Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

Advance Care Planning Among Older Adults with Cognitive Impairment

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

How do cultural factors influence the provision of end-of-life care? A narrative review

BACKGROUND

Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life.

OBJECTIVE

Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life?

METHODS

A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included.

RESULTS

A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism).

CONCLUSIONS

These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.

End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing

BACKGROUND

End-of-life planning helps nurses meet the needs of their patients at a crucial time of life.

PURPOSE

This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views.

METHODS

Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses.

RESULTS

This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning.

CONCLUSION

This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.

Predictors of Advance Care Planning Engagement Among Muslim Americans

Advance care planning (ACP) enables people to discuss their physical, psychological, social, and spiritual needs before nearing death. Most literature examining the determinants of ACP engagement is limited and does not include minority faith communities in the United States, including Muslim communities. The purpose of this cross-sectional correlational study was to examine ACP engagement determinants among Muslims in the United States. Using the Social Ecological Model, we conceptualized the determinants of ACP engagement into intrapersonal, interpersonal, and community factors. The study self-administered questionnaires were distributed using convenience and snowball techniques. Multiple linear regression was used to predict ACP engagement. The total sample was 148 Muslim adults. The age range was 18 to 79 years. Among all tested factors, being Asian American, knowing a deceased person who had received aggressive or minimal medical treatments near death, being born in the United States, having knowledge and awareness about ACP, and being accepting of the American culture were the determinants of ACP engagement. Engagement in ACP is a multifactorial behavior. Several intrapersonal and interpersonal factors, but none of the community factors, were associated with ACP engagement among Muslim adults. Future ACP interventions targeted toward Muslim Americans should be planned with an understanding of the multifactorial nature of ACP engagement.

Design, implementation and evaluation of informal home care support intervention program for lonely older adults in the community: Protocol for a feasibility study

Background

Providing lonely older adults with informal home care services is important to improving their health and quality of life. The study aims to evaluate the feasibility of design, implementation and evaluation of an informal home care support intervention program (HoSIP) for community-dwelling lonely older adults in Gorgan, Iran.

Method/design

This feasibility study is a mixed-method with a concurrent nested design. Lonely older adults will be enrolled as the HoSIP intervention group and will receive 12-weeks of informal home care service by peer supporters. The purpose of this feasibility study is to determine the recruitment capability and resulting sample characteristics, data collection procedure and outcome measures, the acceptability and suitability of the intervention and study procedures, the resource and ability to manage the study and intervention, and preliminary evaluation of participant response to intervention. Primary outcomes including participant feelings of loneliness, quality of life, general health, social network, social support, and self-care ability, will be assessed at baseline and post-intervention for the intervention and control groups. Semi-structured interviews will be conducted immediately after the intervention using content qualitative approach to describe participants’ experiences with HoSIP.

Discussion

Through this study we will examine the feasibility of delivering informal home care services to community-dwelling lonely older adults in a developing country through employing a concurrent nested mixed-method design.

Trial registration

IRCT20190503043455N

Determinants of Subjective Loneliness and Quality of Life among Community-Dwelling Older Adults in Gorgan, Iran

The purpose of this study was to identify the determinants of, and relationship between, subjective loneliness, general health and quality of life (QoL) among lonely community-dwelling older adults. A cross-sectional study was carried out among a sample of lonely (i.e. live alone without any assistance) older adults living in Gorgan city, Iran. The older adults were invited through a census sampling technique to complete six questionnaires, namely a 20-item UCLA loneliness scale, a six-item Lubben Social Network Scale, a 12-item Multidimensional Scale of Perceived Social Support, a 17-item Self-care Ability Scale for the Elderly (SASE), a General Health Questionnaire-12, and a Control, Autonomy, Self-Realization and Pleasure (CASP-19) questionnaire. Hierarchical multiple linear regressions were done with subjective loneliness and QoL as outcome variables. In total, 213 (91% females) lonely older adults (mean age: 68.2 ± 6.2) participated. Hierarchical multiple linear regressions yield socio-demographic characteristics (p < 0.001), predictor group 1 (p < 0.001), predictor group 2 (p < 0.001) explained 12.5, 13.5 and 46.6% of the observed variance in loneliness, respectively. Moreover, socio-demographic characteristics (p < 0.001), predictor group 1 (p < 0.001), predictor group 2 (p < 0.001) and feeling of loneliness (p < 0.001) accounted for 16.9, 21.1, 48.6 and 55.3% of the observed variance in quality of life, respectively. Both subjective loneliness and QoL were moderate in our sample. We suggest the presence of a probable causal inference between subjective loneliness, general health, and QoL; implying the need of population strategies for correcting subjective loneliness for its own sake as well as to help have an improved general health and QoL among older adults. Beside several non-modifiable factors (such as age, ethnic groups), we suggest that corrective measures should be based on social support and networking, self-care behavior, leisure activities, adapted for age, literacy and racial specifications. Given its population health relevance, there should be increased research and intervention on loneliness among older adults.

Does Culture Matter? Young and Middle-Aged Iranian-American Adults' Perspectives Regarding End-of-Life Care Planning

BACKGROUND

An increase of cultural diversity and treatment options offer opportunities and challenges related to end-of-life (EOL) care for healthcare providers and policymakers. EOL care planning can help reduce confusion and uncertainty when individuals and family members need to make decisions about EOL care options.

OBJECTIVE

The purpose of this study was to investigate preferences, attitudes, and behaviors regarding EOL care planning among young and middle-aged Iranian-American adults.

METHODS

A cross-sectional national sample of 251 Iranian-American adults completed surveys. Paper and online surveys in English and Persian were offered to potential participants.

RESULTS

All the participants completed online survey in English language. In incurable health conditions, 56.8% preferred hospitalization and intensive treatments. From the 40.6% participants who preferred comfort care, most preferred care at home (29.5%) compared to an institution (11.1%). Those who preferred hospitalization at EOL mostly preferred intensive and curative treatments. The mean score of attitudes toward advance decision-making was moderately high (11.48 ± 2.77). Favorable attitudes were positively associated with acculturation (r = .31, p < .001), age (r = .15, p < .05), and number of years living in the U.S. (r = .26, p < .001). Conversely, spirituality and favorable attitudes were negatively associated (r = -.17, p < .05).

CONCLUSION

Immigrant and culturally diverse individuals have experienced different living and healthcare environments. These differences can influence their EOL care planning and decisions. Knowledge of diverse perspectives and cultures is essential to design culturally congruent plans of EOL care.

End-of-Life Care Terminology: A Scoping Review

The purpose of this scoping review is to present an overview of terms found in publications associated with end-of-life care management that can impact decision making by patients, health care providers, and researchers. Connotative terminology and syntax can influence the decision-making approach and process. We examined 49 publications for positive, negative, and neutral connotations. We consistently found negative terminology in the publications. To advance the development of nursing knowledge regarding end-of-life care, researchers should be aware of their biases of terminology and syntax use. We propose modifications to language used in end-of-life care planning models and literature can improve care congruency.

Advance Care Planning Engagement Among Muslim Community-Dwelling Adults Living in the United States

Advance care planning (ACP) is a cornerstone of self-determination for the type of care provided at the end of life. Despite many national efforts to improve American adults' engagement in ACP, statistics indicate low engagement. Low engagement, especially among racial and ethnic minority populations, immigrants, people with lower socioeconomic status, young adults, rural residents, or non-English speakers, is common. Advance care planning engagement among Muslims living in the United States has been minimally studied. The purpose of this study was to explore Muslims' engagement in ACP. A cross-sectional descriptive design was used. Participants were recruited from Islamic organizations through convenience and snowball sampling. Engagement in ACP was measured by the Advance Care Planning Engagement Survey. A sample of 148 Muslims (18-79 years of age) participated in the study. The average engagement scores ranged from 1.97 to 2.09, with about two-thirds in the precontemplation stage. Significant differences in engagement scores were found according to health condition and end of life experiences. Results suggest a need for further collaborative efforts by health care providers, policymakers, and researchers to mitigate the disparities in ACP engagement in the American Muslim community.

Leininger's Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future

An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientational definitions. Recent articles, books, and book chapters provide relevant exemplars to enhance scholarly understanding and application of theory constructs. Proposed future directions encompass using the CCT to guide research of discovery and translational research projects for evidenced-based nursing practice; develop nursing courses and curricula to prepare culturally competent nurses; guide future culturally competent administrative and leadership policies and procedures; inform public policy related to cultural diversity and underserved populations; promote grant writing initiatives to enhance cultural diversity in hiring nursing staff, supervisors, and faculty; and promote admission of nursing students from underserved and/or diverse backgrounds.