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Strange KE, Mixer SJ, Embler P, Smith JL, Troutman-Jordan M. "Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults. Issues Ment Health Nurs 2023; 44:809-815. [PMID: 37669558 DOI: 10.1080/01612840.2023.2241072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.
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Affiliation(s)
- Karina E Strange
- University of Tennessee, College of Nursing, Knoxville, Tennessee, USA
| | - Sandra J Mixer
- University of Tennessee, College of Nursing, Knoxville, Tennessee, USA, and Fellow Transcultural Nursing Society Scholars
| | - Pam Embler
- University of Tennessee, College of Nursing, Knoxville, Tennessee, USA
| | - Jennifer L Smith
- University of Tennessee, College of Nursing, Knoxville, Tennessee, USA
| | - Meredith Troutman-Jordan
- Systems Coordinator, Gerontology Society of America Fellow, University of North Carolina, Charlotte, School of Nursing and Gerontology Program
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2
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Strange KE, Troutman-Jordan M, Mixer SJ. Influence of Spiritual Engagement on Appalachian Older Adults' Health: A Systematic Review. J Psychosoc Nurs Ment Health Serv 2023; 61:45-52. [PMID: 36322869 DOI: 10.3928/02793695-20221026-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Appalachia leads the country in mortality related to chronic comorbidities, such as heart disease, cancer, depression, and suicide. Appalachian older adults experience disproportionate risks for poor health outcomes. Spirituality is integral to Appalachian culture, and many older adults use spiritual engagement (SE) to cope with health challenges. Despite these connections, there is limited evidence about SE and well-being in this population. Therefore, the current systematic review addresses the literature gap of how SE influences health of Appalachian older adults. Using thematic synthesis, we analyzed 11 qualitative and three mixed methods studies. Major findings indicate that SE positively impacts holistic health through adaptive coping, guided partnerships with God, decreased loneliness, and enhanced sense of purpose. Future studies could examine SE practices among diverse populations, SE virtual experiences, and SE nursing assessments. Understanding how SE influences health of Appalachian older adults could prepare nurses to reduce disparities and improve health outcomes for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 45-52.].
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Buchman DZ, Lo S, Ding P, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines. Palliat Med 2022; 37:426-443. [PMID: 36522840 PMCID: PMC9760505 DOI: 10.1177/02692163221143153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. AIM To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. DESIGN Scoping review. DATA SOURCES We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. RESULTS Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. CONCLUSIONS Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics.
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Affiliation(s)
- Daniel Z Buchman
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philip Ding
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Naheed Dosani
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Grill KB, Wang J, Scott RK, Benator D, D'Angelo LJ, Lyon ME. What Do Adults With HIV Want? End-of-Life Care Goals, Values and Beliefs by Gender, Race, Sexual Orientation. Am J Hosp Palliat Care 2021; 38:610-617. [PMID: 33464114 DOI: 10.1177/1049909120988282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH). METHODS 223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACE™-HIV Advance Care Planning clinical trial. FINDINGS The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, p = 0.0113; saving larger doses for worse pain, p = 0.0067; and dying in the hospital, p = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, p = 0.0397, and less likely to only take pain medicines when pain is severe, p = 0.0091. CONCLUSION Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.
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Affiliation(s)
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research at Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel K Scott
- MedStar Health Research Institute and Washington Hospital Center, Washington, DC, USA
| | - Debra Benator
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Lawrence J D'Angelo
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, DC, USA
| | - Maureen E Lyon
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, DC, USA.,Center for Translational Research/Children's National Research Institute at 571630Children's National Hospital, Washington, DC, USA
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Cianelli R, Villegas N, Lewis-Pierre L, Valdes B, Iriarte E. Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection. Am J Hosp Palliat Care 2020; 38:583-589. [PMID: 33213192 DOI: 10.1177/1049909120971826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions. OBJECTIVES To examine predictors of EOL discussions with significant others, family members, and friends. METHODS Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV. RESULTS Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM. DISCUSSION Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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Affiliation(s)
- Rosina Cianelli
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
| | - Natalia Villegas
- 16134University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - LaToya Lewis-Pierre
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Beatriz Valdes
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Evelyn Iriarte
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
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