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PubMed2001

Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: the art of the possible.

Patients with life-threatening illnesses face great psychological challenges and frequently experience emotional distress. Yet, the end of life also offers opportunities for personal growth and the deepening of relationships. When physical symptoms and suffering are controlled, it is easier to address patients' central concerns-about their families, about their own psychological integrity, and about finding meaning in their lives. Optimal end-of-life care requires a willingness to engage with the patient and family in addressing these distinct domains. In addition to supporting growth of patients and their caregivers, physicians need to recognize the impact of psychiatric disorders such as depression, anxiety, and delirium at the end of life and develop skills in diagnosing and treating these syndromes. Comments of a patient with pancreatic cancer, his son, and his physician help illuminate the potential opportunities presented when coping with life-threatening illness. Enhanced understanding of the common psychological concerns of patients with serious illness can improve not only the clinical care of the patient, but also the physician's sense of satisfaction and meaning in caring for the dying.

Adaptation, Psychological↗
PubMed2005

Life values in patients with COPD: relations with pulmonary functioning and health related quality of life.

Theories of coping and response shift have suggested that emotional adaptation is related to value changes, e.g. a deemphasized importance of lost life values and an enlargement of the scope of values. Perceived attainment and importance of 82 life values were examined in 65 patients with chronic obstructive pulmonary disease (COPD) and related to clinical and Health-Related Quality of Life (HRQL) measures. The life values covered 10 dimensions--harmony, positive relations, involvement, mobility, communication, knowledge, responsibility, comfort, religion and health. Forty-six of the patients were followed up after 1 year. The patients with COPD were compared with a healthy control group, a group of neurologically impaired and a non-disabled group representing the general population. Significant congruence was found between importance and attainment ratings in all groups (correlations from 0.44 to 0.53), suggesting that both impaired and healthy persons tend to perceive that they have what they find important in life. Congruence was significantly related to mood (correlations from 0.28 to 0.40), but not to functional status or clinical data. Compared to the healthy responders, the patients with COPD had significantly lower attainment ratings in health, mobility, involvement, but no differences were found for importance ratings. No evidence was found that they had replaced unattainable values with new available values, and no changes over time of perceived values were found. This suggests that patients with COPD do not seem to adapt by means of changing their value orientation.

Adult↗
PubMed1980

Calendar life span versus budding life span of Saccharomyces cerevisiae.

This investigation is concerned with the internal factors governing the life span of individual yeast cells. The life span may be limited either by the number of buds a cell can produce or by internal measurement of metabolic time. The natural relationship between the number of cells a single cell can produce and the passage of time was modified by three different kinds of treatment: (1) by cooling the cells for several hours each day; (2) by preculturing the cells in media which inhibit cell division before allowing logarithmic growth; and (3) by culturing the cells in a medium which reduces the rate of budding. All these methods led to a prolongation of chronological life span, but the life span measured by the number of buddings remained remarkably constant. We therefore conclude that there is some kind of factor involved in the budding process which determines life span.

Cell Division↗
PubMed2000

Opioid use in last week of life and implications for end-of-life decision-making.

This study was prompted by public and professional concern that the use of opioids for symptom control might shorten life. We retrospectively analysed the pattern of opioid use in the last week of life in 238 consecutive patients who died in a palliative care unit. Median doses of opioid were low (26.4 mg) in the last 24 h of life and patients who received opioid increases at the end of life did not show shorter survival than those who received no increases. The doctrine of double effect therefore need not be invoked to provide symptom control at the end of life.

Aged↗
PubMedDate not supplied

Late life cognition among men: a life course perspective on psychosocial experience.

This report assesses associations between trajectories of psychosocial experience over the life course and cognitive function in late life men. Survey data from the National Longitudinal Study of Older Men, a community sample of 1835 United States men aged 45-59 years in 1966, are used to explore the cognitive effects of personality (locus of control) and emotion (affect) as these attributes evolve from middle age to late life. Locus of control is very stable over time, whereas negative and positive affect fluctuate. Inverse relationships are found between cognitive function and external locus of control, enduring negative affect, and the absence of positive affect. Levels of education also moderate these effects. Low educational attainment appears to intensify the risk for poor cognitive function associated with mixed internal-external locus of control and poor emotional state over time. The connection between education, usually completed early in the life course, and late life cognitive outcomes emphasizes the importance of promoting educational attainment among young people. Among older men with low educational attainment, the identification of mood disorders and personality attributes that negatively impact cognition may lead to the development of appropriate interventions.

