Siena Kathleen V.

Placino NR101

Joshua Rafael Quiñones Dean Maria Corazon Valdeavilla

Related Literature Compilation

AUTHOR TITLE OF THE LOCALE SIGNIFICANT FINDINGS

(INCLUDE STUDY
DATE)

Archimore The Lived Broward • “HIV/ AIDS dramatically leads to long struggles and
Alexander Experience of County, concerns for human rights at end-of-life (EOL) care.” (1st
Wright, 2016 Registered Florida paragraph; pg. 4)

Nurses Caring Dissertatio • "Method: This study employed a descriptive/interpretive

for Patients n paradigm navigated by Max van Manen’s
Living With phenomenological method. Purposive and snow-ball
HIV/AIDS in sampling were utilized by the researcher to recruit
Broward registered nurses (RNs) for the study. Data collection was
County, acquired using digital voice recorders to conduct semi-
Florida structured face-to-face interviews with a maximum of 12
Dissertation elected participants.” (paragraph 4; pg. 4)

• “Results: Four major related themes were conclusive

from the findings of the study, as unknowing,
incapacitating, dejecting, and nurturing, and five sub-
themes of swimming in deep waters, exasperating,
dreading occupational exposures, feeling of emptiness,
and emotional and physical support through this
phenomenological descriptive/interpretive
exploration.” (5th/ last paragraph; pg. 4-5)

• “The results of the study emphasized the quintessence

of nurse’s experiences by illuminating the fear of the
unknown dealing with the disease HIV/AIDS, in which
they displayed courage, resilience, empathy, and
nurturing while caring for this fragile population.” (2nd
paragraph; pg. 5)

• “The strength of qualitative research is its capability to

deliver intricate textual descriptions of how people
experience a given research issue. The bases of the
research provided information about the human side of
the role in caring. Multiple behaviors, emotions, opinions,
beliefs, and relationships of the RN to intense situations
and settings were explored. Qualitative methods of
inquiry were also fundamental in detecting intangible
factors, such as socioeconomic status, social norms,
ethnicity, religion, and gender roles, which may not have
been visible (Mack, Woodsong, MacQueen, Guest, &
Namey, 2005).” (pg 35)

•
Hermeneutic (Interpretive) Phenomenological
Approach
Yan-Ping Working Fuzhou, • “Results: Two themes (positive and negative working
Wei, Hong Experiences Fujian experiences) and six sub-themes were drawn:
Li, Ping of Nursing Province, companionship, happiness, trust, achievement, hard
Chen, Jing Aides in China
work, and grievance. “ (pg 1; Abstract)

Li, Huiying Nursing

Chen, Li-Li Homes: A • “Most nursing aides expressed positive aspects of their
Chen (2015) Qualitative work experiences, such as companionship, happiness,
Study trust and achievement.” (pg. 3 (Findings: Theme 1:
positive experiences) (3.1))

• (Companionship) “I believe a tender heart and patience

make the elderly trust and love us.” (NA1) 3.11)

• “Most nursing aides considered caring for the elderly as

a process of offering love, during which they had a sense
of happiness. They were happy to have companionship,
love and praise.” (pg. 3 (3.1.2))

• “The nursing aides often gradually gained the trust of the

res- idents after establishing a good relationship.

• Because nursing aides rotate through different wards,

they have to easily adapt to new places.” (pg. 3; 3.1.3)

• “Elderly patients, especially those with dementia, often

thought their belongings were stolen. It was difficult to
deal with, but the nursing aides could often change the
residents' minds by offering kindness. “ (pg. 3; 3.1.3)

• The residents tended to become accustomed to the

care- giver who had cared for them for a longer period,
so a new nursing aide must attempt to get involved.

