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Go gentle into that good night: the past, present, and future of end-of-life care
- Author:
- SINGER Adam E.
- Publisher:
- Rand Corporation
- Publication year:
- 2015
- Pagination:
- 382
- Place of publication:
- Santa Monica, CA
This dissertation examines the past, present, and future of end-of-life care in order to shed light on the most effective ways to organise and deliver it. End-of-life care has received increasing attention in recent years as the baby boomers age and health care costs continue to rise. This attention has brought with it remarkable growth in the field and improvement in care, but there remains work to be done in order to more consistently deliver high quality, compassionate, and patient- and family-centred end-of-life care. The paper presents the results of a cohort study into the symptom trends in the last year of life, 1998‐2010. It then summarises the findings of a systematic review of populations and interventions for palliative and end‐of‐life care and looks at the evidence on estimating the value of palliative care for older adults. (Edited publisher abstract)
Dying in the Age of Choice
- Authors:
- BLACK Kathy, CSIKAI Ellen L.
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 11(1), 2015, pp.27-49.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Due to the unprecedented increase in the United States ageing demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing. Requests for a hastened death can occur among people of all ages and includes those with advanced illness as well as others wanting to die due to unbearable suffering. This article provides an overview of the ongoing discourse about the experience of dying faced by many older adults, including aspects frequently associated with “a good death.” The limitations of established practices which seek to provide a “better” dying experience are identified followed by discussion of the growing availability of alternative options. Reflective considerations are presented to guide practice vis-à-vis the changing landscape surrounding options in dying. (Edited publisher abstract)
Hospice enabled dementia care: the first steps
- Author:
- HOSPICE UK
- Publisher:
- Hospice UK
- Publication year:
- 2015
- Pagination:
- 51
- Place of publication:
- London
This is a guide to assist hospices consider their contribution as local players in the provision of care for people living with, and affected by, a diagnosis of dementia. It explains why dementia care is an increasingly important strategic consideration for palliative and end of life care providers including hospices and considers the degree to which the hospice sector has started to acknowledge the dementia challenge. The document examines the principles underpinning high quality care for people with dementia, their families and carers, and the specific strengths of hospices in taking forward this agenda. The guide sets out what hospices must do to support people with dementia, their families and carers, focusing on: a corporate commitment to reach out to people affected by dementia; a collaborative approach to the development of services and skills in response to the needs of people affected by a diagnosis of dementia; a creative approach to adapting existing models of care to meet new needs and preferences; an evidence-based approach to care and the care environment; and investment in the development and support of its workforce (staff and volunteers). A selection of resources to help hospices achieve high quality care for people with dementia, their families and carers is also included. (Edited publisher abstract)
Palliative care in your nursing home: program development and innovation in transitional care
- Author:
- GIUFFRIDA Jennifer
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 11(2), 2015, pp.167-177.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Each year in the United States, 31% of elders who die do so in hospitals, accounting for over half a million deaths often involving expensive and unnecessary treatments (Zhao & Encinosa, 2010). Re-hospitalisations of frail elders with end-stage illnesses are a concern for the hospitals that have discharged them and for the facilities in which they live. In 2011, Schervier Nursing Care Center, a 364-bed skilled nursing and rehabilitation facility in the Bronx, NY, looked at its re-hospitalisation rates. It was discovered that a large percentage of the residents being sent to the hospital were from the long-term and subacute populations with end-stage diseases that were no longer responding to treatment. This article describes the development of two innovative programmes whose goals were to increase the number of residents receiving palliative care, increase the number of completed advance directives, reduce re-hospitalisations, and increase hospital referrals to the nursing home for palliative care. The key components of both programmes and their outcomes are described. The development and implementation of these programmes were the author's capstone project for the Zelda Foster Social Work Leadership Fellowship in Palliative and End-of-Life Care. (Edited publisher abstract)
Living in the end times: a short course addressing end of life issues for older people in an English parish church setting
- Author:
- COLLICUTT Joanna
- Journal article citation:
- Working with Older People, 19(3), 2015, pp.140-149.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to report a pilot study that evaluated an innovative practice in a faith community context designed to help older people live well at the end of life and prepare for death. Design/methodology/approach: A simple audit of the intervention using a contemporaneous journal kept by the author, and a follow up questionnaire completed by participants. Findings: Rich findings on the process are reported. These indicate a high degree of engagement by participants, the establishment of a high degree of group intimacy and trust, a high level of articulation of wisdom, the emergence of significant anxiety in some isolated cases, and the use made of tea and cake to manage the transition between the existentially demanding nature of the discussions and normal life. The outcome indicated very high levels of appreciation and increased confidence in relation to issues of death and dying. Practical implications: The findings of the pilot have been used to inform training of clergy in the principles of working in this area (e.g. in ways of managing group dynamics and anxiety, pacing, tuning in to archetypes and the natural symbols that people use to talk about death and dying, self-care and supervision of the programme leader/facilitator). Originality/value: The paper adds to knowledge in terms of an in depth description of processes at work in a group of older people working on spiritual and practical issues in relation to death, and offers ideas for supporting older people in this process, some of which are specific to the Christian tradition, and some of which are more widely applicable to people of all faiths and none. It gives a specific worked example of what “spiritual care” in this area might look like. (Publisher abstract)
The positive association of end-of-life treatment discussions and care satisfaction in the nursing home
- Authors:
- REINHARDT Joann P., BOERNER Kathrin, DOWNES Deirdre
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 11(3-4), 2015, pp.307-322.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
With the progression of dementia, the need for families and health care providers to have discussions about end-of-life (EOL) treatments arises. EOL treatment decisions often involve whether or not medical interventions intended to prolong life—such as resuscitation, artificial nutrition and hydration, and use of antibiotics—are desired. It is unclear if family satisfaction with care in the nursing home may be associated with involvement in EOL treatment discussions. The frequency of discussions that family members reported having with health care team members regarding multiple life-sustaining treatments and symptom management for their relatives with advanced dementia were examined over a 6-month period along with the association of these particular discussions with care satisfaction over time. Results showed that greater frequency of discussion of EOL treatment wishes was positively associated with higher care satisfaction scores among family members of nursing home residents with dementia. When considered together, greater frequency of discussion of artificial hydration was uniquely associated with greater care satisfaction and increased care satisfaction over time. Social workers must ensure that EOL treatment discussions with older adults in the nursing home and their family members take place and that preferences are communicated among the various interdisciplinary health team members. (Publisher abstract)
Quick guide: clinical input into care homes
- Authors:
- NHS ENGLAND, et al
- Publisher:
- NHS England
- Publication year:
- 2015
- Pagination:
- 9
- Place of publication:
- London
This quick guide comprises case studies, ideas and practical tips on how to improve the clinical care for people living in care homes for commissioners and providers. Residents in care homes often experience difficulties accessing the right care at the right time. Improving the clinical input into a home and tailoring care around the diverse needs of individual residents can improve the quality of care and quality of life for people, and reduce unnecessary hospital admissions. Focusing on care home settings, the guide explains: how to build effective relationships with health and care systems and commissioners; how to make best use of a multidisciplinary team; how to enhance nursing and therapies; how to improve general practice input; how to manage medicines; how to support people with dementia; how to improve oral health, hydration and nutrition; how to improve end of life care; how to harness technology; and how to promote mental health and wellbeing. (Edited publisher abstract)
Practicing end-of-life conversations: Physician Communication Training Program in Palliative Care
- Authors:
- RUCKER Bronwyn, BROWNING David M.
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 11(2), 2015, pp.132-146.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
A Physician Communication Training Program (PCTP) utilising scripts based on actual family conferences with patients, families, and the health care team was developed at one medical centre in the Northeast. The programme was designed, adapted, and directed by a palliative care social worker. The primary goal of the programme is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning. The scripts focus on improving physicians’ basic skills in conducting family meetings, discussing advance directives, prognosis, brain death, and withdrawal of life support. Excerpts from the scripts utilised in the programme are included. Feedback from participants has been positive, with all respondents indicating improvement in their capacity to take part in these challenging conversations. (Edited publisher abstract)
Social work practice with LGBT elders at end of life: developing practice evaluation and clinical skills through a cultural perspective
- Author:
- ARTHUR Darren P.
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 11(2), 2015, pp.178-201.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programmes, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues. (Edited publisher abstract)
The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality
- Author:
- NATIONAL HEALTH SERVICE. Right Care
- Publisher:
- Public Health England
- Publication year:
- 2015
- Pagination:
- 277
- Place of publication:
- London
This publication uses maps to show the variation in health care for a variety of conditions across England and Wales. The maps are accompanied by commentary on the background context, scale of variation and options for action. Conditions covered include: care of mothers, babies, and children and young people; mental health problems; dementia; care of older people; end of life care; and learning disabilities. Twenty one of the indicators are also presented by local authority area. The Atlas also highlights the work being done by Right to Care to support anyone wanting to reduce unwarranted variation of health care provision within their locality or between their locality and other areas of the country. (Edited publisher abstract)