Affect↗
PubMed2003

Mnsod overexpression extends the yeast chronological (G(0)) life span but acts independently of Sir2p histone deacetylase to shorten the replicative life span of dividing cells.

Studies in Drosophila and Caenorhabditis elegans have shown increased longevity with the increased free radical scavenging that accompanies overexpression of oxidant-scavenging enzymes. This study used yeast, another model for aging research, to probe the effects of overexpressing the major activity protecting against superoxide generated by the mitochondrial respiratory chain. Manganese superoxide dismutase (MnSOD) overexpression increased chronological life span (optimized survival of stationary (G(0)) yeast over time), showing this is a survival ultimately limited by oxidative stress. In contrast, the same overexpression dramatically reduced the replicative life span of dividing cells (the number of daughter buds produced by each newly born mother cell). This reduction in the generational life span by MnSOD overexpression was greater than that generated by loss of the major redox-responsive regulator of the yeast replicative life span, NAD+-dependent Sir2p histone deacetylase. It was also independent of the latter activity. Expression of a mitochondrially targeted green fluorescent protein in the MnSOD overexpressor revealed that the old mother cells of this overexpressor, which had divided for a few generations, were defective in segregation of the mitochondrion from the mother to daughter. Mitochondrial defects are, therefore, the probable reason that MnSOD overexpression shortens replicative life span.

Cell Division↗
PubMed2005

Creating connections to life during life-threatening illness: creative activity experienced by elderly people and occupational therapists.

OBJECTIVE: The aim of this study was to discover and characterize components of engagement in creative activity as occupational therapy for elderly people dealing with life-threatening illness, from the perspective of both clients and therapists. Despite a long tradition of use in clinical interventions, key questions remain little addressed concerning how and why people seek these activities and the kinds of benefits that may result. METHOD: Qualitative interviews were conducted with 8 clients and 7 therapists participating in creative workshops using crafts at a nursing home in Sweden. Analysis of the interviews was conducted using a constant comparative method. FINDINGS: Engaging in creative activity served as a medium that enabled creation of connections to wider culture and daily life that counters consequences of terminal illness, such as isolation. Creating connections to life was depicted as the core category, carried out in reference to three subcategories: (1) a generous receptive environment identified as the foundation for engaging in creative activity; (2) unfolding creations-an evolving process; (3) reaching beyond for possible meaning horizons. CONCLUSION: The findings suggest that the domain of creative activity can enable the creation of connections to daily life and enlarge the experience of self as an active person, in the face of uncertain life-threatening illness. Ultimately, the features that participants specify can be used to refine and substantiate the use of creative activities in intervention and general healthcare.

Aged↗
PubMed2000

Childhood misery and disease in later life: the effects on mortality in old age of hazards experienced in early life, southern Sweden, 1760-1894.

This paper assesses the importance of early-life conditions relative to the prevailing conditions for mortality by cause of death in later life using historical data for four rural parishes in southern Sweden for which both demographic and economic data are very good. Longitudinal demographic data for individuals are combined with household socio-economic data and community data on food costs and the disease load using a Cox regression framework. We find strong support for the hypothesis that the disease load experienced during the first year of life has a strong impact on mortality in later life, in particular on the outcome of airborne infectious diseases. Hypotheses about the effects of the disease load on mothers during pregnancy and access to nutrition during the first years of life are not supported. Contemporary short-term economic stress on the elderly was generally of limited importance although mortality varied by socio-economic group.

Aged↗
PubMed2004

The Kansas LIFE project-living initiatives for end-of-life care.

BACKGROUND: Numerous studies continue to demonstrate the needs for improved palliative and end-of-life care. OBJECTIVE: Kansas stakeholders joined together, under the leadership of the Kansas Hospice and Palliative Care Organization (formerly the Association of Kansas Hospices) in 1997, to improve palliative and end-of-life care for Kansans living with advanced chronic and terminal illnesses. DESIGN: The Kansas LIFE Project (Living Initiatives for End-of-Life Care) plans and implements strategic initiatives and projects that engage public policy leaders, healthcare professionals and Kansas citizens. SETTING: Grassroots community coalitions, LIFE Project Caring Communities, have been developed, supported, resourced, and maintained as a core strategic and action tool. for assuring that local and state progress is achieved and meaningful and relevant to Kansas citizens. CONCLUSION: Local community coalitions have the best understanding of citizen needs and are important to include in state-level planning and action in ways that lead to successful, meaningful and relevant outcomes for improved care for citizens living with advanced chronic and terminal illnesses. With adequate support and strong leadership, local coalitions can effectively leverage their presence and "ownership" of communities to drive change among health care professionals, policy leaders, and citizens.

Communication↗
PubMed1999

Preparing the ground: contributions of the preclinical years to medical education for care near the end of life. Working Group on the Pre-clinical Years of the National Consensus Conference on Medical Education for Care Near the End of Life.

The preclinical years of medical education have rich potential for preparing medical students to provide optimal end-of-life care. Most of the opportunities and settings for this education already exist in the curricula of most medical schools, although they are underutilized for this purpose. In this report The Working Group on the Pre-clinical Years of the National Consensus Conference on Medical Education for Care Near the End of Life identifies the most promising settings and suggests how they might be used for maximum benefit in end-of-life education. Basic end-of-life care competencies are in five domains: (1) psychological, sociologic, cultural, and spiritual issues; (2) interviewing and communication skills; (3) management of common symptoms; (4) ethical issues; and (5) self-knowledge and self-reflection. A centralized group should oversee educational activities related to end-of-life care at each medical school. This group would identify and facilitate teaching opportunities in the preclinical curriculum: basic science courses; problem-based learning seminars; courses in interviewing, the doctor-patient relationship, and introduction to clinical medicine; courses in ethics, humanities, and the social-behavioral sciences; clinical preceptorships; and longitudinal experiences with patients. The group would also assess the potential impact of the "hidden curriculum."

Attitude to Death↗
PubMed1997

Life and the laundromat: reflections on dirty linen and everyday private life.

This is a paper in which I reflect on, and draw issues from, an unplanned ethnographic experience in a London laundromat. The concept of 'everyday life' has a kind of simple, even benign, quality. However, there are many events in everyday life that are complex and complicating. Everyday life can be mundane--boring even. But it can also confront and trouble us, even when it concerns such apparently ordinary matters like doing the laundry. This paper is about how the ordinary matters of everyday life can become problematic and how our involvement in them can confront us with dilemmas that are unwanted yet require our attention and judgement as participants in social life.

Anthropology, Cultural↗
PubMedDate not supplied

The relationship between life goals at thirty and perceptions of goal attainment and life satisfaction at seventy for gifted men and women.

This article examines the relationship between life goals at thirty and perceptions of goal attainment, happiness, and life satisfaction at seventy for gifted men and women. Respondents were members of the Terman Study of the Gifted. Men and women differed in life goals at age thirty, with men predominantly oriented toward occupational pursuit, and women predominantly oriented toward home and family life. Results showed a significant sex difference in feelings of goal attainment at age seventy, with men reporting greater attainment. Women with occupational goals at age thirty reported lower feelings of goal attainment at age seventy than women without such goals. For men, a positive relationship was found between satisfaction and happiness at age seventy and feelings of goal attainment. For women, these relationships varied according to life goals at age thirty. The implications of these results are discussed.

Adult↗
PubMed1995

Successful aging, life satisfaction, and generativity in later life.

This article explores the meanings older people attach to successful aging and life satisfaction and how these concepts can be differentiated. Forty elderly employees of the Ozarks Area Foster Grandparent Program (ages 61-92) were randomly selected and interviewed using an open-ended survey questionnaire. These questions explored understandings of successful aging and life satisfaction, the factors essential for each, and the differences perceived between these concepts. Qualitative data were coded by two independent reviewers. Respondents' understandings of successful aging involved attitudinal or coping orientations nearly twice as often as those for life satisfaction. Descriptions of life satisfaction emphasized the fulfillment of basic needs and was viewed as a precursor to successful aging. Content analysis confirmed five features of successful aging: interactions with others, a sense of purpose, self-acceptance, personal growth, and autonomy. The findings suggest that generativity contributes to successful aging and remains a vital developmental task in later life.

Activities of Daily Living↗
PubMed1996

Self-disclosure and marital satisfaction in mid-life and late-life remarriages.

Self-disclosure and marital satisfaction were studied among 125 males and females who were in their first remarriage. Essentially equal numbers had remarried in mid-life (ages 30-45) and late-life (ages 60-75). The multidimensional Wheeless self-disclosure scales and Locke-Wallace measure of marital satisfaction were employed. Mid-life versus late-life differences were evident for the amount, and depth of disclosure, but not for intentionality, valence or honesty of disclosure. No gender differences were manifested in self-disclosure. Marital satisfaction was greatest for late-life remarriages, and this was due to the high level of male satisfaction in this age group.

Adult↗
PubMedDate not supplied

[Quality of Life of cancer patients: studies by the Oncology Department of the Hospital of Navarra in the Quality of Life Group of the EORTC].

The Quality of Life of cancer patients and its assessment are of great important nowadays. They are useful in offering a treatment that is better adapted to the characteristics of the patient and the development of his/her illness. Patients have to evaluate their Quality of Life through measurement instruments. The European Organisation of Research and Treatment of Cancer-EORTC is an international body devoted to research in cancer treatment. One of its divisions is working on the study of the Quality of Life. They have developed a core questionnaire for Quality of Life measurement and modules for different types of tumour and treatment to complement this. The Oncology Department of the Hospital of Navarra has been collaborating in this group since 1992. The Department has participated in the creation or validation of the core questionnaire and different modules. It is measuring the Quality of Life in different clinical studies. All members of the department are collaborating in these studies.

English Abstract↗
PubMedDate not supplied

Teaching cultural considerations at the end of life: end of life nursing education consortium program recommendations.

BACKGROUND: The End of Life Nursing Education Consortium (ELNEC) is an end of life care nursing education program that addresses the many dimensions of culture, including ethnic identity, gender, age, differing abilities, sexual orientation, and religion and spirituality. This article focuses on one of the program's modules entitled "Cultural Considerations in End of Life Care." METHOD: The ELNEC "Cultural Considerations in End of Life Care" module, which identifies important cultural considerations as well as strategies and responses to teach cultural competence and sensitivity in undergraduate nursing curriculum, is described. FINDINGS: A total of 564 nursing faculty members and 707 continuing education faculty members have undergone ELNEC training. Essential module components including teaching strategies and resources are presented. CONCLUSION: Comprehensive education for nurses regarding cultural considerations in end of life care results in improved care for dying patients who ultimately have a peaceful, respectful death with sensitivity to their cultural expectations and needs.

Cultural Diversity↗
PubMed1999

[Analysis of correlation between some parameters depending on cell proliferation and life span of "stationary phase aging" cultures and maximum life span of mammals].

Earlier we developed a "stationary phase aging" model and introduced a definition of life span of "stationary phase aging" cell cultures. In this model the cells grow after seeding in flasks without subcultivation and medium change. They reach cell saturation density, stop dividing, gradually degrade ("stationary phase aging") and perish. By the term "culture life span" we designate the time from cell seeding until culture death. We designate the culture as dead when the number of living cells is less than 10 per cent of their number at saturation density of cell culture. The life span of transformed Chinese hamster cells was found to be proportional to the duration of their growth from cell seeding up to saturation density, as well as to the number of cell culture doublings and to be inversely proportional to the velocity of cell culture doubling for the same growth period. Maximum life span of mammals is known to be proportional to pregnancy duration and to the age at puberty. We found that maximal life span of mammals was proportional to the number of cell population doublings and inversely proportional to the velocity of cell population doubling during embryonal period or for the time from zygote to growth termination. The dependences for cell cultures and for mammals are analogous to each other.

Aging↗
PubMed2001

Quality of life for patients with diabetes in Korea--I: the meaning of health-related quality of life.

This study describes the impact of diabetes and the meaning of health-related quality of life (HRQOL) for 22 male and female patients in Korea. Open-ended interviews yielded six HRQOL themes: health, overall well-being, harmonious relationships and family responsibilities, a rewarding life, spiritual life, and material support. The physical impact of diabetes included decreased energy, limitations, and physical suffering; while its psychological/spiritual impact extended to general stress, helplessness, fear, depression, anger, and relationship with God. Like Americans, Koreans valued health, psychological well-being and interpersonal support. In addition, the Koreans valued smooth, harmonious interpersonal relationships, overall well-being pertaining to living a comfortable and honorable life.

Adult↗