Older people's attitudes towards death in England

Advance Care Planning in Norwegian nursing homes-Who is it for?

Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations.

Preferences on End-Of-Life Decisions Among Older Chinese in Macau

Purpose: The purpose of the present study was to learn about the perspectives on end-of-life decision making among older Chinese people in Macau. Method: A qualitative approach was used, and interviews were conducted with 18 Chinese aged 65 years or older. Results: Four major themes were identified: (a) institutionalized care at the end of life was preferred as not to be a burden on family, (b) life-prolonging measures were not preferred, (c) funeral arrangement preferences were based on personal and religious beliefs, and (d) end-of-life decision making would be deferred to others. Discussion and Conclusions: These themes provide an understanding of personal preferences of older Chinese on end-of-life issues, and personal preferences are always secondary to their respect toward family and medical doctors. This compliance with family and medical authority can be understood through Chinese cultural beliefs. Implications for Practice: Knowledge of cultural influences is needed for nursing professionals to deal effectively with older adults and families regarding end-of-life issues.

Discrepancies between direct and indirect measures of death anxiety disappear in old age

Mixed findings have been reported on the relationship between death anxiety and aging. However, practically all research on death anxiety is based on self-report measures, reflecting conscious consideration. The aim of this study was to investigate death anxiety in young and middle-aged versus elderly adults using a psychometrically sound questionnaire as a direct measure and an emotional variant of the Stroop task as an indirect index of death anxiety. We found no difference between the age groups based on the questionnaire, whereas the Stroop results revealed interference of death-related words only for the younger age group. The absence of a discrepancy between direct and indirect measures in old people could be indicative of genuine acceptance of the inevitability of their own death.

Mesothelioma from the Patient's Perspective

This study reports findings from qualitative semi-structured interviews with 15 patients who suffered from mesothelioma. The results are described under four headings that reflect the main themes that arose from the data: coping with symptoms (particularly breathlessness and pain), finding out about mesothelioma and its implications, the trauma of medical interventions, and psychosocial issues. The results illustrate the severe disease burden that is borne by people who have mesothelioma. It is hoped that a greater understanding of mesothelioma from a patient's perspective could inform the response of health care professionals.