Last Stage Of Life Research Articles

The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study.

Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Spatial Vortices in The Qur'an and Modern Science

Atmospheric vortices are one of the new issues that have attracted the attention of scientists today. The Holy Qur'an refers to atmospheric vortices in the first verse of Surah Takweer as the extinguishing and wrapping of the sun, in the eighth verse of Surah Qayamat as the dimming of the moon, in the first verse of Surah Najm, the eighth verse of Surah Mursalat and the second verse of Surah Infatar is mentioned as fading, darkening and scattering and collapsing of heavenly lights and stars. One of the types of death of stars is turning into vortices and black holes; Vortices are one of the most important astronomical phenomena that occur after the death of large stars. Vortices and black holes are the strangest objects in the world that do not reflect any light and do not bring us information; In addition, most vortices and black holes are the last stage of life of the brightest stars in the world; The main goal of this research is to explain the existence of the problem of spatial vortices in the Qur'an and compare it with modern science. What adds to the importance of this research is encouraging readers and researchers of today's world to study the Holy Quran and inviting them to discuss the issues of the day. The chosen method in this research is a library and analytical one, which first quotes Quranic verses from authentic books of interpretations and other books of modern science, then analyzes those verses and the ideas of scientists and the works and benefits derived from it. And it has been pointed out.

Communication Gaps in Georgian Palliative Medicine: Ethical and Legal Review

Introduction: Difficulties in communication, decision-making, and end-of-life management have emerged in the implementation of palliative care in recent decades. The imperfection of ethical issues was also highlighted. This fact is confirmed once again by a study conducted by the oncology department of the Batumi High-technology Hospital, which aimed to study the adequate perception of existing oral pathologies by patients under palliative care and their impact on the quality of life.
 Aim: We aimed to discuss the mentioned problem within the framework of bioethics and Georgian legislation.
 Methods: Despite the few amount of literary sources, we tried to discuss the mentioned issue based on Georgian legislation and also existing literature.
 Conclusion: Thus, as we mention in medical activities there are cases when the real diagnosis is not told to the patient for ,,his favor'', also there are cases when an inappropriate diagnosis is made, which can lead the patient to a fatal condition. In this case, the patient can civilly protect his rights.
 The best option is to provide the patient with information in the correct form so that it does not mean the end of the world and does not cause depression in him. The patient should be able to pass the last stage of life peacefully and with dignity.

Estudio comparativo de los problemas de convivencia entre personas mayores institucionalizadas versus aula de mayores

Institutionalized centers have become one of the most demanded alternatives as a home in which to spend the last stage of life due to the resources and services they offer. Traditionally, bullying among peers has been confined to the school environment; however, it is increasingly being shown that this phenomenon also occurs in other contexts. In this sense, several investigations have focused their attention on the phenomenon of bullying among older people. That said, the aim of this study was to compare bullying problems among users belonging to institutionalized centers with students in a classroom for the elderly. Participants were N = 80 elderly people (M = 73.23 years; SD = 11.18) with 63.7% being female. The Bullying Questionnaire adapted to Spanish was administered together with an ad hoc questionnaire to collect the sociodemographic characteristics in both groups. The results show a higher incidence of bullying in institutionalized centers, with social and verbal bullying being more common than physical bullying and cyberbullying. The conclusions revolve around the need to create bullying prevention and intervention programs among the elderly in community settings to improve their quality of life and promote active aging.

Artificial Intelligence Decision Support Tools for End-of-Life Care Planning Conversations

Why Is This an Issue?
 
 End-of-life care provides support for patients and their families during the last stage of life. End-of-life conversations aim to help people better understand their disease prognosis and expected survival, enabling them to make informed decisions regarding end-of-life care.
 Palliative care focuses on relieving symptoms and improving quality of life for patients with serious or life-threatening diseases. Approximately 89% of patients with life-limiting diseases, such as cancer, can benefit from palliative care. However, not all patients receive it in a timely manner.
 Due in part to prognostic uncertainty and optimism bias, end-of-life planning conversations and palliative care decisions do not occur early enough to have maximum benefit. Interventions that aim to prompt or help identify those patients who can benefit from palliative and/or end-of-life planning could improve the quality of care.
 
 What Is the Technology?
 
