Older people living alone has been reported to be socially isolated and suffering from loneliness. Although spiritual care is a core element of end-of-life care for older people, a clear-cut definition of spirituality has not been established yet. It remains unclear how spirituality is perceived by heath care professionals and how spiritual care is delivered in the end of life. Also, most of the previous studies on perspective of older people living alone targeted women, while very few researches shed light on the experience of older men. The aim of the present study was to investigate the spirituality of older men living alone near the end-of-life. We conducted group interviews targeting 30 care managers and individual in-depth interviews to 15 older men living alone. Qualitative content analysis was used. Five main themes emerged: worthlessness and hopelessness, autonomy and independence, comfort and gratitude, past experiences, and well-being indicator. Our findings provide important additional information that can help clinicians, nurses and care managers achieve better patient-centered care for older men living alone and enhance their dignity. Our investigation found that Japanese older men living alone were enjoying their autonomous status and freedom, despite wide spread negative views of them. Their spiritual health was found to be enhanced through gratitude to everyone with whom they had crossed paths in their life, yearning for the presence of a female companion, and confirming their health measurements were comparative or better than those of others in the same age group.
Le philosophe s'attache à définir ce qu'est la vulnérabilité et quels liens elle entretient avec la dignité de chaque homme. Qu'est-ce qui fait la valeur d'un homme : sa vulnérabilité ou sa manière de la surmonter ? Ou alors ce n'est ni l'un, ni l'autre ?
Cet article décrit certains aspects uniques dans les soins des patients de sexe masculin souffrant d'une maladie hématologique, tout au long du processus, depuis l'étape du diagnostic en passant par la phase de traitement jusqu'à la rémission et parfois, malheureusement, jusqu'à la phase de fin de vie. Ce périple peut s'étendre de quelques mois à plusieurs années. Cet article présente aussi le travail effectué auprès de patients de sexe masculin qui suivent une thérapie de groupe au sein du service. Il met en lumière les défis auxquels les hommes sont confrontés, en particulier dans la société israélienne, lorsqu'ils doivent faire face à une maladie potentiellement mortelle.
[Adaptation de l'Intro.]
Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men's overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The "unforeseen suicides" referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, "rationalized suicides" detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause-effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, "managing emotions" whereby participants distanced themselves, but also drew meaning from the suicide.
This study investigated (a) whether significant health changes occur before imminent widowhood and (b) the effects of widowhood on the physical and psychological health of men and women = 50 years old. Generalized estimating equations were used to examine a matched-pair sample of the Taiwanese Elderly. We found that for men, the major effect of widowhood was on psychological health, but that for women, the major effect was on physical health. Psychological health was significantly worse for widowed than for non-widowed women, but not for men. The difference in psychological health between widowed and non-widowed women, however, changed before widowhood.
BACKGROUND: Women who suffer an out-of-hospital cardiac arrest receive bystander cardiopulmonary resuscitation (CPR) less often than men. Understanding public perceptions of why this occurs is a necessary first step toward equitable application of this potentially life-saving intervention.
METHODS: We conducted a national survey of members of the public using Mechanical Turk, Amazon’s crowdsourcing platform, to determine reasons why women might receive bystander CPR less often than men. Eligible participants were adults (=18 years) located in the United States. Responses were excluded if the participant was not able to define CPR correctly. Participants were asked to answer the following free-text question: “Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?” Descriptive statistics were used to define the cohort. The free-text response was coded using open coding, and major themes were identified via classical content analysis.
RESULTS: In total, 548 subjects were surveyed. Mean age was 38.8 years, and 49.8% were female. Participants were geographically distributed as follows: 18.5% West, 9.2% Southwest, 22.0% Midwest, 27.5% Southeast, and 22.9% Northeast. After analysis, 3 major themes were detected for why the public perceives that women receive less bystander CPR. They include the following: (1) sexualization of women's bodies; (2) women are weak and frail and therefore prone to injury; and (3) misperceptions about women in acute medical distress. Overall, 41.9% (227) were trained in CPR while 4.4% reported having provided CPR in a medical emergency.
CONCLUSIONS: Members of the general public perceive fears about inappropriate touching, accusations of sexual assault, and fear of causing injury as inhibiting bystander CPR for women. Educational and policy efforts to address these perceptions may reduce the sex differences in the application of bystander CPR.
Le propos s'interrogera sur les avancées de la recherche au service de l'autonomie de l'homme, aussi handicapé soit-il. En entrant par la porte de l'art, il s'agira, dans un premier temps, d'appréhender l'histoire du handicap par ses représentations artistiques. Puis, par le filtre du 7e art, sera examiné l'impact du développement de la science sur la poursuite de l'écriture de l'histoire du handicap.
Dans le jardin japonais de Buenos Aires, en marge d’une réunion du G7, Bruno Le Maire voit revenir le souvenir de son ami Paul, emporté quelques semaines plus tôt par une tumeur au cerveau. Il se rappelle ses conseils, ses convictions, ses espoirs, ses encouragements, son courage face à la maladie. Bruno Le Maire retrace les mois de cette amitié soudaine, avec sa tendresse et ses divergences. Il montre comment la littérature, la musique et les conseils de Paul ont accompagné son engagement politique. Ce récit est aussi un hommage à la dignité humaine et un témoignage bouleversant sur la fin de vie.
This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.
Two studies were conducted to explore how to engage male volunteers in hospice palliative care. Four male hospice palliative care volunteers were interviewed in study 1. The men agreed that a direct approach is best when it comes to recruiting male volunteers, especially a personal story or testimonial. Two different volunteer position descriptions were created for study 2: one description was similar to what might appear on a community-based hospice palliative care program's web site or in a newspaper ad looking for visiting hospice palliative care volunteers; the other description was in the form of a personal testimonial ostensibly written by a male hospice palliative care volunteer describing his role through examples of interactions he has had with patients and patients' family members. Twenty-five males responded to each description. Both of the descriptions generated low and nonsignificantly different levels of interest in becoming a hospice palliative care volunteer. Believing this work to be too emotionally demanding and not having enough time for volunteering were the two most commonly given reasons for not wanting to become a hospice palliative care volunteer. Suggestions for future recruitment efforts are discussed.
L'objectif de l'étude visait à établir la prévalence du désir de mourir chez les aînés et à explorer les différences selon le genre à partir des données de l'Enquête sur la Santé des Aînés, réalisée au Québec (Canada) entre 2005 et 2006. Les résultats ont permis de constater que 4,9% des 2811 répondants, âgés de 65 ans et plus et vivant dans la communauté, avaient exprimé le désir de mourir, c'est-à-dire qu'ils croyaient qu'il vaudrait mieux qu'ils soient morts. Lorsque les genres ont été comparés aux plans sociodémographique, psychologique, physique et social, les résultats indiquent que les femmes ayant le désir de mourir (n=100) rapportent un niveau de stress plus élevé, un plus grand nombre de tracas quotidiens (ex. problèmes de transport, de sécurité, d'argent) et souffrent davantage de maladies douloureuses que les hommes (n=39). Elles sont plus nombreuses à recevoir un diagnostic de dépression, rapportent une mauvaise qualité de sommeil, une difficulté à s'endormir, un sentiment d'inutilité auprès de leurs enfants ainsi qu'un sentiment d'être incomprises par leurs proches. À l'inverse, les hommes ayant le désir de mourir présentent plus souvent que les femmes des problèmes uro-génitaux, des perturbations du sommeil, des relations conflictuelles avec leur partenaire, un sentiment de distance avec leur entourage, et le sentiment d'être inutile pour leurs amis. La poursuite des recherches quant aux facteurs de risque du désir de mourir chez les aînés pourrait permettre le développement d'interventions spécifiques à chaque genre, tôt dans le processus suicidaire. (R.A.).
Origine : BDSP. Notice produite par EHESP E8nR0xDB. Diffusion soumise à autorisation
Etude de cas d'un homme âgé de 43 ans, voyageant beaucoup, atteint d'un cancer des intestins. Les interrogations portent sur la mise en place d'une nutrition parentérale à domicile, la gestion d'une iléostomie, le soutien que peuvent pporter les soignants à la famille (femme et enfant) et comment aider le patient par raport à son image corporelle. Les pistes de réponses se trouvent aux pages 183 et 184.
