Hmong Older Adults’ End-of-Life Care Preferences: Physical, Psychosocial, Cultural, Religious, and Spiritual

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 507-507
Author(s):  
Youhung Her-Xiong
Keyword(s):  
Older Adults ◽  
Content Analysis ◽  
End Of Life ◽  
Psychosocial Care ◽  
The United States ◽  
Culturally Sensitive ◽  
Religion And Spirituality ◽  
Structured Interviews ◽  
Culturally Sensitive Care ◽  
Eol Care

Abstract As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants

2021 ◽  
pp. 193758672098588
Author(s):  
Pai Liu ◽  
Matthew Powers ◽  
Cheryl Dye ◽  
Ellen Vincent ◽  
Mary Padua
Keyword(s):  
Older Adults ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Culturally Sensitive ◽  
Visual Preference ◽  
Chinese Elderly ◽  
Elderly Immigrants ◽  
Culturally Sensitive Care ◽  
Outdoor Walking

Objectives: This was a study conducted in Atlanta, GA, in the United States with Chinese elderly immigrants, examining the relationship between visual preference and motivation to walk in a particular outdoor space. Backgrounds: Outdoor walking promotes the well-being of older adults. However, their declined body functions impact their motivation to walk outside. For elderly immigrants living in a country with different cultural backgrounds from their homelands, it is important to find the ways to enhance their motivation of outdoor walking. Method: Visual preference survey was conducted to assess preferences of first-generation Chinese elderly immigrants attending a care facility setting. Preferences included Chinese classical walking spaces or American modern walking spaces. The data were interpreted using descriptive statistics and factorial experiment analysis. Results: A total of 95 Chinese elderly immigrants gave valid responses to the visual preference survey. Survey results revealed that respondents had a high preference for Chinese classical walking spaces even though they had an average time of 26 years as a U.S. resident. Although the functions and purposes of the walking spaces caused safety and comfort concerns, the interaction effects of design style, design function, and design purpose illustrated that Chinese classical style had high effectiveness to promote outdoor walking of Chinese elderly immigrants. Conclusions: These results support the significance of culturally sensitive care environments in promoting outdoor walking for elderly Chinese immigrants. It also indicates that spaces designed with an assigned cultural style had higher attractiveness to older adults from the same assigned cultural background.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

scholarly journals Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data

2020 ◽  
Author(s):  
Jennifer Ailshire ◽  
Margarita Osuna ◽  
Jenny Wilkens ◽  
Jinkook Lee
Keyword(s):  
United States ◽  
Older Adults ◽  
Nursing Home ◽  
End Of Life ◽  
Family Caregiving ◽  
The United States ◽  
Place Of Death ◽  
Life Data ◽  
Cross National ◽  
At Home

Abstract Objectives Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. Methods We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. Results Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. Discussion This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

Savvy Surrogates and Rock Star Parents: Compensation Provisions, Contracting Practices, and the Value of Womb Work

2020 ◽  
Vol 45 (2) ◽  
pp. 398-431
Author(s):  
Hillary L. Berk
Keyword(s):  
United States ◽  
Content Analysis ◽  
Social Process ◽  
The United States ◽  
Symbolic Power ◽  
Cultural Norms ◽  
Structured Interviews ◽  
Selective Abortion ◽  
Medical Risks ◽  
Exchange Relations

Abstract:What is the value of surrogate labor and risks, and how is it negotiated by participants as they contract within an unsettled baby market? This article presents novel data on compensation, fee, and bodily autonomy provisions formalized in surrogacy contracts, and the experiences of actors embedded in exchange relations, as they emerge in a contested reproductive market. It combines content analysis of a sample of thirty surrogacy contracts with 115 semi-structured interviews conducted in twenty states across the United States of parties to these agreements, attorneys who draft them, counselors, and agencies that coordinate matches between intended parents and surrogates. It analyzes the value of services and medical risks, such as loss of a uterus, selective abortion, and “carrier incapacity,” as they are encoded into agreements within an ambiguous field. Surrogacy is presented as an interactive social process involving law, markets, medicine, and a variety of cultural norms surrounding gender, motherhood, and work. Contracts have actual and symbolic power, legitimating transactions despite moral anxieties. Compensation transforms pregnancy into a job while helping participants make sense of the market and their “womb work” given normative flux. Contracts are deployed by professionals without informed policies that could enhance power and reduce potential inequalities.

scholarly journals Domestic and International Perspectives on Financing Adult Education and Training

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 389-390
Author(s):  
Abigail Helsinger ◽  
Oksana Dikhtyar ◽  
Phyllis Cummins ◽  
Nytasia Hicks
Keyword(s):  
Older Adults ◽  
Adult Education ◽  
Adult Learners ◽  
Low Income ◽  
The United States ◽  
Education And Training ◽  
Technological Advancement ◽  
Middle Aged ◽  
Structured Interviews ◽  
And Training

Abstract Adult education and training (AET) over the life-course is necessary to participate in economic, social, and political activities in the time of globalization and technological advancement. However, little research has been done to identify mechanisms to fund AET opportunities among middle-aged and older adults from a comparative international perspective. Our study aimed to identify strategies to finance AET opportunities for middle-aged and older adults through an international lens, to help identify barriers and facilitators in effort to best support adult learners regardless of education background or socioeconomic characteristics. We carried out a descriptive qualitative study to facilitate an in-depth understanding of funding mechanisms available to adult learners in the selected countries, from the perspective of adult education and policy experts. Data were collected using semi-structured interviews with 61 international adult education experts from government agencies, non-governmental organizations, and education institutions. Our informants represented 10 countries including Australia, Canada, Germany, Italy, the Netherlands, Norway, Singapore, Sweden, the United Kingdom, and the United States. Data included at least one in-depth phone or web-based qualitative interview per informant in addition to information gathered from written materials (e.g., peer-reviewed publications and organizational reports). We identified three financing options that arose as themes: government-sponsored funding; employer-sponsored funding; and self-funding. We found that government-sponsored funding is especially important for low-skilled, low-income older adults for whom employer-sponsored or self-funding is not available. Our results have implications for lifelong AET policy changes, such as adaptations of successful AET funding programs across global communities.

Oscillations, boundaries and ethical care: Social work practitioner-researcher experiences with qualitative end-of-life care research

2021 ◽  
pp. 147332502110451
Author(s):  
Felicity Moon ◽  
Christine Mooney ◽  
Fiona McDermott ◽  
Peter Poon ◽  
David W Kissane
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Psychosocial Care ◽  
General Medicine ◽  
Visual Methods ◽  
Life Care ◽  
Structured Interviews ◽  
Research Issues ◽  
Health Network ◽  
Human Research Ethics

Policy and research acknowledge that the quality of end-of-life care in hospitals can be poor, with families reporting significant concerns regarding physical and psychosocial care. In order to design appropriate evidenced-based care approaches, we conducted qualitative research examining the perspectives of bereaved families of patients who received end-of-life care in our health network. This paper reports on ethical dilemmas facing practitioner-researchers conducting interviews with bereaved families. We recruited 40 bereaved family members to participate in semi-structured interviews discussing the care a loved one received while a patient under the general medicine units. Bereaved participants expressed grief, humour and anger regarding their experience, and several reported perceptions of negligent and harmful care. Irrespective of the protocols in place to mitigate distress, this posed an ethical dilemma for the practitioner-researcher as a member of the health network, who needed to balance clinical and research roles when responding to distress. The practitioner-researcher’s own bias and assumptions emerged when analysing families’ distressing recollections. More broadly, the issues discussed have clinical implications for models of hospital bereavement support. Participants’ use of photos and mementos jointly served to include the presence of the deceased in the research interview, but also highlighted the potential to utilise visual methods to examine sensitive research issues. It helps every practitioner-researcher to distinguish between research-oriented goals and clinical responsibilities to care provision as they consider their human research ethics application before beginning any research.

Call the Rezadora: Aiding Latino Families at the End of Life

2021 ◽  
pp. 154041532110289
Author(s):  
Kim L. Larson ◽  
Graziella D. Jewell ◽  
Maria Fernanda Maldonado ◽  
Morgan E. Braxton ◽  
Lee Ann Johnson
Keyword(s):  
End Of Life ◽  
Single Case ◽  
The United States ◽  
Latino Families ◽  
Holistic View ◽  
Serious Illness ◽  
Care Services ◽  
Palliative Care Teams ◽  
Eol Care

Introduction: The rezadora, a lay spiritual leader, provides support to Latino families as they provide end-of-life (EOL) care for loved ones. The purpose of this study was to learn about the work of the rezadora in Guatemala as a resource for Latinos with serious illness in the United States. Methods: An ethnographic exploratory case study was conducted during summer 2018 in rural Guatemala. We interviewed three rezadoras who resided in two villages. The study yielded two cases, the single case and the paired case, which allowed for a holistic view of how the rezadora serves the community. Results: Content and thematic analysis led to two themes: Essence of being called and Power of prayerful song. Essence of being called was represented by the prominence of the rezadora and their perpetual faith work. Power of prayerful song was characterized through the mission, customs, and the presence of the rezadora. A good death was aided by the rezadora in this context. Conclusions: As the Latino population ages in place, the need for palliative and EOL care services will increase. Lay spiritual leaders could enhance the palliative care teams in these communities and improve the quality of life for Latinos with serious illness.

Improving the Quality of Care across All Settings

2019 ◽  
pp. 573-605
Author(s):  
Marilyn Bookbinder ◽  
Romina Arceo ◽  
James T. McDaniel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Healthcare Settings ◽  
National Priority ◽  
Hospice And Palliative Care ◽  
Eol Care ◽  
Clinician Assessment ◽  
Care Path

This chapter provides perspectives on quality-based initiatives in the United States across healthcare settings and populations and describes their impact on patient, professional, and system outcomes. The authors discuss the need for quality improvement (QI) at end of life, QI principles, and the models, methods, and tools most frequently used. Also described are areas of national priority for improving end-of-life (EOL) care. A care-path for the end of life is used to illustrate a QI effort and the FOCUS_PDSA method and to encourage use of specific tools for improving EOL care, including respiratory distress, and a clinician assessment of EOL care using The Joint Commission (TJC) tracer methodology. The authors review the linkages between QI and practice changes in hospitals and hospices that ultimately lead to improved EOL care and close with examples of how nurses are providing leadership in the field of quality hospice and palliative care.

User Insights for Design of an Antihypertensive Medication Management Application

2018 ◽  
Vol 62 (1) ◽  
pp. 1077-1081
Author(s):  
Kenneth A. Blocker ◽  
Kathleen C. Insel ◽  
Jeannie K. Lee ◽  
Qiong Nie ◽  
Abidemi Ajuwon ◽  
...  
Keyword(s):  
Older Adults ◽  
Technology Use ◽  
Medication Management ◽  
The United States ◽  
Management Systems ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Common Chronic Disease ◽  
Management Application ◽  
Education Decision

Hypertension is the most common chronic disease affecting older adults (65+) in the United States. Unfortunately, many struggle to adhere to their antihypertensive medications as only about half diagnosed with the disease have it controlled. Therefore, there is a need for designing supportive medication management systems to aid this population with their antihypertensive medications, especially using increasingly adopted technologies such as smartphones. The preferences of older adults with hypertension must be considered when designing such systems for this population. Six older adults participated in structured interviews to inform the design of the Medication Education, Decision Support, Reminding and Monitoring System (MEDSReM). Results revealed management needs, design insights, and reminder preferences, as well as mostly positive opinions regarding technology use for medication management. These findings informed the development of MEDSReM with the goal of supporting older adults in successfully managing their antihypertensive medications.

scholarly journals Exploring Community-Dwelling Older Adults’ Considerations About Values and Preferences for Future End-of-Life Care: A Study from Sweden

2020 ◽  
Vol 60 (7) ◽  
pp. 1332-1342 ◽  
Author(s):  
Malin Eneslätt ◽  
Gert Helgesson ◽  
Carol Tishelman
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Community Dwelling ◽  
Participatory Action ◽  
Action Research Project ◽  
Care Needs ◽  
Swedish Version ◽  
Using Data ◽  
Eol Care ◽  
Community Dwelling Older Adults

Abstract Background and Objectives There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations. Research Design and Methods In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively. Results While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications. Discussion and Implications A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

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