 An artificial intelligence (AI)–based “nudge” is a decision-making support tool that uses prompts and alerts to aid clinicians in deciding whether and when to discuss end-of-life planning with patients.
 The nudge sends alerts and/or reminders to clinicians to prompt end-of-life conversations with patients who are at high risk of short-term mortality. These patients are identified by machine learning mortality prediction algorithms incorporated in the electronic health record (EHR) system.
 Two AI-based nudges designed for patients with cancer were identified. Both tools were developed and internally validated in the US.
 
 What Is the Potential Impact?
 
 AI-based nudges have the potential to increase the number of end-of-life planning conversations between clinicians and patients as well as the number of referrals to end-of life services.
 Implementing the nudges into clinical workflows could also help clinicians more easily identify patients with palliative care needs.
 
 What Else Do We Need to Know?
 
 No AI-based nudges have been approved for use in Canada at the time of this writing nor have there been validation studies using Canadian data.
 As with many AI algorithms, there is uncertainty about the validity and generalizability of the mortality predictive algorithms used in the nudges.
 The acceptance of AI-based nudges by clinicians is unclear due to varying clinician attitudes and experiences with nudges and because we did not identify any studies that reported the experience of AI-based nudges from the patient perspective.

Migration Decisions in the Fourth Age: The Case of East Asian Retirees in Thailand

ABSTRACT Previous studies have not amply explored the next move of older adults currently spending their retirement abroad. This paper examined the future migration decisions of East Asian retirees in the last stage of life marked by frailty, dependency, and abjection (i.e. the fourth age). A survey of Chinese and Japanese retirees in Thailand (n = 204) was conducted during 2019–2021. Binary logistic regression analysis indicated that age, income, religion, residence, Thai spouse/partner, and property at origin were significantly associated with future migration decisions (p < .05). Future research and policymaking should enhance Thailand’s capacity to facilitate fourth age living.

BPIFB4 and its longevity-associated haplotype protect from cardiac ischemia in humans and mice

Long-living individuals (LLIs) escape age-related cardiovascular complications until the very last stage of life. Previous studies have shown that a Longevity-Associated Variant (LAV) of the BPI Fold Containing Family B Member 4 (BPIFB4) gene correlates with an extraordinarily prolonged life span. Moreover, delivery of the LAV-BPIFB4 gene exerted therapeutic action in murine models of atherosclerosis, limb ischemia, diabetic cardiomyopathy, and aging. We hypothesize that downregulation of BPIFB4 expression marks the severity of coronary artery disease (CAD) in human subjects, and supplementation of the LAV-BPIFB4 protects the heart from ischemia. In an elderly cohort with acute myocardial infarction (MI), patients with three-vessel CAD were characterized by lower levels of the natural logarithm (Ln) of peripheral blood BPIFB4 (p = 0.0077). The inverse association between Ln BPIFB4 and three-vessel CAD was confirmed by logistic regression adjusting for confounders (Odds Ratio = 0.81, p = 0.0054). Moreover, in infarcted mice, a single administration of LAV-BPIFB4 rescued cardiac function and vascularization. In vitro studies showed that LAV-BPIFB4 protein supplementation exerted chronotropic and inotropic actions on induced pluripotent stem cell (iPSC)-derived cardiomyocytes. In addition, LAV-BPIFB4 inhibited the pro-fibrotic phenotype in human cardiac fibroblasts. These findings provide a strong rationale and proof of concept evidence for treating CAD with the longevity BPIFB4 gene/protein.

JIGSAW PUZZLE GAME GROUP ACTIVITY THERAPY TO IMPROVE ELDERLY SOCIAL INTERACTION ABILITY IN LOK BAINTAN VILLAGE IN RT 02, BANJAR DISTRICT

Old age is the last stage of life that humans go through, where at this time a person experiences physical, mentally, and social decline little by little so that he cannot carry out his daily tasks anymore (declination stage). Feelings of inferiority experienced by the elderly result in the elderly feeling inferior and reduced in their social interactions. Lack of social interaction can lead to feelings of loneliness in the elderly. Loneliness is a feeling of discomfort associated with a desire to have more contact with other people. The consequences of feeling lonely can cause stress, depression, and an unstable mental status. Based on the results of a survey conducted by our group in the village of Lok Baintan Dalam RT 02, there are many elderly people who have experienced a decrease in their social interactions and most of the elderly just stay silent in their respective homes. The service activities that we do to overcome the problems of social interaction in the area are by doing jigsaw puzzle group activity therapy (GAT). Jigsaw puzzle therapy is carried out because in this game it can train cooperation, thinking skills, train coordination between the elderly, train reason, and also patience. The results of this service activity after the GAT was carried out, the ability of the elderly's social interaction increased as evidenced by the results of the social interaction questionnaire which showed the results of the social interaction of the elderly in the area in the good category

