Jacquelyn J. Benson

Older Homebound Women: Negotiating Reliance on a Cane or Walker

Canes and walkers are commonly characterized as assistive devices that serve the same purpose: as walking aides. These general views were reappraised and tempered in this descriptive phenomenological study with 40 older women (aged 85 to 98 years) who were unable to leave their homes without help. The purpose was to describe the phenomena of negotiating reliance on canes and walkers as walking devices and the lifeworld context underlying each phenomenon. Relative to lifeworld, there were differences between coming to terms with using a cane and coming to terms with using a walker. Data revealed similarities and distinctions between the basic intentions of relying on canes and walkers and the associated purposes served by canes and walkers. Participants did not view either device as consistently assistive. Findings evoke opportunities for dialogue among older persons, scholars, practitioners, and designers of these devices about coming to terms with such devices and relying on them.

Role ambiguity among women providing care for ex-husbands.

Twenty-one women were interviewed regarding their caregiving experiences for ill or dying ex-husbands. Emergent in the analyses was the variety of ways in which they experienced role ambiguity as ex-wife caregivers. This article describes the role ambiguity ex-wife caregivers encountered interpersonally through interactions with network members, institutionally in dealing with professionals and the workplace, and intrapersonally in confusion over their roles and feelings. Consequences of role ambiguity are discussed, and recommendations for policy and practice are made in light of the aging population, changing family forms, and womens care roles.

Intentions of Older Homebound Women About Maintaining Proximity to a Cane or Walker and Using It at Home

Older persons are typically classified as “users” or “nonusers” of walking devices. Little is known about their experience of maintaining proximity to the walking device or the consistency with which they use it. The authors addressed those gaps in this longitudinal, phenomenological study with 40 women (aged 85-98). With regard to maintaining proximity to the device, the experience was structured by “keeping track of my cane,” “keeping the cane handy,” “transitioning between keeping track of the cane and keeping it handy,” and “keeping the walker handy so I can use it.” Despite stated intentions to the contrary, few women consistently walked with a device. The experience was characterized by “walking with it unless . . . ” and “judging whether I need it to walk in this situation.” Rather than assuming that clients use a cane or walker consistently, practitioners should explore intentions to maintain proximity to it and individualize interventions accordingly.

Place of Death and Dying: Introduction

The subject of death is of a considerable interest to all of us, as it has been since the beginning of civilization. However, the place of dying has seldom been studied in the field of environmental gerontology. The concept of aging in place is often explored in the field, but the discussion normally stops short of the last stages as if aging in place is a condition that never ends. Still, dying is part of the inevitability of aging. And even though a number of scientists and statisticians argue whether people die of old age, there is plenty of evidence that life has its natural, inherent limits. Clearly, intrinsic physical developments associated with aging inevitably cause an individual to become more vulnerable to mortality, which “ends in all cases we know of, in death” (Ehrenreich, 2018, p. xv). Even the most successful aging process eventually involves accumulation of disabilities as a result of the ongoing conflict at the cellular level of our bodies. Sadly, “successful” aging is an ideal that hardly accommodates the realities of decline and death (Ehrenreich, 2018). Conforming to the modern demographic pattern, the majority of people in the Western society reach old age, and consequently they are destined to die of one of its ravages. No matter how good our medical care or our exercise and hygienic regimens are, our ability to control the biological continuum between “normal” aging and disease is very limited. We are all susceptible to chronic diseases and death (Cole, 1992), as the paradoxical nature of aging and death discloses.

The “Medicalized Death”: Dying in the Hospital

Abstract This article is part of a larger study dedicated to the place of death and dying. The focus of this article is on the “medicalized death” of older people who died in hospitals in Israel and the United States and is based on the experiences of four family members who cared for them at the end of their lives. In-depth interviews were conducted with each participant, and narrative analysis methods were utilized to identify themes in the data. In the findings section, participant accounts are presented as individual monologues, each followed by the authors’ theoretical commentary. Despite the fact that the process of dying in a hospital is often depicted in the media as being fraught with excessive and aggressive procedures, the cases described in this article suggest there is marked ambiguity and contradiction experienced by caregivers and patients regarding the hospital setting for the process of dying. In some cases, the hospital was perceived as a preferred place for dying because it often reduced caregiver strain. However, participants also remarked on many undesirable aspects about hospital deaths, including dying in the company of strangers; the lack of empathy from physicians; existential dilemmas about the withdrawal of treatment; and several more.