• “I tried to wash face for an elderly once, but she

turned me down as soon as she saw the former nursing
aide with whom she was familiar. I then convinced her to
let me try one time. I did so and then washed her feet
and helped her to go to bed. She felt what I did was not
bad. Next time I asked if she needed another nursing
aide, she refused and accepted my service.” (NA9) (pg
3; 3.1.3)

• “Sub-theme 4: achievement

• Caring for the elderly is difficult work. However, when the

nursing aides overcame the toughness, they felt
achievement.” (pg. 3; 3.1.4)

• 3.2.1. Sub-theme 1: hard work

• Nursing aides considered their work to be an important

process of love, some elderly were difficult to get along
with, had decreased physical abilities, and some of them
suffered from psychiatric symptoms. (pg. 4; 3.2.1)

• “3.2.2. Sub-theme 2: grievance

• Elderly care can cause difficulties and grievance. The

under- standing and cooperation of family members
were crucial to the nursing aides. …The residents might
easily influence each other. For example, one resident's
negative emotion towards the nursing aides tended to
invoke similar emotions in others. … Some residents
took their care for granted because they had paid and
felt they deserved it. “ (pg. 4; 3.2.2)

• “The daily interactions between residents and nursing

aides easily contribute to conflicts, which can lead to
work-related stress on the nursing aides.” (pg. 5, 2nd
paragraph

• “In our study, the nursing aides also described the

negative aspects of caregiving, explaining that their work
was difficult. In addition to caring for the patients' needs,
the nursing aides should also pay particular attention to
the psychological sta- tus of those in their care, as
nursing home residents often suffer from chronic
diseases and deteriorating health condi- tions.
Furthermore, most nursing aides simply intended to earn
their living when their started their careers, and their low
education levels and lack of training made caring for
patients difficult. “ (pg. 5; paragraph 4)

Susan Silver Understandin • “Although Pearlin’s (1994) model refers to development

Koerner, g “Good and change from a long-term perspective, most
DenYelle Days” and individuals in a caregiving role likely experience a range
Baete “Bad Days”: of both “good days” and “bad days” - that is, they
Kenyon Emotional and experience day-to-day fluctuations in caregiving
Physical stressors and personal well-being.” (pg. 1; 2nd
Reactivity paragraph)

Among • “…the purpose of the present study was to (a) document

Caregivers for within-person variability or daily fluctuation in caregivers’
Elder experiences and well-being, (b) determine whether
Relatives caregivers report more signs of negative well-being on
days when they report higher than usual care demands
or care-related stressors, and (c) identify which
caregivers are particularly susceptible or reactive to
fluctuations in daily care demands and care-related
stressors.” (pg. 2; paragraph 1)

• “Stressors are categorized as either primary or

secondary. Primary stressors stem directly from the
needs of the care recipient and the nature and extent of
caregiving demanded by those needs. Key examples of
primary stressors include the hours or tasks involved in
caregiving, care recipient physical impairment, care
recipient cognitive impairment, and behavior problems
such as anger or aggression are associated with poorer
mental and physical health on the part of caregivers
(e.g., Gaugler, Davey, Pearlin, & Zarit, 2000; Schulz,
O’Brien, Bookwala, & Fleissner, 1995)…Secondary
stressors are indirectly linked to caregiver role and come
in the form of intraphysic strains (e.g., feelings of role
captivity) and role strains (e.g., family disagreements
regarding care, job-caregiving conflict).” (pg. 2;
paragraph 1-2)

• “In the present study, we measured two primary

stressors (number of caregiving tasks and care recipient
behavior problems) and one secondary stressor (family
disagreements regarding care) on a daily basis and
focused on caregiver reactivity to fluctuations in those
stressors as measured in daily assessments of
depressive symptoms, feelings of burden, and physical
health symptoms (PHS). In short, we have embraced
Pearlin’s perspective that caregiving stressors are not
static and that caregiver well-being should not be viewed
as an end-state.” (pg 2, paragraph 4)

• “In other words, daily reactivity may have implications for

longer term mental and physical health sequelae.” (pg. 2
paragraph 4)

• “In particular, we found that on days when caregivers

must assist with more caregiving tasks than usual or are
faced with more care recipient behavior problems (e.g.,
anger/ aggression, being awakened at night), they
experience an increased level of depressive symptoms,
feelings of burden and PHS. …In fact, we found that the
occurrence of just one additional family disagreement
can noticeably increase feelings of caregiving burden
and PHS. This finding underscores just how salient the
family can be in influencing the caregiver’s day-to-day
physical health.” (pg. 8; paragraph 2; “Reactivity:
Stressors and Daily Fluctuations in Caregiver Well-Being)

