Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies.

BACKGROUND: Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting. MATERIALS AND METHODS: This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data. RESULTS: While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety. CONCLUSION: Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

End-of-life conversations about death and dying from volunteer perspectives: A qualitative study.

OBJECTIVES: Although often unrecognized, volunteers fulfill many essential roles in hospices and other end-of-life care settings. Volunteers complement the actions of professionals in fulfilling many extra care needs, such as delivering newspapers and tidying bedsides. We explored end-of-life conversations about death and dying between hospice volunteers and terminally ill people, with a particular emphasis on any expressed desire to die. Our 2 research questions were as follows: (1) What is the nature of end-of-life conversations between hospice patients and hospice volunteers? and (2) How do hospice volunteers experience conversations about death and dying with patients who are at the end-of-life? METHODS: We conducted semi-structured interviews using an interpretive phenomenological analysis. We recruited hospice volunteers from 4 hospices in Calgary, Edmonton, and Red Deer; 3 larger cities in the province of Alberta, Canada. RESULTS: We interviewed 12 participants to saturation. Four themes emerged: (1) trusting conversations about death and dying in the context of a safe place; (2) normalcy of conversations about death and dying; (3) building meaningful relationships; and (4) end-of-life conversations as a transformative experience. Our results emphasize the importance of preparing volunteers for conversations about death and dying, including the desire to die. SIGNIFICANCE OF RESULTS: The safe environment of the hospice, the commitment to patient confidentiality, and the ability of volunteers to meet the basic and emotional needs of dying people or simply just be present without having formal care duties that need to be completed contribute to volunteers being able to participate in timely and needed conversations about death and dying, including the desire to die. In turn, hospice experiences and end-of-life conversations provide a transformative experience for volunteers.

Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments.

Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.

Suitability of the Attitudes to Aging Questionnaire Short Form for Use among Adults in Their 50s: A Cross-Sectional e-Survey Study.

This cross-sectional e-survey study examines the suitability (reliability and validity) of the 12-item Attitudes to Aging Questionnaire Short Form (AAQ-SF) for use among adults in their 50s. The AAQ-SF instrument was originally designed to capture subjective perceptions of physical change, psychosocial loss, and psychological growth by asking people aged 60 and beyond how they feel about growing older. Our sample comprised 517 people residing in three Canadian provinces. Respondents completed the Attitudes to Aging Questionnaire Short Form, the Rosenberg Self-Esteem Scale, and a short sociodemographic profile. Our findings replicate the original AAQ-SF structure for physical change, psychosocial loss, and psychological growth, with a promising internal consistency range for the third subscale. In our sample, psychological growth is best represented as 'Self' and 'Generativity', with a particularly greater capacity to explain variations in scores for item 18 and item 21. Physical change and psychosocial loss scores strongly differed based on perceived health and chronic illness presence. Psychosocial loss and psychological growth were moderately correlated with two aspects of self-esteem. We relate these patterns of findings within the context of prevailing growth and development theory and their perceived implications within the context of COVID-19 and post-pandemic life.

Post-death burial and funeral practices in rural Alberta.

BACKGROUND: Burial and funeral practices are important customary mortuary rituals, especially in rural areas as people are likely to have different values and interests than people who live in larger cities. However, little is known about rural post-death practices in Canada. AIMS: This review gathered information on funeral and burial practices in rural Alberta, a western Canadian province with a diverse rural population. METHODS: A literature review of community print sources, including obituaries and funeral home websites, was conducted for select representative rural communities. FINDINGS: This review found that cremations outnumber burials, and mortuary ceremonies more commonly occur in non-religious settings. Furthermore, personalised post-death rituals were identified as highly significant to rural people as they allow the dead to remain connected to their rural land, family and community. CONCLUSION: It is important to understand rural mortuary rituals to help prepare dying rural people and their families.

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study.

AIM: The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0-14 years living with tuberculosis. DESIGN: Exploratory descriptive qualitative design. METHODS: Semi-structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer-enhanced thematic analysis. RESULTS: Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. CONCLUSION: Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad-based emotional and other support for these women.

Location of Death in Developed Countries: Are Hospitals a Primary Place of Death and Dying Now?

Hospitals used to be a common site of death and dying. This scoping project sought published and unpublished information on current hospital death rates in developed countries. In total, death place information was gained from 21 countries, with the hospital death rate varying considerably from 23.9% in the Netherlands to 68.3% in Japan. This major difference is discussed, as well as the problem that death place information does not appear to be routinely collected or reported on in many developed countries. Without this information, efforts to ensure high quality end-of-life (EOL) care and good deaths are hampered.

Intra-Family End-Of-Life Conflict: Findings of a Research Investigation to Identify Its Incidence, Cause, and Impact.

With few investigations of intra-family end-of-life conflict, this study sought to identify its incidence, cause, and impacts. A questionnaire was completed by 102 hospice/palliative nurses, physicians, and other care providers in Alberta, a Canadian province. Participants reported on how often they had observed intra-family conflict when someone in the family was dying, and the impacts of that conflict. 12 survey participants were then interviewed about the intra-family conflict that they had encountered, with interviews focused on why conflict occurred and what the impacts (if any) were. Nearly 80% of families were thought to experience end-of-life conflict, periodically or continuously, among various family members. The interviews confirmed three reasons for intra-family end-of-life conflict and three conflict outcomes that were revealed in a recent literature review. The findings indicate routine assessments for intra-family end-of-life conflict are advisable. Attention should be paid to preventing or mitigating this conflict for the good of all.

Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review.

BACKGROUND: The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients. AIMS AND OBJECTIVES: The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN. METHOD: The systematic review was guided by Whittemore and Knafl's integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO. RESULTS: Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes. CONCLUSION: Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.

A scoping research literature review to explore bereavement humor.

The death of a loved one is extremely impactful. Although much of the focus now on helping people who are experiencing bereavement grief is oriented to distinguishing complicated from non-complicated grief for early pharmaceutical or psychiatric treatment, lay bereavement support comprises a more common and thus highly important but often unrecognized consideration. A wide variety of lay bereavement programs with diverse components have come to exist. This scoping research literature review focused on bereavement humor, one possible component. Humor has long been recognized as an important social attribute. Researchers have found humor is important for lifting the spirits of ill people and for aiding healing or recovery. However, humor does not appear to have been recognized as a technique that could benefit mourners. A multi-database search revealed only 11 English-language research articles have been published in the last 25 years that focused in whole or in part on bereavement humour. Although minimal evidence exists, these studies indicate bereaved people often use humor and for a number of reasons. Unfortunately, no investigations revealed when and why bereavement humor may be inappropriate or unhelpful. Additional research, multi-cultural investigations in particular, are needed to establish humor as a safe and effective bereavement support technique to apply or to use. Bereavement humor could potentially be used more often to support grieving people and bereaved people should perhaps be encouraged to use humor in their daily lives.

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief.

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

How and why nurses became involved in politics or political action, and the outcomes or impacts of this involvement.

BACKGROUND: Nurses' political engagement is needed for societal advancements. PURPOSE: The purpose of this study was to explain why and how nurses became politically active, and what they achieved. METHODS: Qualitative, constant-comparative data analysis was used for this study. After 10 elected or politically-active Canadian nurses were interviewed, data saturation was confirmed. FINDINGS: All were motivated by early life events to realize the importance of social justice and good government. Their nursing education and work equipped them to be capable of engaging in political spheres. All had developed knowledge of relevance for political purposes; in addition to confidence, communication skills, and other abilities to be effective politically. All highlighted the importance of being encouraged and assisted to engage politically. Positive micro-, meso-, and macro-level benefits of this involvement were identified. CONCLUSIONS: More nurses should be inspired and helped to become active politically. It is critically important for nurses to inform and advance public policy, through direct political activities.

What Exactly Is "Complicated" Grief? A Scoping Research Literature Review to Understand Its Risk Factors and Prevalence.

Most people will experience bereavement grief, but some suffer from persistent or prolonged (PoP) grief, grief that used to be identified as "complicated" before recent DSM-5 and ICD-11 definitional developments. In 2020, a scoping literature review was undertaken to identify and consolidate contemporary evidence from research articles published in 2018 or 2019 in paper-based and open access peer-review journals on: (a) the incidence or prevalence of PoP grief, and (b) who develops it or is diagnosed as suffering from it, and correspondingly what causative factors or predictors are associated with PoP grief. All of the 11 identified research articles reported an incidence or prevalence rate, with these varying greatly, but with a much higher rate now that a 6-month post-death measurement timeframe is used. The predictors or factors among people who were identified as having PoP grief also varied considerably, although sudden and unexpected deaths were often implicated.

Older women's experiences of companion animal death: impacts on well-being and aging-in-place.

BACKGROUND: Companion animal death is a common source of grief, although the extent and context of that grief is poorly understood, especially in older adulthood. The aim of this multiple-methods study was to develop a greater understanding of the impact of companion animal death on older women living alone in the community, as older women are a distinct at-risk group, and the supports that should be available to help these individuals with their grief. METHODS: Participants were recruited from across Alberta, a Canadian province, through seniors' organizations, pet rescue groups, and social media groups of interest to older women. After completing a pre-interview online questionnaire to gain demographic information and standardized pet attachment and grief measures data, participants were interviewed through the Zoom ® computer program or over the telephone. An interpretive description methodology framed the interviews, with Braun and Clarke's 6-phase analytic method used for thematic analysis of interview data. RESULTS: In 2020, twelve participants completed the pre-interview questionnaires and nine went on to provide interview data for analysis. All were older adult (age 55+) women, living alone in the community, who had experienced the death of a companion animal in 2019. On the standardized measures, participants scored highly on attachment and loss, but low on guilt and anger. The interview data revealed three themes: catastrophic grief and multiple major losses over the death of their companion animal, immediate steps taken for recovery, and longer-term grief and loss recovery. CONCLUSIONS: The findings highlight the importance of acknowledging and addressing companion animal grief to ensure the ongoing well-being and thus the sustained successful aging-in-place of older adult women in the community.

A study to determine if and how bereavement support programs provided by Irish and Canadian hospices are evaluated.

A study of the bereavement programs provided by hospices in Ireland and the Canadian province of Alberta was done to determine if and how these are evaluated for efficacy. All but one hospice offered multiple different bereavement programs, with routine in-house evaluations of all programs performed. In all cases, staff and client unsolicited and solicited comments made during and at the end of each program provided data for continuing program refinement. Most hospices also routinely employed a self-devised questionnaire to gain specific sought information to retain or change programs. Other information, including news about program developments elsewhere, was also actively sought for program adoption or for the improvement of existing programs. With most bereavement programs having been in place for many years, participants were confident their programs are needed, safe, and effective. Their continuing quest for high-quality programming, however, meant they were active in monitoring these programs and in seeking developments in this field.

Autonomy and control in the wish to die in terminally ill patients: A systematic integrative review.

BACKGROUND/OBJECTIVE: Personal autonomy and control are major concepts for people with life-limiting conditions. Patients who express a wish to die (WTD) are often thought of wanting it because of loss of autonomy or control. The research conducted so far has not focused on personal beliefs and perspectives; and little is known about patients' understanding of autonomy and control in this context. The aim of this review was to analyze what role autonomy and control may play in relation to the WTD expressed by people with life-limiting conditions. METHODS: A systematic integrative review was conducted. The search strategy used MeSH terms in combination with free-text searching of the EBSCO Discovery Service (which provides access to multiple academic library literature databases, including PubMed and CINAHL), as well as the large PsycINFO, Scopus, and Web of Science library literature databases from their inception until February 2019. The search was updated to January 2021. RESULTS: After the screening process, 85 full texts were included for the final analysis. Twenty-seven studies, recording the experiences of 1,824 participants, were identified. The studies were conducted in Australia (n = 5), Canada (n = 5), USA (n = 5), The Netherlands (n = 3), Spain (n = 2), Sweden (n = 2), Switzerland (n = 2), Finland (n = 1), Germany (n = 1), and the UK (n = 1). Three themes were identified: (1) the presence of autonomy for the WTD, (2) the different ways in which autonomy is conceptualized, and (3) the socio-cultural context of research participants. SIGNIFICANCE OF RESULTS: Despite the importance given to the concept of autonomy in the WTD discourse, only a few empirical studies have focused on personal interests. Comprehending the context is crucial because personal understandings of autonomy are shaped by socio-cultural-ethical backgrounds and these impact personal WTD attitudes.

A scoping research literature review to map the evidence on grief triggers.

Grief is understandably severe in the first days, if not weeks or months, following the death of a beloved person. Unless the mourner develops complicated grief, which is prolonged severe and impactful grief, the initial acute grief lessens in severity over time, although waves of significant grief will still occur with grief triggers. A scoping research literature review was undertaken in early 2021 to determine how often grief triggers occur, what the most common grief triggers are, the impact of triggered grief, and what can be done (by those not diagnosed with complicated grief) to manage grief triggers and mitigate the effect of them. Nine academic library databases were searched for English-language research reports using the keywords "grief trigger(s)" and "research": CINAHL, Directory of Open Access (online) Journals, Humanities Index, JSTOR, Medline (Ovid), Periodicals Index Online, PsychArticles, Scopus, and Web of Science. Six research papers relevant for review were published in the last two decades, with some evidence gained on how often grief triggers occur, what constitutes a grief trigger, and the impact of grief triggers. Major gaps in evidence were revealed, despite grief triggers being identified as a major consideration for grief in general and for grief recovery specifically.

A Study to Understand the Impact of Bereavement Grief on the Workplace.

Although most employees and business owners or operators will likely experience the death of one or more loved ones over their work lives, attention has not focused on how bereavement grief impacts the workplace. A study was conducted for foundational information. Data on the annual incidence of bereavement leaves and related matters were collected from a relatively representative sample of small, medium, and large Canadian organizations. Two of every three organizations had 1+ employees take a bereavement leave last year, with 3.2% of all employees taking a bereavement leave consisting of 2.5 days on average and often with additional travel and accommodation days. The findings suggest that more should be done by organizations to prepare for bereavement leaves and assisted work returns. This preparation is essential for the tsunami of bereavement grief in the years ahead as deaths increase rapidly in number with population aging.

Funeral and interment practices of rural residents: A mixed methods study.

There are few studies on interment preferences and practices for people in remote and rural regions of developed countries. This mixed methods study in rural Australia collated data on funeral and interment practices with an ethnographic exploration of the post-death preferences of terminally-ill rural residents. In the region, between February 2015 and May 2016, 44% of decedents were cremated. Burial preferences reflected family traditions, generational connections to historic cemeteries, and the wish to instantiate belonging to people and place. Cremation provided the opportunity for ashes to be scattered at personally-significant places. Funeral planning was important for patients and family caregivers, and funerals are valued rural community rituals.

A Research Literature Review to Determine How Bereavement Programs Are Evaluated.

A review of all 44 research reports published between 2000 and 2018 on bereavement program evaluation was undertaken to identify evaluation methods and assess their apparent efficacy. Bereavement program evaluations varied considerably, with multiple data collection methods per study common (61.4%) over single methods (38.6%). Among these evaluation methods, a self-devised questionnaire was most often used (59.1%), followed by qualitative interviewing (36.4%), and the use of 1 or more of 35 data collection instruments such as grief inventories or depression scales (40.9%). Evaluative data were usually only collected once (77.3%), typically around program completion. Formal bereavement program evaluation appears to be ad hoc and sporadic, and potentially unlikely to provide the type and quality of information needed to retain, improve, expand, or abandon programs. Evaluation method developments including evaluation standards are needed to ensure recipients and others benefit as expected from bereavement programs.