The Last Habitat: Living and Dying in Residential Care Facility

Abstract This article is a part of a larger study regarding the place of dying. Through narrative analysis methods, we strived to obtain rich descriptions and idiosyncratic accounts of the experience of dying in institutional settings, predominately in the nursing home. The quality of the physical environment can impede or greatly enhance the extent to which a disabled older person can remain in his or her own home. Most of long-term care is provided by family members. However, as the condition of the care recipient deteriorates and the stress level of the caregiver increases, the need to supplement the informal care with formal care resources grows. Consequently, frail older adults may be relocated to a residential care facility. In other cases they may be discharged from a hospital to these institutional settings. Nursing homes are considered the last resort for frail, old people. Despite attempts to improve the environment of long-term care settings through “cultural change,” the overriding theme of much of the literature about the nursing home experience is one of rejection, loss, and in some extreme accounts, a “double burial” that equates relocation to a nursing home with a person’s final terminus of life.

Care Pathways for the Dying Patients: Physician Perspective

Abstract The overriding care philosophy in medicine is to prevent death, rather than focus on dying. However, increasing longevity in most parts of the world has resulted for many people in prolonged periods of declining health toward the end of life. This has complicated our understanding of when the dying process begins. As a result, there has been a growing movement within society and among health care systems to focus on finding ways to contribute to the quality of life of patients just before they die. The modern hospice and palliative-care movement has gained distinction as an alternative way of looking at health care. These care philosophies perceive dying as a natural part of the life cycle. Staff members prioritize comfort and quality of life over longevity. However, the goals of hospice and palliative care are often misunderstood by the public. This article is based on interviews with two palliative-care physicians that were conducted as part of a larger study about the place of dying. The goal of these interviews was to obtain the physician perspective of dying at a hospital, at home, and in an institutional setting, as well as to provide readers greater clarity on the palliative and hospice care perspectives within these contexts.

The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives

Abstract Although ample research suggests that individuals prefer to die at home, the realities of a home death experience, from the perspective of family members, are not well understood. The following study addresses this gap in knowledge via a narrative analysis about the process of dying at home. Five family caregivers participated in semistructured interviews about their experiences witnessing and supporting the end-of-life process of an older family member who died at home. Their stories paint a vivid picture about the motivations and consequences of the experience, including themes such as caregivers’ immense feelings of uncertainty regarding their caregiving abilities and decision making, the significance of the home environment as a symbol of comfort and security, the influence of family and social networks, and “dying well” as a social justice issue. Overall, the caregivers’ narratives support the notion that being at home is considered an essential aspect of ”dying well.” However, the narratives also demonstrate that dying at home presents many challenges for family members, especially to those with limited resources and social support. Thus, the authors caution against viewing the home death as a proxy for a good death.

Multiple Segment Factorial Vignettes in Family Health Interventions

Abstract Purpose Older adults and their families, geriatricians and gerontological practitioners, other health care providers, and social policy makers are invested in finding ways to prevent health and safety problems so that older adults can remain in their homes safely and independently. Family life education and problem-prevention programs designed for older adults are cost-effective ways of trying to avoid or prevent problems before they occur. The purpose of this chapter is to describe the use of multiple segment factorial vignettes as an educational method to promote safety and health. Design Multiple segment factorial vignettes (MSFVs) are short stories comprised of two to five separate segments. In research, MSFVs have been used to study attitudes, values, beliefs, and behaviors. MSFVs also have potential for use in interventions with individuals, couples, and families. We present an example of the use of MSFVs in an intervention project in which we taught the family members and friends of older adults who lived alone how to use MSFVs in collaborative problem-solving with older adults about maintaining their independence safely in their homes. The MSFV method was easily learned by project participants, readily individualized to fit the situations of older individuals, and the participants enjoyed using them. Findings MSFVs were effective in changing behaviors and cognitions of older adults. Value We present issues to consider for practitioners who want to develop and utilize MSFVs in interventions. Examples of MSFVs as interventions are presented and limitations to MSFVs are discussed.