Dying in the Age of Choice

Due to the unprecedented increase in the United States aging 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

Ethical Problems in End-of-Life Care Decision Making Faced by Oncology Social Workers and the Need for Practice Guidelines

Difficult ethical problems are often faced by patients, families, and social workers who assist in decision-making around issues regarding end-of-life care. In qualitative interviews with 12 hospital social workers in one large urban cancer center, common ethical issues identified through thematic analysis were preservation of patients\u27 autonomy/self-determination, beneficence of health care providers, and medical futility of end-of-life treatments. Continued communication with all parties involved was key in resolving ethical problems. Discussion, along with referrals of more complex cases to ethics committees and ethics consultation teams, also occurred. Participants further indicated the potential helpfulness of developing practice guidelines for social workers dealing with decision making about end-of-life care

Advance Care Planning in the Delivery of Adult Protective Services

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed

Bereavement services for Hispanics: an exploratory study of Florida hospices

Hispanics are the fastest growing minority group in the United Sates, numbering over 42 million and making up 15% of the total population. Hispanics are a diverse, intricate, and heterogeneous group that experiences various disparities in health care, including care at the end of life. One specific area, bereavement care, has received minimal attention in the literature, and previous national bereavement studies have not discussed ethnic variations related to the provision of bereavement services. This exploratory study, conducted in Florida, was undertaken to address existing policy, research, and practice gaps regarding bereavement services available to Hispanics. An on-line survey was developed to explore five research questions that centered on bereavement services offered by hospice agencies, bereavement coordinators' perceptions about the needs of Hispanics, and the strengths and challenges of hospice agencies when offering bereavement services to Hispanics. The sample consisted of all hospice bereavement coordinators in Florida. Initial contact was made by telephone to solicit participation and confirm contact information. An electronic survey was responded to by 73% (n = 30) of the total state sample. Results of this study reveal language and cultural barriers as major challenges in communicating with Hispanics and in offering and delivering bereavement services. Embedded within these challenges were reports by bereavement coordinators of the lack of Spanish-speaking personnel available to provide bereavement services. Additionally, results disclose that the number of Hispanics participating in bereavement services was much lower than the estimated number of potential Hispanic families and individuals eligible to participate in these services. Referrals to religious and spiritual support systems were considered an important referral source for Hispanics in bereavement agencies. Implications for social workers include the need to increase access to and the effectiveness of bereavement services for Hispanics through efforts in research, policy, and practice. Social work practitioners and researchers need to focus on the creation of instruments and processes for tracking bereavement services, and establishing practice standards for bereavement services. Needed policy efforts include advocating for more attention to the bereavement needs of Hispanics in state and national venues in addition to securing funds for creating grass-roots interventions. (Published By University of Alabama Libraries

Long-term survival among individuals diagnosed with end stage renal disease: an exploratory study

your words (Published By University of Alabama Libraries