Findings suggest that the nursing home environment in these two facilities, as now structured, is an inappropriate setting for end-of-life care.

No abstract

No abstract

The purpose of this study is to describe the symptom experience of adult patients hospitalized in medical/surgical units, to examine the relationship between demographic characteristics and symptom experience, and to explore the relationship between symptom severity and symptom distress. Utilizing the Memorial Symptom Assessment Scale (MSAS), patients (n=334) were asked to convey the presence or absence of each of 31 symptoms, the severity of the symptoms, and the degree to which the symptoms distressed or bothered them. Higher levels of symptom distress were found in women and in those who were unpartnered. The average number of symptoms reported per patient was 9.31 (SD=5.15), with a mean symptom distress rating of 1.8 (SD=0.84) and a mean symptom severity rating of 1.65 (SD=0.83) on a 1-5 scale. The correlation between reports of symptom severity and symptom distress varied greatly by symptom, ranging from r=0.37 to r=0.82. This is the first study to examine the symptom prevalence, severity, and distress of hospitalized medical/surgical patients. The large sample size allowed for the detection of demographic differences in the reporting of symptom distress, and advances the current knowledge in the area.

Although hospice care is of some benefit, pain management and high-quality end-of-life care is dependent upon the context in which it is provided. Given that between 1991 and 2001 Medicare expenditures for nursing home-based hospice care increased from dollar 8.6 million to dollar 21.8 million, the effectiveness of hospice-care programs in nursing homes warrants further study.

For the many older adults living in long-term care facilities, the ability to connect with others, as well as with one's own personal past, may be of particular value. Reflecting on the past and sharing reminiscences with others serves different psychosocial functions in various settings. This study examined the functions of reminiscence for long-term care residents in the United States (M = 86.5) by addressing the self-reported frequency of reminiscence, the counterparties involved, the overall purpose and value of reminiscence, and the relation to residents' mental health and well-being. Results demonstrated that although some functions of reminiscence were comparable to those found in community-dwelling older adults, others were unique to the long-term care setting. Residents were most likely to reminisce alone and they found the experience enjoyable. They reported engaging in and enjoying reminiscence with family more than with fellow residents, and a subset desired increased opportunities to share memories with healthcare providers. Residents with lower morale and more depressive symptoms were more likely to engage in unhealthy styles of reminiscence. These findings suggest that interventions shaping reminiscence encounters may have positive outcomes for long-term care residents.

The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs.

This chapter explores the ways in which remembering alone or with others shapes what older adults remember and what they forget, and how such memory activities impact their mental health and well-being. Two related but largely separate bodies of research on older adults are examined, one using a primarily laboratory approach to understand how and when collaborative remembering helps or hinders memory, and the other using descriptive and correlational studies about the functions and values of reminiscing and sharing one’s personal memories with other people. We examine the use and value of reminiscence in healthy community-dwelling older adults, as well as in older adults with some degree of cognitive impairment living in long-term care nursing facilities.