Background: Economic analyses of end-of-life care often focus on single aspects of care in selected cohorts leading to limited knowledge on the total level of care required to patients at their end-of-life. We aim at describing the living situation and full range of health care provided to patients at their end-of-life, including how informal care affects formal health care provision, using the case of colorectal cancer.
Methods: All colorectal cancer decedents between 2009 and 2013 in Norway (n = 7695) were linked to six national registers. The registers included information on decedents’ living situation (days at home, in short- or long-term institution or in the hospital), their total health care utilization and costs in the secondary, primary and home- and community-based care setting. The effect of informal care was assessed through marital status (never married, currently married, or previously married) using regression analyses (negative binominal, two-part models and generalized linear models), controlling for age, gender, comorbidities, education, income, time since diagnosis and year of death.
Results: The average patient spent four months at home, while he or she spent 27 days in long-term institutions, 16 days in short-term institutions, and 21 days in the hospital. Of the total costs (~NOK 400,000), 58, 3 and 39% were from secondary carers (hospitals), primary carers (general practitioners and emergency rooms) and home- and community-based carers (home care and nursing homes), respectively. Compared to the never married, married patients spent 30 more days at home and utilized less home- and community-based care, but more health care services at the secondary and primary health care level. Their total healthcare costs were significantly lower (-NOK 65,621) than the never married. We found similar, but weaker, patterns for those who had been married previously.
Conclusion: End-of-life care is primarily provided in the secondary and home-and community-based care level, and informal caregivers have a substantial influence on formal end-of-life care provision. Excluding aspects of care such as home and community-based care or informal care in economic analyses of end-of-life care provides a biased picture of the total resources required, and might lead to inefficient resource allocations.
OBJECTIVES: Evidence on associations between marital status and frailty is limited. The objectives of this study were to perform a systematic review for associations between marital status and physical frailty and to perform a meta-analysis to combine findings.
DESIGN: Systematic review and meta-analysis.
SETTING AND PARTICIPANTS: Community-dwelling older people with mean age =60 years.
METHODS: Systematic literature search using 5 databases was conducted in February 2019 to identify longitudinal and cross-sectional studies examining associations between marital status and Fried's phenotype-based frailty status. Additional studies were searched for by reviewing the reference lists of relevant articles and conducting forward citation tracking of included articles. Odds ratio (OR) of marital status and frailty was pooled using a random-effects meta-analysis. Subgroup analysis and analyses stratified by gender and marital status (married, widowed, divorced or separated, and never married) were completed.
RESULTS: A total of 1565 studies were found, from which 3 studies with longitudinal data and 35 studies with cross-sectional data were included. Although longitudinal studies suggested that married men had lower frailty risks than unmarried men while married women had higher frailty risks than widowed women, meta-analysis was not possible because of different methodologies. Meta-analyses of cross-sectional data from 35 studies including 80,754 individuals showed that unmarried individuals were almost twice more likely to be frail than married individuals (pooled odds ratio = 1.88, 95% confidence interval = 1.70-2.07). A high degree of heterogeneity was observed (I2 = 69%) and was partially explained by reasons for not being married and study location. Stratified analyses showed that pooled risks of frailty in the unmarried compared with the married were not statistically different between women and women (P for difference = .62).
CONCLUSIONS AND IMPLICATIONS: Three and 35 studies, respectively, were found providing longitudinal and cross-sectional data regarding associations between marital status and frailty among community-dwelling older people. A meta-analysis of cross-sectional data showed almost twice higher frailty risk in unmarried individuals compared with married individuals. Marital status should be recognized as an important factor, and more longitudinal studies controlling for potential confounding factors are needed.
Research on marital status-gender differences in later-life trajectories of cognitive functioning is scarce. Drawing on seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, this research uses growth curve models to examine later-life dynamics of cognitive functioning among married and widowed older men and women of Mexican descent (aged 65+; N = 3329). The findings demonstrate that the widowed, regardless of gender, had lower initial levels of cognition but a less steep cognitive decline across waves, compared to married men. Age and socioeconomic resources accounted for these marital status differences in levels and rates of change in cognitive functioning completely among widowed men and partially among widowed women. Moreover, net of all the factors, married women had a slower cognitive decline than married men. This study also shows that health and social integration might shape cognitive functioning among older adults of Mexican descent.
BACKGROUND: As the U.S. population ages, dramatic shifts are occurring in the proportion of older adults who are divorced and widowed. Health status and behaviors are known to differ across marital status groups, yet research on end-of-life (EOL) care planning has only compared married and unmarried persons, overlooking differences between divorced and widowed individuals, by gender.
OBJECTIVE: This study aimed to examine marital status differences in EOL care planning by comparing the likelihood of discussions about EOL care, designation of medical durable power of attorney (MDPOA) for health care decisions, and completion of a living will for married, divorced, and widowed older adults, by gender.
METHODS: Analyses used data from the U.S. Health and Retirement Study for 2243 adults (50 years of age and older), who died during the course of the study. Post-death, proxy respondents reported on the decedents' EOL care discussions, living will completion, and establishment of an MDPOA. Multivariate regressions were estimated to test differences in care planning across marital status groups, for men and women.
RESULTS: Divorced men were less likely than married men to have had care discussions and to have engaged in any of the three planning behaviors. Widowers were more likely to have established an MDPOA. Both divorced and widowed women were more likely to have performed any of these EOL planning activities than married women.
CONCLUSIONS: Divorced men and married women are at risk for lacking EOL care planning. Practitioners are encouraged to discuss the importance of such planning as they encounter these at-risk groups.
OBJECTIVE: The long-term consequences of military spousal grief have not been adequately studied. Although the literature emphasizes the widow's connection with the deceased as part of the grief process, the importance of the sharing patterns of such grief has been overlooked. This study aimed to add to the understanding of remarried military widows' long-term grief, via 2 main processes: The first was to explore their grief processes, and the second was to reveal whether and how their grief processes were shared with others.
METHOD: Semistructured interviews were conducted with 29 Israeli remarried military widows, more than 3 decades after their husbands' deaths. Data were analyzed by using thematic content analysis.
RESULTS: Findings revealed 2 continuums, 1 for each process. The first continuum was the grief process timeline, which covered a spectrum going from time- and emotionally limited processes to prolonged mourning processes. The second continuum was the sharing process, which covered a spectrum ranging from solitary grief to shared grief. Consequently, we suggest that widows can be viewed as occupying shifting points, over the years, on these intersecting continuums.
CONCLUSIONS: The findings illuminate varied courses of coping and sharing of grief among older remarried military widows.
IMPLICATIONS: An integration of loss, aging, and family relations theories for clinical work is suggested.
BACKGROUND: The utilization of the health care system varies in relation to cohabitation status, but conflicting results have been found in studies investigating the association in relation to specialized palliative care (SPC).
OBJECTIVE: To investigate the association between cohabitation status and admittance to SPC; to establish whether this association differed between hospital-based palliative care team/units (mainly outpatient/home care) and hospice (mainly inpatient care).
DESIGN: A nationwide study based on the Danish Palliative Care Database, which is linked with additional registers.
MEASUREMENTS: The study population included all patients dying from cancer in Denmark between 2010 and 2012 (n = 44,480). The associations were investigated using logistic regression analysis adjusted for sex, age, diagnosis, and geography and standardized absolute prevalences.
RESULTS: Comparison with cohabiting patients showed that overall admittance to SPC was lowest among patients who were widows/widowers (odds ratio [OR] = 0.86; 95% confidence interval [CI]: 0.81–0.91) and those who had never married (OR = 0.74; 95% CI: 0.68–0.80). Patients living alone were more likely to be admitted to a hospice [e.g., divorced OR = 1.41 (95% CI: 1.31–1.52)] than to a hospital-based palliative care team/unit [e.g., never married OR = 0.64 (95% CI: 0.59–0.70)] compared with cohabiting patients. Standardized prevalences of overall admittance to SPC showed a similar pattern, for example, admittance was highest (41%) for patients cohabiting and lowest (30%) for patients who had never married..
CONCLUSION: Cohabiting individuals were favored in admittance to SPC.
Compared with cohabiting patients it is unlikely that patients living alone have lower needs for SPC: results point toward inequity in admittance to specialist health care, a problem that should be addressed.
L'auteure étudie les actes en cause et regarde si le droit prend en compte la situation de fin de vie lorsqu'il les réglemente. Elle vérifie ainsi s'il existe ou non des dispositions spéciales encadrant la fin de vie ou à tout le moins comment peut être adapté le droit existant à cette circonstance extrême dans le cadre de l'union des personnes (mariage, PACS) et la transmission des biens (donation, testament).
Cet ouvrage rassemble les actes du Colloque organisé par l'Espace de Réflexion Ethique Basse-Normandie et la Faculté de droit de l'Université de Caen Normandie. Cette manifestation scientifique s'est tenue les 19 et 20 mars 2015, soit quelques jours après l'adoption par l'Assemblée nationale, en première lecture, de la proposition de loi Claeys / Leonetti réformant le droit des personnes en fin de vie. Chaque intervenant à ce colloque a eu la possibilité de mettre à jour sa contribution de la loi n°2016-87 du 2 février 2016 créant de nouveaux droits aux personnes en fin de vie et des textes d'application.
L'auteur aborde le terme "Résidence" sous un angle juridique puis il étudie le choix de sa résidence par la personne en fin de vie (la liberté de choix, les choix possibles) ainsi que la protection de la résidence de la personne en fin de vie (le droit des incapacités, le droit des régimes matrimoniaux).
Au moment où les religions font un retour retentissant dans la vie sociale, s'impose la nécessité de les comprendre dans leur cohérence et leurs différences. Car on ne peut plus se contenter d'une simple description factuelle et encore moins de quelques idées caricaturales.
Pour lutter contre l'intolérance, l'embrasement des passions haineuses et le fanatisme, le seul geste décisif consiste à dégager les points de rapprochement des grandes religions, et à se laisser interroger intelligemment par leurs singularités. C'est à cette condition que "la question religieuse" trouvera une réponse pacifique et féconde pour tous.
Cet ouvrage aborde la problématique du deuil et montre que la foi chrétienne, basée sur des textes bibliques ou évangéliques, permet de surmonter l'épreuve de la mort du conjoint. Ce témoignage fait suite à "L'aventure du mariage chrétien".
Cet article présente la théorie de Durkheim sur le suicide: le niveau d'intégration des membres d'une société (par le mariage, les enfants) a un impact direct sur le taux de suicide de cette société. Comme le montrent 3 études effectuées en France, en Finlande et aux Etats-Unis, cette théorie se vérifie chez les détenus masculins.
L'analyse rétrospective de dossiers de personnes décédées d'un cancer a permis de comparer trois groupes de patients: ceux mariés, ceux ayant été mariés et les célibataires. Des tableaux et graphiques statistiques illustrent les résultats qui mettent en évidence une interaction positive entre le statut marital notamment chez les hommes et la venue en soins palliatifs. Il montre le rôle de l'accompagnement par la famille. La différence constatée entre hommes et femmes semble reliée à des facteurs sociologiques sur leur rôle respectif.
Les effets de la structure familiale et de sa recomposition sur le parcours scolaire des enfants ont déjà donné lieu à des recherches. Elles concernent surtout les conséquences du divorce suivi ou non d'un remariage. L'article pose les mêmes questions sur la différence de comportement dans les situations de veuvage, lorsque le parent restant demeure veuf ou s'il se remarie. L'étude a été effectuée à deux périodes séparées de 4 années. Des tableaux récapitulatifs statistiques présentent les résultats sur différents paramètres : niveau scolaire atteint compte-tenu de différentes matières, survenue ou non de redoublement. Elle présente aussi un comparatif avec les résultats des analyses faites sur le divorce.
Ce numéro aborde le thème de la séduction des personnes âgées, en s'attachant à divers aspects : la chirurgie esthétique, l'habillement, la cosmétologie. Est également développée la question de la sexualité et du vieillissement, notamment à travers le regard porté par les jeunes et les soignants sur la sexualité des personnes âgées. Le mariage après 50 ans, ainsi que la sexualité en institution gériatrique et la nécessité de former le personnel en conséquence complètent ce document.
L'auteur fait découvrir l'islam à travers cet ouvrage. Il retrace l'histoire du prophète Mahommet, les confrontations entre islam et christianisme, la naissance du Coran et les fondements religieux de la conception de l'Homme dans l'islam.