Art-Based Learning in the last stage of life: An exploratory study on how cancer patients create meaning in relation to artworks

Art-Based Learning in the last stage of life: An exploratory study on how cancer patients create meaning in relation to artworks

Student nurses' knowledge of and attitudes toward palliative care in the Middle East: an integrative review

Palliative care is one of the most important areas of practice because it includes caring for vulnerable people who are mostly in their last stage of life. Palliative care is a relatively new specialty in the Middle East and little is known about student nurses' knowledge of and attitudes towards it. The aim of this study was to explore students' knowledge of and attitudes towards palliative care in the Middle East, and to use the findings to make recommendations to higher education institutions about its importance. An integrative review following an established framework was used. Hawker's Assessment Tool was employed to evaluate the quality of the research articles. The search found seven quantitative studies from four countries in the Middle East. Their focus was on students' knowledge (n=5) and attitudes (n=2). The number of participants ranged from 110 to 452, with knowledge scores ranging from 5.23 to 8.0 out of 20 on all or part of the Palliative Care Quiz for Nursing. Students' attitudes were marginally positive toward palliative care and dying patients. There are few studies in the Middle East investigating student nurses' knowledge of and attitude toward palliative care; consequently, more attention needs to be given to this area of practice.

The time of agony, know, understand to inform and explain

The agony, this pivotal moment, which is more or less long, before death, is very anxiety-provoking. When the person and his or her loved ones want this last stage of life to take place at home, healthcare professionals play an important role in providing clinical support to the patient and creating the conditions for relative emotional security for everyone. This requires clinical knowledge and interpersonal skills to explain what is happening to loved ones, to reassure them and to accompany the life that is passing away. A nurse referent in palliative care sheds light on the challenges of this specific multi-professional practice at home.

THE RELATION BETWEEN DEATH PREPARATION AND LIFE SATISFACTION AMONG KOREAN OLDER ADULTS

Abstract Objectives There is a growing interest in death preparation as an important process to achieve ego integrity at the last stage of life. However, in South Korea, conversations about death remain taboo especially with older adults. Thus, this study aims to examine the association between preparation for one’s death and life satisfaction among Korean older adults. Methods Data for this study were drawn from the 2020 National Survey of Older Koreans conducted by the Korean Ministry of Health and Welfare. The sample was limited to adults aged 65 and older (N=10,097). The survey measured preparation for death, life satisfaction, and various covariates (e.g., sociodemographic characteristics, physical conditions, psychological conditions). Hierarchical multiple regression analysis was used to examine whether death preparation influences life satisfaction among Korean older adults. Results Results from hierarchical multiple regression showed that after adjusting for covariates, those who reported more preparations for death mentally (B=.054, p&amp;lt;.001) and materially (B=.035, p&amp;lt;.001) were more likely to have greater satisfaction in life than their counterparts. Conclusion Findings suggest that it is necessary to generate proper information and recognition about death at the government level and activate discourses on death preparation in later life.

Comparing the Perceptions of Operating Room Technicians and Nurses Regarding Futile Care: A Cross-Sectional Study

Background. The growing trend of useless care might lead to negative consequences for patients, staff, and the organization. The employees who care for patients in their last stages of life for a long time might not tend to pay enough attention to the patients' pain. As a result, the quality of care services might be negatively affected. This study aimed to compare the perceptions of operating room technicians and nurses regarding futile care in the selected hospitals in Hamadan province, Iran from October to December. Methods. Using available sampling method, the present descriptive cross-sectional study was performed on 200 health care workers (114 nurses and 86 operating room technicians). Data collection tools included a two-part demographic information questionnaire and the perception of futile care designed based on the Corley’s Moral Distress Questionnaire. The questionnaires were distributed in person and electronically. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. We used frequency, mean, and standard deviation for descriptive statistics and independent t-test and analysis of variance (ANOVA) for analytical statistics. Results. The mean score of nurses' perceptions regarding futile care was significantly higher (16.53±6.18) than that of operating room technicians. While the nurses' perceptions of futile care in both dimensions of intensity (66.71±13.72) and repetition (60.03 13 13.72) were at a high level, the perceptions operating room technicians in both dimensions of intensity (50.19±18.90) and repetition (52.43±18.8) were at an average level. Conclusion. Nurses seem to have a relatively better understanding of futile care compared to operating room technicians. This is probably due to frequent contacts with patients overlooking death, as well as direct contacts with their family and relatives. In this regard, it is essential to develop guidelines in Iran delimiting the standards for the staff’s provision of futile care.

