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Monday, August 21, 2017

Hospice Dementia Live Discharge Impacts Caregiver Grief (Research, Video 2:23)

Live discharges from hospice include patients deciding to resume curative care, improved patient conditions beyond hospice guidelines, or hospices inappropriately using live discharge to avoid costly hospitalizations. In terms of patients discharged who have dementia, another layer of concerns can be added for caregivers. Caregiving a hospice patient who has dementia includes a series of transitions in their roles. When the patient no longer meets eligibility criteria, it can be very difficult for caregivers who have been anticipating an end to understand the discharge in the context of their grief process.  

Research on hospice discharge of patients with dementia explains the unique grief experience of these caregivers. They struggled to understand the patient’s terminal prognosis as temporary. In addition, caregivers were left to resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Hospice social workers are particularly needed to offer emotional and other concrete support to caregivers who experience a live discharge of patients who have dementia.

This video indicates the symptoms and behaviors commonly seen during the final stage of dementia progression.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, August 14, 2017

Keeping Older Adult Volunteers (Research, Video 2:15)


The presence of older adult volunteers in many nonprofit organizations is increasing steadily along with their numbers in the general population. But how can they be persuaded to keep returning? When it comes to keeping older adult volunteers, being mindful of what motivates them and their needs are significant. A critical clue lies in the reasons they find their service satisfying. That’s what will tell you when and how to hold them.

A research sample of 172 older adult volunteers reported that, in addition to enjoyment of the volunteer tasks, the degree of satisfaction with management is an important predictor of older volunteers’ intention of remaining in service. These answers have important implications on how organizations manage volunteerism and the relationship between paid staff and volunteers.

Numerous volunteer programs exist that provide varieties of tasks that need to be done. One popular program in America that is designed specifically for older adults is Senior Corps RSVP (Retired and Senior Volunteer program). It is one of the largest volunteer platforms for individuals at least 55 years of age. Their motto is “lead with experience” because experience is what these volunteers have and what our community needs.

Sharing with volunteers the many research-based benefits that they can receive is another means of encouragement. As this video highlights, those benefits include improvements in health, longevity, brain function, depression, and a sense of purpose.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, August 7, 2017

Caregiver Guilt, Gender, Forgiveness (Research, Video 1:32)


Women and men who are caregivers don’t always want to be caregivers. Some enjoy nurturing their patients and find the caregiving experience challenging, but rewarding. Few people talk about caregivers who feel depressed, trapped in a hole with no way out except the death of persons in their care. Even reading this may sound scary. Imagine the guilt a caregiver might have when these feelings rise to the surface during their daily living.

This study analyzed guilt among family caregivers of dependent patients from a gender perspective. Interviewed were 73 family caregivers and 23 health professionals (family medicine, community nursing, and social work) with a focus on the following areas of guilt:

1) Guilt for abandoning family and friends

2) Guilt for the relationship with the dependent person

3) Guilt for placing the relative in a nursing home

Results indicated that women report more guilt than men for abandoning family and friends because of their relationship with the dependent person. Regarding nursing home placement, no difference was observed as a function of gender.

Guilt is a major problem that must be addressed by caregivers and healthcare professionals. Not finding solutions for guilt can lead to mental health issues. Caregivers need respite time away from patients, so they can share their experiences, gain information from others, and relieve stress. They need programs that save them time and make them feel that they are cared about by others. They need people to be their caregivers by temporarily relieving their burdens, sharing an uplifting activity, being good listeners, and providing encouragement.

One important beginning for caregiver relief of guilt is forgiveness of self.
In this video, Dr. Alexis Abramson discusses various ways for accepting and alleviating caregiver guilt.
    

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, July 31, 2017

Predicting Your Future Health (Research, Video)

Can people accurately predict their own health? Can self-rated predictions of mortality or decline in instrumental daily living activities be mostly true? This study of self-rated health predictions and decline in instrumental activities of daily living included community-dwelling older adults 65 years or older (2,638 males and 3,346 females). 

Results reported that poorer self-rated health was significantly associated with decline in both men and women and confirmed that self-rated health is an independent predictor of decline in instrumental activities of daily living among non-disabled community-dwelling older adults.

For those interested in a personal comprehensive diagnosis of their future medical health and health risks, a company started by a geneticist can provide this service at a cost of up to $50,000. Some say knowing the future in such detail is not natural. View other pros and cons in this “WHDT World News” video that includes a brief “60 Minutes” interview. Would you pay thousands to have your future health predicted? 


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 24, 2017

Dementia, Long-Term Care Sexual Intimacy Views (Research, Video 4:54)


When the topic of long-term care sexual intimacy regarding people who have dementia arises, family members, loved ones, and staff have varied views. While research is limited on the best ways these residents can express themselves sexually within guidelines respectful of others, this particular study investigated this issue.

Through interviews, this dementia long-term care sexual intimacy research
explored the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia who were still married to other people. The following themes emerged:

1) The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes.

2) A light-hearted or non-physical connection between residents is deemed acceptable. The moment it becomes a sexual relationship, decision-making becomes more complicated.

3) Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern.


4) Relatives were considerate of the difficulties and dilemmas faced by care home staff.


Older adults with dementia can and do express sexual intimacy that is appropriate. Mutual consent is an important factor.  However, sometimes sexual behaviors can be inappropriate. Dr. David Conn explains in this video some causes of inappropriate sexual behavior and how these behaviors can be addressed by caregivers and family members:


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 17, 2017

Age-Friendly Communities for Older Adults (Research, Video 3:41)

Older adults have made their voices very clear about wanting to age in place at home. But without a great deal of support from the community in addition to varied and better services, aging in place will be hard to meet mental and physical needs of a rapidly growing population. More emphasis should be on prevention-focused and community-based approaches.

Fortunately, initiatives such as the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States have stepped up to meet the challenge. What should be provided to create successful age-friendly communitiesThese are necessary considerations:

1) Older adults should be actively involved, valued, and supported with necessary infrastructure and services.

2)  There should be affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options.

3)  There should be opportunities for social participation, community leadership, and accessible health and wellness services.

4)  Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important.

5)  Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.

Age-friendly West Chester, PA, which is featured in this video, is a great example of a World Health Organization's Global Network of Age-Friendly Cities and Communities. Older adults there are socially integrated, diverse, and connected to younger generations.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 10, 2017

Family Caregivers Managing End-of-Life Pain (Research, Video 2:05)


This is the face of serious pain, a face that many who work in the healthcare fields have seen. I remember describing in a poem a hospice patient of mine in this way: “Eyes that have seen ninety years squint tightly as daggers of pain pierce his cancerous form.” Imagine how family caregivers must feel witnessing their loved ones experiencing intermittent frustration and distress of an internal battlefield of pain.

According to several research studies, pain management was the most identified burden faced by family caregivers in end-of-life caregiving. These fourteen research papers focused on family caregivers' experience of pain management and strategies in end-of-life care. 
These were the major areas of pain management research focus:

1) Family caregivers' engagement in pain management and
    communication with the hospice care team about pain control

2) Family caregivers' knowledge, skills, and effectiveness in treating pain

3) Family caregivers' concerns and experience of pain management


Results confirmed what previous studies have already reported with these themes:

1) Inadequate knowledge and assessment skills in pain management

2) Misunderstanding of pain medications

3) Poor communication with the care team


Efforts in understanding and supporting family caregiving pain management needs are areas that must be addressed far better if patient-centered care is to be realized. Implementation is critical to patients’ care and family caregiver empowerment. In addition, more diverse patients and caregivers must be participants in the research. In this video, Dr. Mimi Pattison, Director of Franciscan Hospice, discusses beneficial pain management for those who are dying:



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, July 3, 2017

Volunteering, Making Friends with People Who Have Dementia (Research)


A hospice volunteer many years in Detroit, Michigan nursing homes with residents who had dementia, I was delighted to find research about volunteers “befriending” people with this disease. This study included a small group of nine volunteers who were younger and older adults. Responding to interview questions, they shared their friendship experiences in detail. They emphasized numerous complex and unique processes that generated issues of power, equality, and boundaries. These are some of the rewards they received from volunteering. Remember, good volunteering is always win-win:

1)   Making friends with people who have dementia was described as “a deeply personal and human experience, often with emotional power and profound meaning.”
2)   Volunteers were able to see past dementia stereotypes.
3)   Volunteers’ personal assumptions and boundaries were challenged.
4)   Volunteers became more reflective about love, life, and humanness.

This research concluded that future studies should consider the experiences of those receiving the volunteer service, ways of making the mutual friendship more effective, and more exploration of volunteer difficulties and support.

The recommendation that I would make to all volunteers and anyone else making friends with people who have dementia is based on what I have learned while making friends with my hospice patients and others who have dementia. I have included this advice in number four of my list titled Hospice Volunteer Success in 10 Steps:” 

4) Try other doors.

Patients will have challenges such as dementia that may not respond to your usual front-door communication. Try other doors and even windows. Obstacles are enrichment opportunities in your partnerships with patients. Touch, music, pictures, stories, and fantasies are a few entry points. Let patients help you navigate your way into their world.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, June 26, 2017

Lesbian, Gay, Bisexual, Transgender (LGBT) Patients: Research on Nursing Students (Doctors' Support Video 2:43)



Lesbian, gay, bisexual, and transgender (LGBT) patients have a history of being discriminated against in the healthcare system and society in general. Very little research is available on the attitudes of nursing students toward this marginalized population. The purpose of this research on LGBT nursing students’ attitudes was to appraise findings on this issue through an electronic search. Medical subject headings using search terms such as gay, lesbian, transgender, bisexual, LGBT, nursing students, etc. were used.

These were the results:

1) Fewer than 50 percent of the studies (5 out of 12) suggested more positive attitudes of nursing students toward LGBT persons.

2) Six studies reported negative attitudes, and one study reported neutral attitudes.

These studies indicate that nursing students' attitudes are becoming more positive. Studies published before 2000 reported a preponderance of negative attitudes toward LGBT patients. Negative attitudes impact disparities.


UC Davis Health System has incorporated a practice with doctors that provide LGBT support they believe can reduce LGBT healthcare disparities. Doctors ask patients sexual orientation and gender identity questions as part of the routine clinical assessment. By standardizing the collection of this information through the electronic health record, UC Davis officials believe this gives doctors a better understanding of each patient and helps them provide more well-informed medical advice and care. The following video explains the outcomes:




Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog