COVID-19 and the Long-Standing Vulnerabilities of Older Adults

2020 ◽  
Vol 119 (820) ◽  
pp. 323-325
Author(s):  
Deborah Carr
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Financial Resources ◽  
Life Care ◽  
Medicaid Reimbursement ◽  
The Us ◽  
Health And Mortality ◽  
Policy Solutions

The COVID-19 pandemic has taken a devastating toll on the lives of older adults, intensifying long-standing challenges in the US health care system. Persistent health and mortality disparities on the basis of race and socioeconomic status, staffing shortages and insufficient financial resources at some nursing homes, and a reluctance among Americans to make formal plans for their end-of-life health care are problems of heightened magnitude in the pandemic era. Policy solutions like extending Medicare benefits to younger people, increasing Medicaid reimbursement rates, and facilitating formal conversations regarding end-of-life care may help Americans to age and die with dignity.

scholarly journals End-of-Life Care for Patients With Advanced Kidney Disease in the US Veterans Affairs Health Care System, 2000-2011

2018 ◽  
Vol 72 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan P.Y. Wong ◽  
Margaret K. Yu ◽  
Pamela K. Green ◽  
Chuan-Fen Liu ◽  
Paul L. Hebert ◽  
...  
Keyword(s):  
Health Care ◽  
Kidney Disease ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Veterans Affairs ◽  
Life Care ◽  
The Us ◽  
Us Veterans ◽  
Care System

scholarly journals Health Care Professionals’ Views Associated with the Barriers and Facilitators of Advance Care Planning (ACP) for Community Dwelling Older Adults with Palliative and End-of-Life Care Needs Towards Achieving a ‘Good’ Death: Findings from a Qualitative, Exploratory Pilot Study

2018 ◽  
Author(s):  
Gary Bellamy ◽  
Jennifer Stock ◽  
Patricia Schofield
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Face To Face ◽  
Telephone Interviews ◽  
Advance Care

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

scholarly journals PALLIATIVE AND END-OF-LIFE CARE TO THE LGBT COMMUNITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S623-S623
Author(s):  
Gary L Stein ◽  
Cathy Berkman
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Providers ◽  
Term Care ◽  
The Us ◽  
Lgbt Community ◽  
And Gender

Abstract The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care – across cultures and countries. Health care providers may fail to recognize, acknowledge or address disparities in care. Providers and institutions may be uncomfortable with gender and sexuality issues, and often fail to inquire about sexual orientation and gender identity. It is estimated that there are approximately 2.7 million LGBT adults in the U.S. age 50 and older and approximately 1.1 million age 65 and older. In the UK, an estimated 5-7% of the population identify as LGBT; there are between 600,000 and 840,000 LGBT adults aged 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even greater numbers of LGBT older adults, and their families, will require palliative and end-of-life in the coming years. Researchers in the US and UK have found that LGBT older adults living in the community and in long-term care facilities experience inadequate, disrespectful, and abusive care due to their sexual orientation and gender identity status. They fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. This symposium will describe the experiences of LGBT individuals and their family members, and compare commonalities and differences faced by LGBT communities in the US and UK in accessing palliative and end-of-life care.

scholarly journals “She’s Dying and I Can’t Say We’re Married?”: End-of-Life Care for LGBT Older Adults

2020 ◽  
Author(s):  
Carey Candrian ◽  
Kristin G Cloyes
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Poor Quality ◽  
Life Care ◽  
Quality Health Care ◽  
Quality Health ◽  
Bisexual And Transgender ◽  
And Gender

Abstract Lesbian, gay, bisexual, and transgender (LGBT) older adults are at particular risk for receiving inequitable end-of-life care. Their health care wishes may be ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care. This is particularly important during sensitive transitions along the care continuum to end-of-life settings; 43% of respondents of a 2018 survey of 865 hospice professionals reported having directly observed discriminatory behavior toward LGBT patients. Lack of visibility and accountability perpetuates vulnerabilities and the potential for discriminatory treatment. Unfortunately, while other areas of health care have prioritized and normalized collecting sexual orientation and gender identity (SOGI) data, hospices do not routinely assess patients’ SOGI in the context of end-of-life wishes and decisions. Drawing insight from a sample of 31 in-depth interviews with older LGBT adults, this paper focuses on one participant’s story—Esther’s. We chose her story to illustrate how care can be compromised at the end of life if an open discussion with patients about what and who matters most to them at the end of life, is avoided.

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 Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer

2017 ◽  
Vol 8 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Siran M. Koroukian ◽  
Nicholas K. Schiltz ◽  
David F. Warner ◽  
Charles W. Given ◽  
Mark Schluchter ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Social Determinants ◽  
End Of Life Care ◽  
Life Care
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