• “Although the addition of daily care and care-related

stressors was associated with within-person fluctuations
in caregiver well-being, the strength of some of those
associations differed as a function of both caregiver
gender and caregiver personality. As hypothesized, in
comparison with male caregivers, female caregivers were
more susceptible to fluctuation in their emotional and
physical well-being in the face of daily changes and
events in the caregiving role.” (pg. 8, paragraph 4;
“Gender and Personality as Moderators of Reactivity)

• “With regard to the role of personality, as hypothesized,

caregivers high on neuroticism were especially reactive
to day-to-day increases and decreases in caregiving
demands. In other words, caregivers high on neuroticism
not only experience higher levels of distress than their
low-neuroticism counterparts (a between-person finding)
but they also are less even-keeled and experience more
fluctuations in well-being as care demands (ie., number
of caregiving tasks) change from day to day. …
Specifically, caregiving tasks and events that recur,
though not necessarily on a daily basis (e.g. managing
financial issues, cleaning up after a toileting accident,
experiencing a disagreement with a family member), are
characteristic of the caregiving experience and may be
especially unsettling for caregivers high on
neuroticism.” (pg. 8; paragraph 5)

• “We also found that extroversion was a significant

moderator of reactivity. Caregivers low on extroversion
were more vulnerable to fluctuations in well-being in the
face of care recipient behavior problems and family
disagreements regarding care. This suggests that
caregivers higher on extroversion not only have higher
well-being overall (fewer depressive symptoms, less
feelings of burden, and fewer health symptoms- found in
additional analyses) but they also are more steady in
their emotional and physical well-being as care and care-
related demands change from day to day.” (pg. 9; 1st
paragraph)

• “Conscientiousness also appears to play a moderating

role, although to a lesser extent. We found that having to
assist with additional caregiving tasks on a given day
was more strongly associated with increased depressive
symptoms for those caregivers with comparatively low
conscientiousness scores. A look at the items that
comprised the conscientiousness subscale (e.g.,
organized, hardworking) suggests that being playful can
be a protective factor in terms of caregiver reactivity; or,
stated conversely that being relatively disorganized and
careless can exacerbate the daily negative impact of an
already demanding situation.” (pg. 9; paragraph 2)

• “Caregivers who were more burdened or depressed may

have been more likely to report themselves as more
worried (a key feature of neuroticism) or as less socially
active (a key feature of extroversion).
Linda Nurses’ (all nurses • “Of 429 eligible nurses, 307 (72 percent) returned the
Ganzini, Experience employed questionnaire, and 102 of the re- spondents (33 percent)
M.D., with Hospice by reported that in the previous four years they had cared
M.P.H., Patients who hospice for a pa- tient who deliberately hastened death by
Elizabeth R. Refuse Food programs voluntary refusal of food and fluids.

Goy, Ph.D., and Fluids to in) Oregon • Nurses reported that patients chose to stop eating and
Lois L. Hasten Death drinking because they were ready to die, saw continued
Miller, Ph.D., existence as pointless, and considered their quality of life
R.N., poor. The survey showed that 85 percent of patients died
Theresa A. within 15 days after stopping food and fluids. On a scale
Harvath, from 0 (a very bad death) to 9 (a very good death), the
R.N., Ph.D., median score for the quality of these deaths, as rated by
Ann the nurses, was 8.” (pg. 1 (Abstract: Results)

Jackson, • “On the basis of reports by nurses, patients in hospice

M.B.A., and care who voluntarily choose to refuse food and fluids are
Molly A. elderly, no longer find meaning in living, and usually die a
Delorit, B.A.
“good” death within two weeks after stopping food and
(2003) fluids.” (pg. 1 (Abstract: Conclusions)

• Of these nurses, 16 reported that the patient

subsequently resumed eating and drinking, 8 did not
know the outcome of the patient’s deci- sion, and 102
reported that the patient hastened death as a
consequence of stopping food and fluids.

• "Of these nurses, 16 reported that the patient

subsequently resumed eating and drinking, 8 did not
know the outcome of the patient’s decision, and 102
reported that the patient hastened death as a
consequence of stopping food and fluids.