Cause and place of death in Norwegian nursing home residents.

Nursing home (NH) residents are in their last phase of life, and two aims of the NH's medical care in Norway is to prevent unnecessary hospital admissions that would not benefit the resident and to facilitate a peaceful death in familiar surroundings when the time comes. However, little is known about the share of residents dying in NHs and the causes of death. We therefore evaluated the cause and place of death in a cohort of NH residents followed from the time of NH admission until death. NH residents were followed from admission to the NH and over the entire course of their NH stay. Demographic and clinical data were collected. Cause and place of death were retrieved from the Norwegian Cause of Death Registry. Of 1283 residents, 6.2% died in hospital and 91.2% in a NH. Those who died in hospitals were more often male, died sooner after NH admission, had a less severe degree of dementia and had poorer general health. Dementia was the most common underlying cause of death, followed by cardiovascular disease. Dementia is one of the main causes of death in NH residents. In addition, our findings indicate a low number of inappropriate referrals to hospital during the last stage of life. However, further research should explore whether the terminal phase of NH residents is formed in accordance with their preferences and whether appropriate palliative care is offered.

MODERN APPROACHES TO UNDERSTANDING OLDER PEOPLE AS A PECULIAR SOCIAL GROUP

Global aging trends, which are characteristic of Ukraine as well, lead to an understanding of the specific characteristics of older people. Based on the analysis of modern Ukrainian and international literature, this paper systematizes modern scientific views on the elderly as a special social group.Demographic, psycho-physiological, and sociological concepts related to ideas about old age, aging, and age limits of older people are characterized. In demography, older people are persons aged 60 years and older. At the same time, current documents of EU and other international organization stress that it is impossible to determine the fixed beginning of old age, because it depends on the individual characteristics of a person and many external factors that can slow down this process.From the point of view of physiology, older persons are characterized by involutive aging processes, which lead to a reduction in the functioning of the body and a higher need for external assistance (dependency on assistance). Psychological representations are based on the fact that elderly people are at the last stage of life, which is characterized by the search for the meaning of their life and reevaluation of achievements, who need self-affirmation and who self-identify with old age. Sociological ideas about the elderly are focused on singling out these people as a separate social group, which are characterized by a reduced social status, certain sociocultural roles and which require adjustments for communication with other groups in society.It was determined that an integrative definition of old age derived from socio-age status and identity is essential for social work. Social workers have to appreciate that individuals who usually experience a change in their own social environment have the same rights as other people and at the same time need respect for their choices, quality care and support

Hospitalisations of patients with cancer in the last stage of life. Reason to improve advance care planning?

The aim of this study is to examine why patients are hospitalised in the last stage of life. Our study was conducted in a large Dutch teaching hospital. We conducted a retrospective chart review of patients aged ≥18 years who died of cancer either during hospitalisation or after discharge to receive terminal care outside the hospital. We collected data about the characteristics of these hospitalisations and indicators of advance care planning. Of the 264 deceased patients, 56% had died in the hospital and 44% after hospital discharge. Of all patients, 80% had been admitted to the hospital because of symptom distress. Dyspnoea (39%) and pain (33%) were the most common symptoms. Most patients underwent diagnostic procedures (laboratory tests [97%] and radiology tests [91%]) and received medical treatment (analgesics [71%] and antibiotics [55%]) during their hospitalisation. A 'Do-Not-Resuscitate' code had been recorded before admission in 42% of the patients and in an additional 52% during admission. Our study shows that patients with cancer in the last stage of life were mainly admitted to the hospital because of symptom distress. Some hospitalisations and in-hospitals deaths may be avoided by more timely recognition of patients' impending death and start of advance care planning.