Objective: Caring for someone close who is dying, such as a spouse, is an emotive experience; however, there is little research examining the phenomenon of caregiving for a spouse at the end of life and of men's experiences specifically. Existing literature suggests that men who are providing care are less likely to seek help than women, especially psychological and emotional support for themselves. The aim of the current study was to explore the lived experiences of men caring for a dying spouse or partner and their help-seeking for themselves during this time.
Methods:Eight semi-structured interviews were conducted with men caring for their partner, who was receiving palliative care. Interviews were transcribed verbatim and analyzed using interpretative phenomenological analysis.
Results: Three superordinate themes emerged from the data, "Illness Questions Everything," "Constructing the Caring Role," and "Help-Seeking at the Limit." The arrival of a terminal illness into a partnership is traumatic, and while it can deepen relationships, it can also create distance. The carer role has conflicting demands and carers need to make sense of their experience in order for the carer role to be constructed as a source of purpose or meaning. Finally, the idea of seeking help for oneself as a carer during this time is seen as "incompatible," unmanageable, and can only be considered if constructed as a "last resort."
Significance of Results: Men care too; however, they can feel confused by this role and unsure as to how this fits with their identity as a man. They make sense of this by identifying as a partner whose "duty" or "responsibility" is to provide care. Although this is an understandable stance, it puts them at risk of further emotional, psychological, and physiological difficulties if their own needs are not met. Men need to be supported during this time and their caring qualities need to be destigmatized and demystified so that they can feel more able to identify with the role and look after themselves while caring for their dying partner.
Lorsque l’expérience du vieillissement se conjugue aux réalités d’être atteint d’un cancer incurable, plusieurs souffrances psychologiques peuvent être vécues. Si des études médicales explorent la pathologie du cancer et ses particularités chez les hommes âgés, les études sur les souffrances psychologiques reliées à cette réalité sont beaucoup plus rares. Pour mieux accompagner les hommes âgés atteints d’un cancer incurable, nous avons réalisé une recherche qualitative intitulée : « Mieux comprendre la souffrance psychologique des hommes âgés atteints d’un cancer incurable afin de mieux les soutenir : le point de vue des professionnels ». Dans cette recherche, 5 groupes de discussion furent réalisés avec 27 intervenants œuvrant auprès d’hommes âgés atteints d’un cancer incurable. Une analyse thématique fut effectuée avec ces données. Les résultats obtenus dévoilent que les intervenants rapportent diverses formes de souffrances psychologiques vécues par les hommes âgés atteints d’un cancer incurable : les souffrances liées à la perte du rôle de pourvoyeur, celles liées à la perte de rôles familiaux et les souffrances liées au sentiment d’être un fardeau pour l’entourage. Enfin, nous avons repéré différentes stratégies que les intervenants ont observées chez ces hommes pour faire face à ces souffrances.
CONTEXT: Men and those with low educational attainment are less likely to receive palliative care. Understanding these disparities is a high priority issue.
OBJECTIVE: In this study of advanced cancer patients, we hypothesized that men and those with lower levels of educational attainment would have less favorable attitudes towards palliative care.
METHODS: We performed a cross-sectional analysis of data collected from 383 patients at study entry in the Values and Options in Cancer Care (VOICE) clinical trial. Patients were asked about their preferences for palliative care if their oncologist informed them that further treatment would not be helpful. Palliative care was defined as "comfort care" that focuses on "quality of life, but not a cure". Response options were definitely no, possibly no, unsure, possibly yes, and definitely yes. Those preferring palliative care (definitely or possibly yes) were compared to all others. Predictors were patient gender and education level. Covariates included age, race, disease aggressiveness, and financial strain.
RESULTS: Women were more likely [OR (95%CI)] than men to prefer palliative care [3.07 (1.80, 5.23)]. The effect of education on preferences for palliative care was not statistically significant [0.85 (0.48, 1.48)].
CONCLUSIONS: Significant gender differences in patient preference for palliative care could partially account for gender disparities in end-of-life care. Interventions to promote palliative care among men could reduce these disparities.
BACKGROUND: Cancer care and end-of-life (EOL) care contribute substantially to health care expenditures. Outside of clinical trials, to our knowledge there exists no standardized protocol to monitor disease progression in men with metastatic prostate cancer (mPCa). The objective of the current study was to evaluate the factors and outcomes associated with increased imaging and serum prostate-specific antigen use in men with mPCa.
METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data from 2004 to 2012, the authors identified men diagnosed with mPCa with at least 6 months of follow-up. Extreme users were classified as those who had either received prostate-specific antigen testing greater than once per month, or who underwent cross-sectional imaging or bone scan more frequently than every 2 months over a 6-month period. Associations between extreme use and survival outcomes, costs, and quality of care at EOL, as measured by timing of hospice referral, frequency of emergency department visits, length of stay, and intensive care unit or hospital admissions, were examined.
RESULTS: Overall, a total of 3026 men with mPCa were identified, 791 of whom (26%) were defined as extreme users. Extreme users were more commonly young, white/non-Hispanic, married, higher earning, and more educated (P<.001, respectively). Extreme use was not associated with improved quality of care at EOL. Yearly health care costs after diagnosis were 36.4% higher among extreme users (95% confidence interval, 27.4%-45.3%; P<.001).
CONCLUSIONS: Increased monitoring among men with mPCa significantly increases health care costs, without a definitive improvement in survival nor quality of care at EOL noted. Monitoring for disease progression outside of clinical trials should be reserved for those in whom findings will change management.
Background: Despite the evidence that the patient gender is an important component in the intensive care unit (ICU) admission decision, the role of physician gender and the interaction between the two remain unclear.
Objective: To investigate the association of both the patient and the physician gender with ICU admission rate of critically-ill emergency department (ED) medical patients in a hospital with restricted ICU bed capacity operates with "closed door" policy.
Methods: A retrospective population based cohort analysis. We included patients above 18 admitted to an ED resuscitation room (RR) of a tertiary hospital during 2011-2012. Data on medical, laboratory, and clinical characteristics were obtained. We used an adjusted multivariable logistic regression to analyze the association between both the patient and the physician gender to the ICU admission decision.
Results: We included 831 RR admissions, 388 (46.7%) were female patients and 188 (22.6%) were treated by a female physicians. In adjusted multivariable analysis (adjusted for age, diabetes, mode of hospital transportation, first pH, and patients who were treated with definitive airway and vasso-pressors in the resuscitation room), female-female combination (patient-physician, respectively) showed the lowest likelihood to be admitted to ICU (adjusted OR 0.21, 95% CI 0.09-0.51) compared to male-male combination, in addition to a smaller decrease among female-male (adjusted OR 0.53, 95% CI 0.32-0.86) and male-female (adjusted OR 0.43, 95% CI 0.21-0.89) combinations.
Conclusion: We demonstrated the existence of the possible gender bias where female gender of the patient and treating physician diminish the likelihood of the restricted health resource use.
Background: To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (=80 years) in China.
Methods: We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last three years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting).
Results: About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36-months to 24-months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12-months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men.
Conclusions: In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the three years prior to death is high and is greater in women than men and those who die at the oldest ages.
Increasingly men are becoming widowed in later life due in part to a longer life expectancy. Social networks and social support are thought to help buffer the negative consequences of such later life transitions. This paper explores the personal communities of a group of older men experiencing widowhood. Qualitative in-depth interviews were conducted, September 2013-February 2014, with seven older widowers, 71-89 years of age, in North Staffordshire, UK. Interviews included personal community diagrams to identify the structure of the older men's social relationships. Data analysis comprised thematic analysis of interview transcripts and content analysis of personal community diagrams. Three overarching themes were identified from the interview data: "Personal identity and resilience assist transition," "Continuity in personal communities provides stability" and "Changes in social relationships and practices facilitate adaptation." The study identified three types of personal community among the older widowers, comprising different combinations of family, friends and others. The findings illustrate that some older widowers have very restricted personal communities which puts them at greater risk of loneliness and social isolation. The social needs of long-term carers should be addressed as isolation and loneliness can begin long before the death of a spouse. It is important to consider gender differences and preferences when designing interventions for older people in order to promote engagement, social inclusion and well-being.