he use of medicines for the treatment of disease is a common health-related action by Australians. Medicines are not only used to treat diagnosed medical conditions but, increasingly, to manage risk factors. 1 Individuals' patterns of medicines use are not well understood, including the combined use of prescription, over-the-counter (OTC) and complementary medicines. Smaller surveys of specific populations' use of medicines have been conducted, 2,3 but the most recent Australia-wide survey was the 1995 National Health Survey. 4 A majority of published Australian research on the use of medicines is based on the analysis of dispensing data from the Australian Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme; however, these data sources do not include OTC, complementary and unsubsidised prescription medicines. 5 Use of and access to medicines is changing. An ageing population is contributing to the national increase in medicine consumption and cost. 6 The popularity of complementary medicines has led to increased access to these products through conventional sources of non-prescription medicines, such as pharmacies and supermarkets, as well as through complementary medicine practitioners. 7,8 Our study, a national census of medicines use, aimed to address current knowledge gaps by exploring current use of prescription, OTC and complementary medicines, and the patterns and predictors of their use, by Australians aged 50 years and older.

Palliative family caregiving for older adults is gendered. Gender affects why people care and the consequences of providing care. Palliative care literature needs to incorporate a greater gender focus for future research and policy makers need to be aware of the gendered ramifications of providing more palliative care in the community.

There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice.

BackgroundIn most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. Despite the fact that they provide the majority of direct care for residents, little is known about a key care aspect of their work, namely their experience of caring for dying residents.MethodsTwenty-six Health Care Assistants working in aged residential care facilities in Auckland, New Zealand participated in six focus group discussions. Focus groups were designed to explore the experiences of Health Care Assistants caring for imminently dying residents in aged care facilities and to identify barriers and facilitators to their work in this area. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach.ResultsParticipants confirmed that Health Care Assistants provide the majority of hands on care to dying residents and believed they had a valuable role to play at this time due to their unique ‘familial’ relationship with residents and families. However, it was apparent that a number of barriers existed to them maximising their contribution to supporting dying residents, most notably the lack of value placed on their knowledge and experience by other members of the multidisciplinary team. Whilst a need for additional palliative and end of life care education was identified, a preference was identified for hands on education delivered by peers, rather than the didactic education they currently receive.ConclusionGiven ageing populations internationally coupled with a constrained health budget, the role of Health Care Assistants in most developed countries is likely to become even more significant in the short to medium term. This study makes a unique contribution to the international literature by identifying the barriers to caring for dying residents experienced by this valuable sector of the aged care workforce. These data have the potential to inform new, innovative, interventions to address the urgent need identified to improve palliative and end of life care management in aged care internationally.

Focus on creating a shared narrative not recording choices