• Reasons for resuming food and fluids, which were coded

from written comments by 11 nurses, included family
pressure or encouragement to eat (five patients), hunger
or discomfort (four), amelioration of depression (one),
and alleviation of other concerns (one).” (pg. 3; Results
(1st paragraph)

• “Three of the 102 nurses who cared for a patient who

died after stopping food and fluids believed that allowing
a hospice patient to hasten death deliberately in this
manner was unethical. None of the nurses reported that
they would actively oppose a patient’s choice to hasten
death by refusing food and fluids, and only one reported
wanting to decline to care for such a patient.” (pg. 3;
Results (1st paragraph))

• “Twelve nurses (12 percent) report- ed that the patients

who died after stopping food and fluids had a mental
disorder such as depression, which, in their opinion, may
have influenced the decision to refuse food or
fluids.” (pg. 4; paragraph 2)

• “According to the hospice nurses, the most im- portant

reasons for the decision to stop food and fluids were a
readiness to die, the belief that con- tinuing to live was
pointless, an assessment of the quality of life as poor, a
desire to die at home, and a desire to control the
circumstances of death (Table 2).”( pg. 4; paragraph 3)

• The least important reasons were dyspnea, men- tal

confusion, nausea, depression or other psychiat- ric
disorders, concern about being a financial drain, the
experience of having witnessed “bad deaths,” and lack
of social support. The nurses rated the last two weeks of
life as peaceful, with low levels of pain and suffering
(Table 3). ( pg. 4; paragraph 3)

• “Most deaths were rated as “good”(a score of 5 to 9 on a

scale of 0 to 9),though eight nurses (8 percent) rated the
patient’s death as “bad” (a score of 0 to 4). ( pg. 4;
paragraph 3)

• “As compared with patients who died by physician-

assisted suicide, those who stopped eating and drinking
were rated by nurses as suffering less and being more at
peace in the last two weeks of life (Table 3).” (pg. 4;
paragraph 3)

Sara A Quest for Midwester • “Research shows that few social workers are interested
Sanders, Meaning: n (U.S.) in working with cognitively impaired older adults, such as
Peggy Hospice hospice those with Alzheimer’s disease or a related dementia. …
Swails (Apr. Social agencies Although much attention has been given to the needs to
2011) Workers and (2007) individuals with early- and middle stage dementia, little
Patients with attention has been directed towards patients at the end
End-Stage stages of the disease. Even less is known about how
Dementia professionals, particularly hospice social workers, form
therapeutic relationships with these patients given their
severe cognitive impairment.” (Abstract; pg. 1)

• “Two primary themes emerged, each containing three

subthemes, that captured the barriers to and strategies
for forming meaningful relationships with patients with
end-stage dementia. The results of this study have
implications for hospice social workers and social
workers in other healthcare settings and the types of
training they need to strengthen their practice with
cognitively impaired populations.” (Abstract; pg. 1)

• “The social workers felt that biases about dementia care

naturally developed in hospice settings, where the focus
is on helping patients prepare for death, which
commonly occurs through mutual interactions and
relationships. “I think society and hospice validates
physical ailments more than dementia or cognitive
problems. Patients who are unable to cognitively
participate in their dying process are often dismissed
and treated as last.”…The tendency to “dismiss”
dementia patients was even more prevalent when social
workers struggled to engage families in the care of the
patient or if the families lived out of state and had
minimal contact with the patient. “ (pg. 6 paragraph 2)

• “The biases that the social workers had about dementia

care created feelings of guilt. …Guilt was heightened by
the recognition that dementia patients had been
“disregarded” by the social workers on hospice teams.
…The guilt about the biases toward dementia care
transitioned into “embarrassment” or “shame” in the
social workers as the topic was discussed more in the
focus groups…(pg. 6 paragraph 3)

• “Fear. The social workers indicated that fear of dementia

was another barrier that prevented them from finding
meaning in their work with patients with dementia.
According to one social worker, “I remember very
distinctly, I went to the third floor (of a nursing home) and
it was so frightening to be up there, to be surrounded by
such confusion.”

