Kathy Black

Health Care Professionals' Death Attitudes, Experiences, and Advance Directive Communication Behavior

The study surveyed 135 health care professionals (74 nurses, 32 physicians, and 29 social workers) to examine their personal death attitudes and experiences in relation to their reported advance directive communication practice behavior. Negative correlations were found between collaborating with other health care professionals regarding the directives and fear of death, avoidance of death, and escape acceptance of death. Approach acceptance of death positively correlated with initiating the discussion of advance directives. Practitioners indicating recent personal experiences with terminal illness reported disclosing more information about the documents.

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n = 114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.

Advance Directive Communication: Nurses’ and Social Workers’ Perceptions of Roles:

As a facet of advance care planning for future health care, advance directive communication represents an important aspect of professional health care practice with older patients. Nurses and social workers routinely discuss advance directives in acute care settings; however, communication practices by discipline are not well understood. This qualitative study explored differences in advance directive communication practices by comparing and contrasting nurses’ and social workers’ perceptions of their roles. Focus group interviews were conducted with nurses (n = 6) and social workers (n = 5). Five key themes emerged from the data. Findings suggest that both professions perceive primary educational roles, though their informational practices differed in content. The professionals reported differential pathways that led to their practices with patients. Both disciplines identified advocacy roles with families and providers. The practitioners reported distinct roles with families. There was mutual recognition of interdisciplinary roles. The findings suggest that nurses and social workers engage in both parallel and complementary advance care planning practices with their patients.

Aging in Community Mobilizing a New Paradigm of Older Adults as a Core Social Resource

Dignity and independence are widely considered as core concepts to aging well, yet little research has explored how older adults perceive these issues in the context of community life. Moreover, little is known regarding the ways in which the broader public views and enhances aging with dignity and independence with their older residents. Using participatory action research, multiple methods of qualitative inquiry, and tenets of appreciative inquiry, this article reports on a community-based initiative aimed to better understand the positive aspects of aging with dignity and independence. Synthesized findings yielded 6 “actionable themes”: (1) meaningful involvement, (2) aging in place, (3) respect and inclusion, (4) communication and information, (5) transportation and mobility, and (6) health and well-being. The findings invoke a new paradigm for community aging that highlights the unique contributions of older adults as a core social resource. Implications for mobilizing community action to promote aging with dignity and independence are discussed.

Advance care planning throughout the end-of-life: focusing the lens for social work practice.

Abstract Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nations population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.

Community-dwelling older adults' perceptions of dignity: core meanings, challenges, supports and opportunities

ABSTRACT Dignity is a universally important issue for all people, and particularly vital for older adults who face multiple losses associated with ageing. In the United States of America and beyond, the maintenance of dignity is a key aim of policy and service provision for older people. Yet surprisingly little research has been conducted into the meaning of dignity to community-based older adults in the context of everyday life. As life expectancy continues to increase worldwide, unprecedented numbers of people are living longer than ever before. The majority of older adults will face declining health and other factors that may impact dignity in the course of ageing in their communities. This paper reports on a study that explored older peoples understandings and experiences of dignity through focus groups and a survey. Three key components of dignity are identified: autonomy, relational and self-identity. In addition, the paper discusses a range of factors that can facilitate or inhibit a sense of dignity for older people, including long-term health issues, sensory deficits and resilience to life events. Finally, the implications of these findings for policy and practice are considered in the context of American social structures and values.

Factors associated with advance care planning among older women in Southwest Florida.

ABSTRACT As the nations population continues to age, many older women will face care needs that can be anticipated in advance. However, little is known about the advance care plans of older women and the characteristics of those who plan. This study utilized a stratified random sampling design to survey older women (n = 124) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of attitudes toward future care and planning behavior by domain. Results suggest that advanced age predicts greater planning behavior, while living alone is associated with less advance care planning behavior. Other factors associated with less planning by domains of care needs include income status, chronic health conditions, educational attainment, and religious status. Nonaccepting attitudes toward planning were associated with a decreased likelihood to have advance care planning documents.

Measuring case managers' advance care planning practice: translating focus group findings to survey development.

Sequential mixed methods is a useful research design to inform second-stage methodology when investigating an area of practice in which relatively little is known. This article describes how focus group findings were used to measure advance care planning practice among community-based case managers. The initial qualitative study utilized focus groups to explore aspects of practice in this area. Data revealed themes that embodied ambiguous views of advance care planning, divergent roles in practice, a continuum of practice activities, and multiple facilitators and barriers to practice. In order to further examine case managers’ advance care planning practices, qualitative findings were used to develop the Case Managers Advance Care Planning Practices Instrument. Implications for qualitative to quantitative measurement are discussed.

Establishing Empirically-Informed Practice With Caregivers: Findings From the CARES Program

There is increasing interest in delivering efficacious interventions to caregivers. This study reports on the processes and findings from a modified approach of the Wraparound System of Care. The practice model is implemented over 4 phases and is based on 3 theoretical constructs and 10 principles. The evaluation utilized treatment fidelity measures and employed a quasi-experimental pretest/posttest design to examine caregiver outcomes (N = 120). Findings suggest significant improvement among caregivers’ self-reported health, life satisfaction, well-being, and quality of life, as well as a reduction in caregiver risk and burden. Delineation of the processes used in the model are presented.

Dying in the age of choice.

Due to the unprecedented increase in the United States aging demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing. Requests for a hastened death can occur among people of all ages and includes those with advanced illness as well as others wanting to die due to unbearable suffering. This article provides an overview of the ongoing discourse about the experience of dying faced by many older adults, including aspects frequently associated with “a good death.” The limitations of established practices which seek to provide a “better” dying experience are identified followed by discussion of the growing availability of alternative options. Reflective considerations are presented to guide practice vis-à-vis the changing landscape surrounding options in dying.