Importance: Medicare Advantage (MA) insures an increasing proportion of Medicare beneficiaries, but evidence is lacking on patient or family perceptions of the quality of end-of-life care in MA vs traditional Medicare.
Objective: To determine if there is a difference in quality of care reported by family and friends of individuals who died while insured by MA vs traditional Medicare at the end of life.
Design, Setting, and Participants: This cross-sectional study used the 2011 to 2017 Medicare-linked National Health and Aging Trends Study to conduct population-based survey research representing 8 668 829 Medicare enrollees. Included individuals were 2119 enrollees who died when aged 65 years or older, with quality of care reported by a family member or close friend familiar with the individual’s last month of life. Analysis was conducted in July 2020.
Exposures: MA enrollment at the time of death or before hospice enrollment.
Main Outcomes and Measures: Perception of end-of-life care was measured with 9 validated items, with the primary outcome variable being overall care rated not excellent. We conducted a propensity score–weighted multivariable model to examine the association of each item with MA vs traditional Medicare enrollment. The propensity score and multivariable model included covariates capturing demographic and socioeconomic factors, function and health, and relationship of the respondent to the individual who died. The sample was then stratified by hospice enrollment and setting of care in the last month.
Results: Of 2119 people in the sample, 670 individuals were enrolled in MA at the time of death or prior to hospice (32.7%) and 1449 were enrolled in traditional Medicare (67.3%). In survey-weighted percentages, 53.6% (95% CI, 51.0% to 56.1%) were women and 43.4% (95% CI, 41.5% to 45.3%) were older than 85 years at the time of death. In the adjusted model, family and friends of individuals in MA were more likely to report that care was not excellent (odds ratio, 1.28; 95% CI, 1.01 to 1.61; P = .04) and that they were not kept informed (odds ratio, 1.48; 95% CI, 1.06 to 2.05; P = .02). For those in nursing homes, there was an estimated probability of 57.2% of respondents reporting that care was not excellent for individuals with traditional Medicare, compared with 77.9% of respondents for individuals with MA (marginal increase for those in MA, 0.21; 95% CI, 0.08 to 0.32; P = .001).
Conclusions and Relevance: In this cross-sectional study of people who died while enrolled in Medicare, friends and family of those in MA reported lower-quality end-of-life care compared with friends and family of those enrolled in traditional Medicare. These findings suggest that, given the rapid growth of MA, Medicare should take steps to ensure that MA plans are held accountable for quality of care at the end of life.
Laurent Ciccone raconte l'histoire de Luc, une tranche de sa vie durant laquelle, héros malgré lui, il chute et se relève. Durant cette tranche de vie découpée dans le vif, Luc souffre du coeur et du genou, part en vacances en Italie avec des potes, rit beaucoup de tout ou de rien, et pleure, pleure un ami qui meurt. La mort profite des phrases comme un train, des rails, pour coudoyer la vie, la croiser sans crier gare à moins que ce ne soit l'inverse.
Few studies have explored the inter-relationships of sources of social support and caregiving self-efficacy with caregiver burden and patient's quality of life among patients with palliative care needs and their caregivers. This study tested the associations of two sources of social support (family and friends) and the mediating role of caregiving self-efficacy on caregiver burden and patient's quality of life. A convenience sample of 225 patient-caregiver dyads recruited between September 2016 and May 2017 from three hospitals in Hong Kong was included in the current analysis. Results showed that the final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (p = 0.326). Significant associations were detected. Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient's quality of life through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on patient's quality of life. These findings emphasized (1) the importance of caregiving self-efficacy in improving caregiver burden and patient's quality of life and that (2) sources of social support may be an important dimension moderating the associations of caregiving self-efficacy with caregiver burden and patient's quality of life.
Boléro le lapin et Musette l'oursonne sont inséparables. Quand Musette meurt, Boléro reste tout seul et n'a plus goût à rien. Mais peu à peu, au rythme des saisons, et grâce aux autres animaux de la forêt, Boléro redécouvre la saveur des choses simples et la force de l'amitié.
Avec beaucoup de sensibilité, on découvre les différents sentiments de Boléro au fil des jours après la mort de Musette. Le partage avec les autres animaux tient une place importante dans l'histoire qui aidera Boléro jusqu'à la fin de l'histoire.
Simon et Annabelle sont à l'école primaire ensemble et sont amoureux. Un jour, Simon tombe malade : une leucémie. Malgré les traitements, il meurt. L'album présente les émotions traversées par Annabelle.
Advance care planning is spreading globally, but it is still a difficult task for healthy, community-dwelling Japanese residents. In Japan, it is called “life discussion,” and the first step is a discussion on goals, values, and preferences of medical care among family or other close persons, as knowledge on this topic is limited. This study aimed to explore the factors associated with the degree of engagement in life discussions among friends and family in depopulated areas. In 2 areas of Japan, 2466 individuals (aged 40-79 years) participated in this survey. Health/life habits, such as collecting health information and participating in some community activities, were significantly associated with the discussions more than attitude to medical/long-term care and community. Additionally, it was discussed how local governments could intervene to encourage advance care planning in depopulated areas. In conclusion, health habits or attitudes for care such as preference and desire for care among community-dwelling adults were associated with engaging in the discussions. It was proposed that local governments should motivate individuals to consider end-of-life experiences from a first-person perspective for creating advance care planning directives, and nurses could facilitate the discussion when death is imminent.
In this Australian, constructivist grounded theory study, we undertook in-depth interviews with 11 dying people and 8 caregivers to examine their perspectives on role relations at end-of-life. We found that situations of role alignment between dying people and their family and friends support positive relational and practical outcomes, whereas role mismatch can cause considerable distress. Factors contributing to role mismatch at end-of-life were: dying people and their caregivers’ efforts to shield each other from emotional harm; fear of social exclusion; and unwanted focus on the dying identity. Our findings highlight a need for flexibility and adaptability in end-of-life role relations.
L'auteur aborde les aspects suivants sur le bénévolat :
- vouloir du bien, est-ce réservé aux proches, aux amis ?
- quel rapport la bienveillance entretient-elle avec l'amitié ?
- Quelle est la nature du bien visé par le bienveillant ?
- Qu'est-ce que la bienveillance dans la cité ?
This article explores the relationship between grief and best friendship (BF) dynamics among adolescent girls. Based on a qualitative interview study with 10 Danish girls, findings suggest that bereavement affects friendship dynamics in ways that challenge the by-standing friend in succeeding with being and staying supportive. Through a thematic analysis, we identify 12 themes that cut across the case stories, all of which testify to the difficulties bereavement represent to friendship quality and maintenance. Among other issues, it seems like grief is contagious and the bereaved friend changes her way of responding to the by-standing friend in ways that disturb expectations, values, and virtues of BF among girls in adolescence. The general categories found to be characteristic for long-term BFs, that is, positivity, supportiveness, openness, and interaction are all affected by bereavement in adolescent BFs among girls.
Besides seeking social support, connecting with bereaved others, and maintaining relationships with the deceased, bereaved Facebook users may express their grief on Facebook to reduce their death anxiety. Notably, research has not yet explored the psychological outcomes of expressing grief on Facebook. This study undertook quantitative analysis of survey data from an initial community sample of 409 bereaved Facebook users (77.8% survey completion rate, n = 312; Mage = 34.46, SD = 12.38; 90% women) to ascertain whether expressions of grief on Facebook had negative psychological outcomes, and whether terror management theory (TMT) provided an appropriate lens for understanding Facebook grief expressions (FBGE). The aims of this study were three-fold: to clarify rates at which Facebook profiles of deceased users are deactivated, memorialized, unchanged, or managed; frequency and types of FBGE; and prevalence of/visitation to commemorative groups. Results—though insufficient to support TMT as an explanatory theoretical framework for FBGE—indicated that individuals who participated in FBGE reported higher anxiety and stress compared to bereaved individuals who did not express their grief on Facebook. Results provide a useful starting point for future research regarding online grieving behaviors and psychological wellbeing.
Ethel, 7 ans, tente de faire le deuil de sa mère à l'aide de son imagination et se réfugie souvent sur sa tombe. Un jour, elle y croise Victor, 10 ans, venu assister à l'enterrement d'un grand-oncle qu'il n'a pas connu. Une amitié profonde débute entre les deux enfants et les fait basculer entre réalité et merveilleux.
This paper reports the impact of a major life event-death-on the physical, psychological and social well-being of the deceased's close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002-2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent's satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people's support networks may be a fruitful approach to minimising these negative outcomes.
Griffin a choisi de quitter Théo, son premier amour parti à l'autre bout du pays pour ses études. Les deux garçons s'aiment toujours et sont restés en contact. Griffin était convaincu qu'ils formeraient à nouveau un couple un jour, même quand Théo se met à fréquenter Jackson. Malheureusement, tout vole en éclats à la mort de Théo, laissant derrière lui un garçon qui a bien du mal à vivre dans un monde où il n'est plus.
Juniper Lemon tente de supporter l'absence de sa soeur, morte dans un accident de voiture, en continuant de remplir ses fiches d'index de bonheur. Un jour, elle perd la fiche vierge du jour, en faisant un trou de plus dans sa vie. Elle décide donc de la chercher dans le lycée... jusque dans les poubelle. Lorsqu'elle trouve par hasard un mot de suicide, elle décide de retrouver son auteur. Commence pour elle une véritable enquête qui va l'entraîner dans des amitiés inattendues. Grâce à ses nouveaux amis, elle se confrontera à sa famille, à la partie de vie que sa soeur lui cachait et à elle-même.
Renard qui a eu une belle vie se couche ferme les yeux pour toujours. Peu à peu ses amis se réunissent autour de lui car tous ‘l'avaient aimé. Hibou fit l éloge de Renard et tous ont les yeux qui brillent.Chacun se rappelle d’un souvenir heureux avec Renard.
Une petite plante se met à pousser là où est enterré Renard ainsi toujours il sera présent près d’ eux.
Death-Cast appelle les gens qui vont mourir 24 heures avant pour qu'ils profitent de leurs dernières heures. En se connectant sur le site dédié aux Deckers (ceux qui vont mourir), Mateo et Rufus vont se rencontrer et passer ensemble les derniers moments.
Beaucoup de choses les séparent: Mateo est préoccupé par le devenir de son père hospitalisé avec un diagnostic très précaire et Rufus, petit délinquant, préoccupé par les rixes entre groupes rivaux et son ancienne petite amie. Pendant ces derniers moments, une vraie amitié va se lier entre rires, joies et réalité moins gaie. Bien sûr leurs morts sont programmées et ils ne pourront pas y échapper même si un moment, on y a cru.
Luc Argent a 19 ans, il y a trois ans il a eu une greffe de cœur mais son corps la rejette. Il en a marre des hôpitaux, des médecins, des médicaments. Il ne se voit pas revivre tout le cheminement pour une deuxième greffe qui a peu de chances de prendre. Il s’organise un road trip avec sa meilleure amie Evelyne pour l’Oregon, état où le suicide assisté est légal. Ira-t-il jusqu’au bout de sa démarche ?