Living, loving, dying: Insights into rural compassion

Objective:To improve understandings of the enablers and barriers to maintaining good quality of life for people dying, caring and grieving in rural areas.Design and setting:In‐depth interviews designed on participatory research principles were held with bereaved carers living in a small community in rural Tasmania. Participants had cared for someone until their death within the 3‐year period prior.Participants:Nineteen participants comprising 18 bereaved former carers and one person with a life‐limiting illness, and all but four were over retirement age.Study aim:To explore experiences of end‐of‐life care in a rural community.Results:Participants discussed the challenges they experienced during end‐of‐life caring, including transport into the city for treatment, and access to basic and specialised services. However, they also reported positive aspects of formal and informal palliative care, and described experiences of personable, expert, flexible and innovative caregiving.Conclusions:The rural location enabled personalised and innovative expressions of care. This research adds new insight into rural end‐of‐life palliation, as a complex intersection of supererogation, innovation and place‐driven care

Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches

PURPOSE: To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS: A narrative overview. RESULTS: The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/CONCLUSION: Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments