender differences within the bereaved groups. Results: The results showed that having lost a child, spouse or both child and spouse had a negative association with LS, although this effect was small. Having experienced multiple losses did not predict more variance than a single child or spouse loss. Gender differences were found within all the bereaved groups with bereaved men having lower LS than bereaved women. Longer time since the loss was associated with higher LS. Conclusions: Bereaved older adults have somewhat lower LS than non-bereaved and bereaved men seem more affected than bereaved women. Future research needs to address older men´s experiences after the loss of a loved one. (Publisher abstract)
Death wishes among older people assessed for home support and long-term aged residential care
- Authors:
- CHEUNG Gary, EDWARDS Siobhan, SUNDRAM Frederick
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1371-1380.
- Publisher:
- Wiley
Objective: Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. Methods: Data were collected from 35 734 people aged over 65 during 2012–2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. Results: Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29–2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20–2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78–3.07) had the greatest odds ratios in the full model. Conclusions: Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. (Publisher abstract)
Learning from PPO investigations: older prisoners
- Author:
- PRISONS AND PROBATION OMBUDSMAN
- Publisher:
- Prisons and Probation Ombudsman
- Publication year:
- 2017
- Pagination:
- 37
- Place of publication:
- London
This thematic review explores common findings and recommendations made by the Prisons and Probation Ombudsman at the end of investigations into the natural deaths of prisoners over 50 and identifies 13 lessons for the care of older prisoners. It highlights the increasing numbers of older prisoners, and a substantial increase of older people dying in prison resulting in the Prison Service having to tackle risks and procedures they were not previously forced to consider. The review looked at over 314 investigations between the years 2013 and 2015. It examines six areas in depth: healthcare and diagnosis; restraints; end of life care; family involvement; early release; and dementia and complex needs. It also provides one good practice case study for each area. The findings fall into three overarching themes: that prison staff should make proportionate decisions in context; for prisons to have a coordinated approach to the health care and management of older prisoners; and for prisons and healthcare staff to ensure their actions conform to local and national policies, Prison Service Orders and NICE guidelines. (Edited publisher abstract)
‘Old and ill’: death anxiety and coping strategies influencing health professionals' well-being and dementia care
- Authors:
- McKENZIE Ellen L., et al
- Journal article citation:
- Aging and Mental Health, 21(6), 2017, pp.634-641.
- Publisher:
- Taylor and Francis
Objectives: This paper examined the psychological factors that influence the well-being of health professionals who work with people with dementia and the types of care (person-centred or task-oriented) provided to these patients. Methods: The literature was reviewed to identify the factors influencing the well-being of, and types of care provided by, health professionals working with people experiencing dementia. Results: Based on their review of the literature, the authors propose that approaches to care and the well-being of health professionals working with dementia patients are influenced by the characterisation of dementia as a terminal illness that typically occurs in older people. Drawing upon terror management theory, they argue that exposure to dementia patients is likely to promote awareness of one's own mortality and death-related anxiety. A theoretical model is presented which posits that health professionals working in dementia care draw on experiential avoidance to manage this anxiety. Both death anxiety, and coping strategies, such as experiential avoidance, used to manage this anxiety may influence health professionals' approaches to care of, and attitudes towards, dementia patients. The authors also suggest a bi-directional relationship between health professionals' approaches to care and well-being. Conclusion: Recommendations are made regarding future directions for research and implications for training of health professionals providing direct service or consultation in dementia care. (Edited publisher abstract)