[Guidelines for estrogen and gestagen replacement in the climacteric and postmenopause. The 21st work meeting of the Zurich Discussion Group, November, 1998]

Older women survivors of physical and sexual violence: a systematic review of the quantitative literature

BACKGROUND

This systematic review synthesizes the quantitative empirical literature concerning older women survivors of physical and sexual assault.

METHODS

A literature search was conducted using a range of scholarly databases. Information is presented here on the prevalence, correlates, and consequences of these types of interpersonal violence in older women. Additionally, age-related differences in prevalence, psychiatric distress, and characteristics of violence, including information on perpetrators, are reviewed.

RESULTS

Overall, older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women. Additionally, older women who experienced interpersonal violence report greater psychiatric distress, including posttraumatic stress disorder (PTSD), than older women who have not experienced such events.

CONCLUSIONS

Some women who have been physically or sexually assaulted decades earlier in life continue to report significant levels of PTSD well into older adulthood. Gaps in the literature, including lack of information on ethnicity and culture, are presented, and future research directions are proposed.

Ethical Wills and Suffering in Patients with Cancer: A Pilot Study

INTRODUCTION

Suffering at the end of life may be caused by many factors, including pain and other symptoms, concern about family and friends, and loss of control of one's life. Several authors have suggested that loss of meaning is pivotal in suffering. An ethical will (EW) is a statement, usually written, capturing one's values, wisdom, hopes, and advice. EWs have been suggested as a vehicle for finding meaning as the end of life approaches. This pilot study of EWs examined methods for exploring the role of EWs in reducing suffering at the end of life.

METHODS

Oncology clinic patients 65+ years of age in active therapy for cancer were randomly assigned to one of two arms: EW or control. Subjects in both arms had writing assignments, three home visits, and exit interviews. Suffering was measured at baseline and at the time of the exit interview, using a series of Likert-like scales.

RESULTS

Twenty-four subjects (10 EW and 14 control) completed the study. Among EW subjects, trends toward reduced suffering were noted in "concern for loved ones," "unfinished business," and "fear of the future." Several methodological issues were identified by this pilot study, including selection of population for studying suffering, placebo effect, and randomization.

CONCLUSIONS

EW may be valuable in alleviating suffering; a larger study will be needed to examine efficacy. The study of interventions designed to reduce suffering at the end of life requires careful attention to the definition and measurement of suffering, study design, and subject selection.

Seeing the person behind the patient: enhancing the care of older people using a biographical approach

Recent policy statements have stressed the need for fundamental changes to the NHS, especially to the hospital care of older people. Person-centred care underpins such changes. If practitioners are to deliver person-centred care, then they need to learn more about the patient as an individual. One way that this might be achieved is through biographical approaches. This paper describes the findings of a developmental study undertaken over a 6-month period to investigate the introduction of a biographical approach to care on a unit in a NHS hospital. It concentrates on the views of the practitioners who used the approach. The study aimed to explore whether a biographical approach - in the form of storytelling - might be used to encourage person-centred practice. Using a practice development approach, the study explored the views of older people, their family carers and practitioners regarding their participation in life story work. Initial data were collected by focus groups with staff from a nursing home who regularly used life stories as a basis for care planning. Further data were collected through focus groups, semistructured interviews and observation - undertaken before and after the introduction of life story work - with older people, family carers and practitioners. Findings revealed that life stories helped practitioners to see patients as people, to understand individuals more fully and to form closer relationships with their families. Support workers also said how much they enjoyed using the approach to inform their care. Further longitudinal research is required to investigate biographical approaches more fully and to work more closely with practitioners to explore how biographical approaches can be undertaken as part of standard practice and be integrated into the culture and management of care.