Awareness and expectations of visitors to family medicine practices about palliative care in Slovenia

Purpose: In Slovenia, palliative medicine and care are developing more intensively in the last years. Appraisal of the existing evidence on, expectations in, and awareness about palliative care (PC) in Slovenia is essential to inform the emerging practice and future research.&#x0D; Methods: A cross–sectional survey of 2000 individuals aged over 18 years old was performed. Information was collected using a structured questionnaireconsisting of 18 items. Analysis of the questions is presented using descriptive statistics. The significance level was set at p ≤0.05 in all analyses.&#x0D; Results: 58.6% of participants report having little awareness of PC, with most information received via media (radio, TV, internet) and experience obtaineddirectly or through family and friends. In this sample, increasing age, being female and higher levels of education were related to higher reported levels of awareness of PC. 69.6% of our participants said they wish to die at home. According to our participants, patients at home need, their physical symptoms be well controlled (93.8%), followed by medical and health care (65.9%), and support from voluntary carers (41.4%) and they also highlighted the wish of relatives and patients to be consulted via telephone by a health care providers in case of problems (55.4%). 28.4% confirmed they know the advance healthcare directive form.&#x0D; Conclusion: The survey data presented here provides an empirical basis from which we can begin stimulating discussions about death, dying and support empowered decision–making, as confronting end of life issues is inevitable for us all. All patients have the right to dignity and peace through their last stages of life.

CAUSES AND CONSEQUENCES OF AGE DISCRIMINATION - AGEISM OF THE ELDERLY IN THE INSTITUTIONAL SPACE

The presented professional article is devoted to the analysis of social aspects of the situation of elderly people in modern society. Its aim is to bring new knowledge about the quality of life and status of the elderly in Slovakia and Ukraine based on the analysis of this issue and to point out the causes and consequences of age discrimination of ageism in the institutional space (in social services for the elderly in Slovakia and Ukraine). The introduction of the article is the theoretical basis of the research, through which the author characterizes the period of aging and defines such concepts as population aging, quality of life, as well as the concept of ageism and others. It also describes the social services provided in the framework of social work in Slovakia and Ukraine (institutional care and pension scheme).The main tasks of a social worker in social work with the elderly are also revealed. One of them is the provision of appropriate professional assistance and care based on mutual trust, respect, empathy and respect for the point of view and needs of older people. The main starting point is respect for the person, which in principle does not change with illness, age or other factors. The social worker's competencies in caring for the elderly depend on the specific area of services in which the social worker works.It was found that social work with the elderly is based on a broader social context and ethical principles, which consists of a set of specific professional activities and services, designed for the elderly.The next part is discovering factors of internal and external environment, subjective and objective, which can be further classified into medical, psychological or socio-economic. The purpose of active preparation for elder age is to go through the last stage of life in the best physical and mental condition.Attention is drawn to the fact, that modern society perceives old age mostly negatively, which in turn leads to the fact that this negative vision in many cases is integrated into the minds of older people. Age discrimination is increasingly associated with health care or social services. The aim of this work was to draw attention to ageism in social work in the context of the scientific achievements of Slovakia and Ukraine. At the same time, we tried to pay attention to how social workers can contribute to the comprehensive rehabilitation of the elderly in the context of psychological and social impacts on the elderly in the paradigm of rejection of ageism.

ELDERLY PEOPLE LIVING IN OLD AGE HOMES IN MADURAI DISTRICT

Ageing has been defined as the total constellation of social, biological and psychological changes that occur in the last stage of life. Ageing of the population is one of the most important demographic factors that have emerged in the 21st Century. Old age is the closing period of the life span. It is a period when people ‘move away’ from previous more desirable periods or times of ‘usefulness’. Old age homes are a boon to those who do not enjoy the support of their children or have nobody to take care of them. At least old age homes provide them shelter, food and company. But definitely, nothing can compensate for living with affectionate children and grandchildren. The objectives of the present study are as follows: i) to understand the socio-economic conditions of inmates of old age homes in the study area, ii) to find out the living conditions of inmates of the old age homes in the study area and iii) to understand the reasons behind the joining of the respondents in old age homes in the study area. This study is based on primary data. The data were collected from Madurai District. There are 30 registered old age homes in Madurai district. From each home, 10 respondents have been selected by adopting a systematic sampling technique. The researcher has selected 300 respondents for this study. Average, Simple Percentage, Weighted Arithmetic Mean and factor analysis are used to analyze the collected data.

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective.

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong’s integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic—in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel.