Dying in long-term care facilities: support needs of other residents, relatives, and staff.

This paper explores the support needs of residents, relatives, and care staff when someone dies in a facility for older people. The authors draw on the qualitative findings from an English study, which investigated the case for applying the principles and practices of palliative care to people dying in these settings. Relatives need practical as well as emotional support, which is often not met adequately by nursing home staff. Managers varied in the extent to which they recognized other residents' emotional needs or supported relatives. Care staff members acknowledged needing practical and emotional support, but management was often unable to deliver it. Lack of training in recognizing and addressing needs in addition to financial and staffing constraints were factors that prevented managers from providing support for staff, residents, and relatives.

The quality of terminal care in residential and nursing homes.

This article presents some of the findings from a large national multi-method study on the management of death and dying in residential and nursing homes for older people. The study included all types of registered homes and interviews were conducted with staff, residents and visitors to the homes. Stage 1 used a survey questionnaire to provide background demographic data. Stages 2 and 3 included 100 interviews with the heads of homes and 12 case studies. Particular consideration was given to internal and external influences on care provision in the interviews and observations were made in the case study homes. Clearly, home staff are committed to the provision of good quality terminal care for residents. This article focuses on some of the reasons why that commitment is difficult to translate into practice.

Death in homes: bereavement needs of residents, relatives and staff.

This article reports findings from a study in the UK, which investigated the case for applying the principles and practices of palliative care to caring for older people dying in residential and nursing homes. It focuses on the emotional and practical consequences of a death occurring in these settings. It outlines the bereavement needs of residents, relatives and staff as well as obstacles to providing adequate support. Homes differed in policies and practices in relation to providing bereavement support for relatives. Most managers felt some responsibility for relatives of deceased residents, but rarely felt capable of providing what they perceived as appropriate bereavement support. They recognized the need for practical as well as emotional support for staff and other residents after a death but felt that they lacked the skills and time to provide this. Certain types of home prioritized bereavement support, but many homes operated under considerable resource and staffing constraints. Even where support needs were recognized it was often difficult to put the requisite help into operation. This study identified a lack of training in communication skills and in particular little access to training in bereavement care. This area needs to be addressed if residents, relatives and home staff in these settings are to have their bereavement needs met.

omega-Agatoxin IVA identifies a single calcium channel subtype which contributes to the potassium-induced release of acetylcholine, 5-hydroxytryptamine, dopamine, gamma-aminobutyric acid and glutamate from rat brain slices.

The voltage-dependent calcium channels (VDCCs) involved in K(+)-induced transmitter release have been studied. A maximally effective concentration of the N-type VDCC inhibitor, omega-conotoxin GVIA (GVIA) blocked the release of 5-HT (30%), DA (30%) and ACh (60%) but not that of GABA or glutamate. The O, P and Q-type VDCC inhibitor, omega-agatoxin IVA (Aga IVA, 1 microM), blocked 100% of GABA and glutamate, 70% of DA and about 50% of 5-HT and ACh release. The slopes of the inhibiton curves indicate that it acts on the same, single type of VDCC in all cases. omega-Conotoxin MVIIC (MVIIC) completely inhibited the release of all the transmitters. It is concluded that a single GVIA-insensitive type of VDCC is involved in the K(+)-induced release of all the transmitters and, in addition, N-type VDCCs, with a higher affinity for GVIA than MVIIC, are required for the release of 5-HT, DA and ACh. The non-N-type VDCC is not the O-type as it is not blocked by low (< 10 nM) concentrations of MVIIC. Further resolution of this VDCC into P or Q-type requires more selective antagonists.