Making sense of a changed physical body: why gender matters at end of life

The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019

This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.

Exploring the gender dimension of problems and needs of patients receiving specialist palliative care in a German palliative care unit - the perspectives of patients and healthcare professionals

Background

Gender disparities of specific symptoms and problems have frequently been observed in palliative care patients, but research rarely focused on the range of problems and needs affected by gender.

Methods

We conducted semi-structured interviews with patients and healthcare professionals (HCPs) of a hospital-based palliative care unit to examine gender effects on patients’ problems and needs based on systematically gathered qualitative data. Content analysis was used to identify emerging themes with data coded using MAXQDA.

Results

Ten patients (5 female, 5 male) and 17 HCPs (12 female, 5 male) were interviewed. Seven categories of gender-specific problems and needs emerged: “physical symptoms, care and body image”, “psychological symptoms and emotional response”, “interaction with the palliative care team”, “use of professional supportive measures”, “activation of informal social networks”, “decision-making”, and “preservation of autonomy and identity”. Both patients and HCPs felt that female patients adopt more expressive coping strategies, have stronger need for communication with and support of HCPs, and activate an extended social network for support and decision-making. Further, both groups thought that male patients mainly rely on social support from partners, have higher expectations to be cared for at home, and have higher need for preservation of autonomy.

Conclusion

Gender relevantly impacts patients’ problems and needs during palliative care. Therefore, gender-sensitive palliative care that acknowledges the patient’s individual situation and respective ramifications are required.

Masculinity and Military Culture in VA Hospice and Palliative Care: A Narrative Review With Clinical Recommendations

This article examines the intersection between masculinity, military culture, and hospice and palliative care (HPC). The authors conducted a narrative literature review, supplemented with clinical annotations, to identify the impact of masculinity and military culture on the following topics salient to end-of-life care with older male veterans: pain management, mental health, coping, communication, autonomy and respect, and family roles. Findings suggest that traits associated with masculinity and military culture have an influence on the end-of-life process and HPC for older male veterans. Specifically, results suggest that older male veterans may deny or minimize physical pain, decline mental health treatment, utilize maladaptive coping strategies, avoid emotional conversations, struggle to manage perceived shifts in autonomy, and experience challenges negotiating changing family roles. The authors provide clinical recommendations for providers across various disciplines to address the aforementioned concerns with older male veterans in HPC. Overall, information presented in this article may be an important contribution to the literature for building cultural competencies with older male veterans and has the potential to improve the delivery of HPC for veterans and their families.

The Importance of Sex and the Meaning of Sex and Sexual Pleasure for Men Aged 60 and Older Who Engage in Heterosexual Relationships: Findings from a Qualitative Interview Study

That many older individuals continue to engage in various forms of sexual expression well into later life is now well established in the literature. To date, however, only a small body of qualitative research has examined older men's experiences and understandings of sex in later life. Likewise, the ways in which older men's discussions on sex may be used as an avenue for "doing" masculinity remain underexplored. Older men are particularly interesting in this regard, as they inhabit an increasingly subordinated position in relation to hegemonic masculine ideals because of their age. To what extent might this limit or, alternatively, open up the possibilities for sexual expression and subjectivity in later life? Drawing on a subset of findings from Sex, Age, and Me: A National Study with Australian Women and Men Aged 60 and Older, data from qualitative interviews with 27 Australian men were explored in this article. The first Australian study of its kind, we argue that older men who engage in heterosexual relationships draw on a diverse and complex array of discursive positions regarding sex, relationships, and masculinity in making sense of their experiences of sex in later life. Older men are a heterogeneous group, and their experiences and understandings of sex do not simplistically follow "decline" or "success" narratives of aging. The findings of this research build upon and extend emerging research illustrating the centrality of intimacy to older men's sexual lives, while simultaneously highlighting the ways in which the body and discursive constructions of sex intersect to shape older men's sexual subjectivities.

Changing Attitudes Toward Euthanasia and Suicide for Terminally Ill Persons, 1977 to 2016: An Age-Period-Cohort Analysis

Several longitudinal studies show that over time the American public has become more approving of euthanasia and suicide for terminally ill persons. Yet, these previous findings are limited because they derive from biased estimates of disaggregated hierarchical data. Using insights from life course sociological theory and cross-classified logistic regression models, I better account for this liberalization process by disentangling the age, period, and cohort effects that contribute to longitudinal changes in these attitudes. The results of the analysis point toward a continued liberalization of both attitudes over time, although the magnitude of change was greater for suicide compared with euthanasia. More fluctuation in the probability of supporting both measures was exhibited for the age and period effects over the cohort effects. In addition, age-based differences in supporting both measures were found between men and women and various religious affiliations.

Preserving Dignity in Later Life

Cet article examine comment les personnes âgées qui recoivent l’aide sociale dans la communauté subissent une perte de la dignité et comment ils conservent leur dignité. La recherche qualitative a révélé que la perte de dignité est une préoccupation majeure pour ces aînés, et qu’ils conservent leur dignité de differentes manières, variant de s’engager activement à la vie jusqu’à s’en détacher. Nous concluons que, dans la vie plus tard, la préservation de la dignité tout en recevant des soins sociaux diffère de conserver la dignité dans le contexte des soins de sante, en particulier les soins de santé fournis dans un cadre institutionnel. En outre, conserver la dignité en fin de vie, tout en recevant des soins sociaux, est un processus complexe, qui dépend non seulement de l’exécution des activités et la prise des actions individuelles et de leurs responsabilités, mais aussi d’autres actions, dont certaines impliquent une certaine inactivité/passivité, ainsi qu’interagir avec les autres, surtout les soignants. Cet article propose meilleures politiques et pratiques pour la promotion de la dignité des personnes âgeés dans le contexte de la protection sociale à base communautaire.