• “Talking with families about the struggles they had

experienced as they provided care at times enhanced
the fear of the social workers about the dementia
diagnosis, because the stories that were shared
demonstrated the impact of the disease on the patient
and the entire family.” (pg. 6-7; paragraph 9)

• “Educational Needs. The social workers indicated that

their lack of education about dementia was a barrier: The
social workers made statements such as these: “I don’t
feel at all like I was prepared to deal with dementia.” …
The social workers indicated that they were providing
services with “very few skills.”” (pg. 7; paragraph 2)

• “Throughout each focus group, the social workers,

without prompting, outlined training needs. These
training needs included working with caregiver grief and
loss, knowledge of the disease and behavioral
management, strategies to enhance their relationship
with the patient, and ways to address and resolve issues
from the past.” (pg. 3; paragraph 3)

• “One of the strategies to find meaning in the interactions

with patients with dementia was setting realistic
expectations about a visit in advance. A question that
the social workers asked themselves prior to the visit
was this: “What is my purpose here and with this
patient?” The answer to this question provided a
framework for their visit.” (pg. 7; paragraph 6)

• “Another strategy that the social workers used to find

meaning from their visits was to redefine what it meant
to provide end-of-life care for patients with dementia.
The social workers indicated that their definition of end-
of-life care was based on a model of “reminiscence, “life
review,” and “providing a time for reconciliation…steps
toward a good death,” all of which are most successfully
accomplished through “two-way conversations.” (pg. 7;
paragraph 7)

• “The social workers found that when they saw a spark of

the hidden person during visits or made a connection
with the patient, dementia care, at least for a moment,
became more enjoyable.” (pg. 8; paragraph 5)
Jennifer The Long • “All of the women who provided in-home care had more
Caputo and Term Effects depressive symptoms in 1989 and functional limitations
Eliza K. of Caregiving in 1995 than noncaregivers, and women who were caring
Pavalko on Women’s for someone other than a spouse or parent in the home
(Indiana Health and had higher mortality rates than noncaregivers.” (pg. 9;
University); Mortality paragraph 2)

Melissa A. • “Out-of-home caregivers were younger than

Hardy noncaregivers, whereas those who cared for a spouse
(Pennsylvani in-home were older….Out-of home caregivers were
a State better educated than noncare- givers, whereas in-home
University) caregivers of spouses or someone other than a spouse
(Oct 2016) or parent had fewer years of education than
noncaregivers. ” (pg. 9; paragraph 3)

• “Turning to differences in health, social inte- gration, and

family, we first noted that other in-home caregivers were
more likely to have been depressed in 1981 than
noncaregivers. All in-home caregivers tended to have
more precaregiving health problems than noncare-
givers. By contrast, those who provided care outside of
the home were less likely to have a health problem that
limited or prevented work and less likely to be
functionally limited during the years before caregiving
was measured. All caregivers were more likely to have
volunteered than women who did no care work between
1984 and 1989. Caregiving experiences also varied by
marital status. Married women were at greater risk of
caregiving both inside and outside the home, and in
general, women with more living parents and fewer
siblings were at greater risk of providing care.” (pg. 9;
paragraph 4)

• “On many characteristics, women who provided care for

a parent or parent-in-law were the most similar of any
care- giving group to noncaregivers, whereas those who
provided care to a spouse or other house- hold member
tended to be in poorer health, less educated, less likely
to be employed, and less likely to be volunteers. In
contrast, out-of-home caregivers tended to have more
education, better health, and more social integration
from mar- riage and volunteer work.” (pg 9; paragraph 5)

• “Model 1 also showed that coresidential caregivers had

more depressive symptoms than noncaregivers.” (pg. 9;
paragraph 5

• “Model 1 also showed that those who provided care

outside the home from 1984 to 1989 reported fewer
functional limitations than noncaregivers, whereas in-
home caregivers experienced more functional
limitations.” (pg. 12; paragraph 2)

Katharine The Lived Canada • “The purpose of this phenomenological study was to
Fuchigami Experiences better understand the lived experiences of 10 home care
(May 2018) of Home Care nurses providing palliative care information to
Nurses community-dwelling older adults with a terminal illness.
Providing Thematic analysis revealed eight key themes:
Palliative Care importance of support and unity; tools for providing
Information to information; building relationships with clients; comfort
Community- level talking about death and dying; language and
Dwelling Older cultural barriers; clients’ readiness to accept information;
Adults with a influence of the home environment; and helping clients
Terminal to a good death.” (pg. 2; Abstract)

Illness • “Eight key themes emerged from this study: (1)

importance of support and unity, (2) tools for providing
information, (3) building a relationship with clients, (4)
comfort level talking about death and dying, (5) language
and cultural barriers, (6) clients’ readiness to accept
information, (7) influence of the home environment, and
(8) helping your client to a good death. Several of these
themes contained multiple sub-themes.” (pg. 46;
paragraph 3)

• Participants explained that in an ideal situation, when a

client is first admitted to the palliative care service, the
client’s most responsible physician has already provided
the client with information regarding diagnosis,
prognosis, and what to expect. Participants stated that
they would then receive an update from the physician
regarding the client’s condition. This enabled them to
answer any questions the clients may have about their
diagnosis and discuss what they would be able to do for
the client, including care options. It was noted by the
participants that if any physician decided to become the
client’s most responsible physician, they agreed to be
available for contact at all times. (pg. 49; paragraph 1)

• In some cases, participants found that they were not

getting valuable information, updates, or clear
instructions from physicians. Many participants
expressed that it then became a challenge for them to
provide information to their clients. Participant 1 stated:

• ...well a big challenge that we haven’t talked about is just

getting the information from the hospital or from the
family doctor, you know, from people like that...a
discharge note will go from the specialist or from the
oncology to the family doctor, but it never comes to us.
And sometimes there’s good information in there that
would be helpful for us to have. “ (pg. 49; paragraph 2)

• “Participant 1 further expressed her worries: “I worry

about, you know, if I haven’t gotten clear instructions
from the doctor about something, um, you know, I’m
worried about not having all the answers for them [her
clients] because I haven’t been given the most recent
reports”. She noted feeling frustrated that she would
sometimes have be “a little vague” with her clients
because she did not want to give them the wrong
information.” (pg. 49; paragraph 3)

• “One participant in particular explained that the most

challenging part of providing information was when “the
most responsible physician has not had a frank
discussion with the client” (participant 3). She went on to
explain: “I don’t feel it’s my place to give them the
diagnosis and the prognosis, it’s the most responsible
physician. It’s, I think, their kind of job to give them the
diagnosis and prognosis”. Participant 3 stressed that it
was a big challenge for her when she was unable to
provide her client with the information they requested
because the physician had not discussed the diagnosis
and prognosis.” (pg. 50; paragraph 1)

• “Many of the participants indicated that they turned to a

colleague, quite often another nurse who was
experienced and trained in palliative care, when they
needed help with difficult situations. Participant 4
explained that when a family was not hearing any of the
information, her colleague would make a joint visit with
her to help facilitate end of life discussions with the client
and family. Similarly, participant 6 explained that a joint
visit with a colleague was very helpful to learn some
‘tricks and tools’ to facilitate difficult conversations that
she could use with her clients in the future. Participant 2
added that the clinical lead resource practice nurse at
the agency was another great resource for difficult
situations.” (pg 50; paragraph 3).

• A few participants recalled moments of having to

decompress after difficult situations. In these cases,
colleagues, such as their managers, were very
supportive “either if it’s venting or you know,
crying” (participant 7). Participant 6 revealed having
previously called all three managers at her office in times
of stress. She shared the following example of a difficult
situation:

• One day I had been 6 hours, 6 and a half hours with a

client because there had been miscommunication... I
spent the last 6 hours of his life, keeping him
comfortable and dealing with stuff. And my day that day
went to 15 hours because I couldn’t give away the rest of
my clients. So I’d seen 2, I went to see this guy, wound
up staying until he died, because we could not control
everything, so it was 6 hours...the doctor was there for
the first hour, and I called him 8 or 9 times in the
intervening hours. And then I called and said he passed.
And then I did all the stuff that we do, and then I left to
my next client...The next day I went into the manager
and I...she held me, and let me cry, and let me vent, and
I went on with my day. Because that’s what we do.
(participant 6) “ (pg. 52; paragraph 2)

• “Some of the participants noted that sometimes they just

end up working longer days to spend that extra time with
their palliative care clients.” (pg. 53 paragraph 2)

• “Identifying clients in their final year of life was deemed

an important part of advanced care planning. Participant
1 used a tool, which she could not remember the name
of, to identify clients that were in the last year of their life
to aid in the timing of advanced care planning
conversations …” (pg. 55; paragraph 55)

This Classic An Impact Elderly persons represent an increasing percentage

Paper is of Aging of all clients served by allied health practitioners.
reprinted Society on Patterns of specialization are shifting toward those
from the Allied Health areas of practice unique to the elderly.

November Practice and Practice will increasingly be called upon to address
1987 issue Education the interactive nature of multiple chronic conditions
of the in our aging population.

Journal of METHOD:The broader context for these actions is
Allied the need to adapt current services to nonhospital
Health. settings, more often those in underserved rural and
This inner city areas. The section that follows explores
special the impact of these needs on allied health practice.

issue was allied health practice should emphasize the
entitled importance of life-style improvements across the life
“An Aging cycle.

Society: 

Implication Emphasis on treatment and rehabilitation of chronic
s for diseases and disabilities, maintenance of
Health independent lifestyles, and health promotion and
Care prevention methodologies are growing, while
Needs, attention to acute patterns of treatment and
Impacts on traditional concepts of “cure” lessens. These growth
Health areas fall more directly within the practice domain
Education, of many allied health professions.

and 

Practice” Allied health professionals and students must also be
and familiar with the varying long-term care options for
comprised mentally ill older patients and how particular skills
an invited need to be adapted for those care environments.
collection Similarly, because medications and other
of articles interventions typically interact, allied health
guest education should emphasize the unique
edited by pharmacologic needs of older people as they relate
Leopold G. to the treatments and interventions attempted by
Selker. J each health profession. Allied health students should
Allied study drug interactions and adverse reactions in the
Health elderly, and how medication may affect provision of
1987; care and compliance with treatment regimens. This
16:323– should be part of basic entry-level education for all
334. allied health professions



RESULTS:the result of this study is After all, nursing
and allied health are long-term care. Home health
agencies and nursing homes may find it economically
desirable to expand their staff of therapists,
nutritionists, and other allied health professionals.



Health problems which increase in frequency with
age (strokes, heart attacks, mental disorders,
malignancies, respiratory and circulatory disorders,
periodontal disease, visual and auditory disorders,
depression, and amputations) will have an even
greater impact because of the associated disability
and complexity of such chronic conditions and the
low potential for full or complete recovery. Such
conditions will require long-term services of a wider
variety of rehabilitative professions, including
physical and occupational therapy, social work,
speech-language pathology and audiology,
recreational therapy, clinical psychology, respiratory
therapy, and a variety of medical specialties



One impact of the aging society has been the
emergence of geriatric allied health professionals
who specialize in care of the elderly.



allied health professionals and others are unable to
influence the health and life-style behaviors of
today’s young and middle-aged people, tomorrow’s
elderly will suffer from many of the same health
problems



The current crisis, well beyond the problem of
students’ and professionals’ ageist attitudes toward
older persons, may best be depicted as a vicious
cycle involving insufficient interest in and emphasis
on geriatric care, declining replacement of older
geriatric faculty and clinicians, declining geriatric
enrollments, and increasingly insufficient numbers
of geriatric practitioners.



impacts on practice and education, the Task Force
identified five major areas where substantive
commonalities exist across allied health professions.
The topics of recruitment, case management,
barriers to progress, reimbursement, and research
funding are all of sufficient import to merit
expanded treatment. This section serves that
purpose



 Authors: 
 A National United To date, knowledge of the experiences of older
Ornstein, Profile Of States of adults’ caregivers at the end of life has come from
K. , Kelley End-Of-Life America studies that were limited to specific diseases and so-
A. , Caregiving In called primary caregivers and that relied on the
Bollens- The United recollections of people in convenience samples.
Lund, E. , States. Using nationally representative, prospective data for
and Wolff, 2011, we found that 900,000 community-dwelling
J. (N.D)
 Medicare beneficiaries ages sixty-five and older who

 died within the following twelve months received
The support from 2.3 million caregivers.

People-to- Elderly persons represent an increasing percentage
People of all clients served by allied health practitioners.
Health Patterns of specialization are shifting toward those
Foundation areas of practice unique to the elderly. Emphasis
, Inc. on treatment and rehabilitation of chronic diseases
(2017) and disabilities, maintenance of independent
lifestyles, and health promotion and prevention
methodologies are growing, while attention to acute
patterns of treatment and traditional concepts of
“cure” lessens. The impact of the Prospective
Payment System (PPS) has caused hospitals to refer
the elderly with chronic diseases and long
convalescences to alternative care, such as nursing
home and home care. The problem is that many
allied health personnel have not been trained to
care for the elderly in these surroundings.

METHOD:

This work expands knowledge about the scope of
end-of-life caregiving and its related challenges by
examining all caregivers—both paid and unpaid—who
are involved in the care of older adults. While our
work confirms the vital role of family and other
unpaid caregivers before and during the end-of-life
period.



A national representative survey of family members
National and other unpaid caregivers who assist older people
Study of with disabilities, NSOC identified people on the
Caregiving NHATS helper roster who were listed as a family
(NSOC) member or other unpaid helper who provided
(N.D) assistance with mobility, personal care, household
activities, transportation, or medically oriented
tasks.

The NHATS sample for our analysis consisted of
2,423 community-dwelling older adults who received
help with personal care, mobility, or household
activities from a family member or other unpaid
helper. Older adults were classified as being at the
end of life if they died within twelve months of
completing the NHATS interview, based on dates of
death from the Medicare Master Beneficiary
Summary File. Additionally, older adults who were
identified as having died within twelve months in
the NHATS Last Month of Life survey and who did not


The NHATS sample for our analysis consisted of
2,423 community-dwelling older adults who received
help with personal care, mobility, or household
activities from a family member or other unpaid
helper. Older adults were classified as being at the
end of life if they died within twelve months of
completing the NHATS interview, based on dates of
death from the Medicare Master Beneficiary
Summary File. Additionally, older adults who were
identified as having died within twelve months in
the NHATS Last Month of Life survey and who did not
subsequently incur Medicare-reimbursed services
were classified as being at the end of life. In total,
264 of the 2,423 older adults were characterized as
being at the end of life. At least one NSOC interview
was completed with caregivers of the 1,369 eligible
older adults, resulting in a sample of 2,007 family
and other unpaid caregivers who provided
assistance, of whom 235 were end-of life caregivers.
Caregivers may assume new and potentially
challenging tasks as an older adult’s end of life
approaches, including managing symptoms, engaging
in difficult decisions about transitioning to long-term
care or hospice, serving as a surrogate in medical
decisions, and hiring paid caregivers



RESULTS: Results from this study confirm the
significant and enduring involvement of caregivers in
meeting the needs of older adults at the end of life.
Supporting the growing population of family and
other unpaid caregivers is an urgent public health
issue. Our findings indicate that the need for
adequate support is especially pressing when the
2,423 community-dwelling older adults receiving
help for health or functioning, the 264 (11 percent)
who died within one year of study enrollment were
representative of an estimated 905,000 people
nationwide in 2011. Those at the end of life were
older, less likely to be female, in worse health, and
more likely to have been hospitalized within the
past twelve months, and had more impaired
functioning, compared with their counterparts who
were not at the end of life. Older adults at the end
of life were also more likely than other older adults
to be assisted by paid caregivers (20 percent versus
14 percent). Only 9 percent of older adults at the
end of life received any caregiving support that was
funded by federal, state, or private insurance. An
estimated 2.3 million caregivers nationwide assisted
older adults at the end of life. An examination of
help by disease type indicated that the total
numbers of caregivers, hours of help, and rate of
receipt of any paid help were higher at the end of
life than at other times for people with cancer,
dementia, and heart disease. Older adults with
heart disease at the end of life were the most likely
to receive any paid help (33 percent for heart
disease, 22 percent for cancer, and 25 percent for
dementia). While older adults with cancer or heart
disease at the end of life were more than twice as
likely as others with these diseases to receive help
paid through government or other insurance, there
was no significant difference by survival status
among those with dementia (9 percent for older
adults not at the end of life and 12 percent for those
at the end of life)