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After significant early interest in aging and dying, recent empirical studies have been few and theoretically fragmented.The aims of this review were to map what is empirically known about the intersections between existential aging (a sense of passing years that evoke a sense of nearness-to-death) and dying identity and to describe the available evidence.Articles were reviewed employing PRISMA guidelines. Seven data bases were searched resulted in 165 records. Of these 165 records a final selection of 24 studies that met the criteria were examined.Evidence from the review found that the formation of the identity of dying alongside existential aging was associated with personal changes related to self/gerotranscendence, self-concerns about the inevitability of death (mortality salience), self-concerns about the prospect of death (death anxiety), attitudes toward the older self as a moderator of attitudes to death (aging attitudes), or simply anticipating the death of self (the future). Collectively, these studies found that death and dying were threats or challenges to life as an increasingly aging identity and that this seems to require compensation or accommodation.These studies confirm the importance of nearness-to-death on identity formation and psychological change in older populations. However, most of the studies were quantitative and tested for pre-existing ideas and concepts. There is a need for more qualitative studies to search for wider or parallel meanings about identity change in the face of aging and death, more longitudinal designs, and greater attention to mixed methods approaches, especially for populations for whom talk or writing may be restrictive.

This is a book about the public health approach within palliative care. Often when we think about ‘public health’ it is more usual to think about palliative care as part of the public health system – similar to the hospitals, nursing homes, and community clinics – but also the broader supports for population health such as sewerage and water purification systems or workplace health and safety. In universities, we often think of public health in terms of the surveillance sciences – epidemiology, health services research, computer modeling, or the bench sciences devoted to understanding disease. But in this volume, we are specifically addressing a newer and less recognized aspect of public health – public health practice methods such as education, health policy, community development, or social ecology. We are also specifically examining the role of the ‘new’ public health, sometimes also known as health promotion. Health promotion is a major departure from the emphases on surveillance, disease, and health services by placing its gaze and efforts on practice solutions, health and wellbeing, and community and civic involvement in healthcare – in this case, palliative care. The Oxford Textbook of Public health Palliative Care is an introduction to this dimension of practice. This chapter provides an overview of what public health palliative care is and outlines the themes and topics that will be covered in each section.

Public health palliative care draws its main ideas and methods from the wider field of the new public health. This chapter outlines the key ideas of the new public health and identifies the main reasons this approach has emerged from earlier historical ideas about public health and healthcare. Three non-palliative care examples (the long-term management of an ageing population living with HIV, new public mental health management, and ear and hearing health) are described to illustrate how these ideas infuse other healthcare specialisms before examining how some of these ideas persist or have changed for public health palliative approaches.

This chapter introduces the idea of the social ecology of health and links this approach to the social ecology at the end of life. This approach is founded upon a ‘setting’-based, or place-based, set of ideas that links health and illness to characteristics of the physical and social environment. From these frameworks emerge practice methods to directly address these kinds of determinants—healthy cities and compassionate cities. Two examples from England and Spain are described to illustrate how these approaches are deployed in encouraging full civic participation in palliative care. Strengths as well as barriers and changes to these approaches are described.

This chapter outlines the reasons to believe that dying is a predominantly social experience and that a predominantly social model for its care is both logical and essential. Themes for the major research traditions studying dying are summarized. This is followed by an explanation of the 95% rule—time spent by dying people outside of the formal healthcare encounter. The next sections describe how a public health palliative care approach is a quintessential social model of palliative care suitable and relevant to today’s experience of dying and its care. This model places both the social experience and the pursuit of health and well-being at the heart of its approach.

Compassionate Cities programs are civic efforts to contribute to the work of palliative care by providing a variety of supports – educational, interpersonal, policy-oriented – for the end of life c...

In the last 100 years, American orphanages have dramatically declined at the same time as nursing homes have seen exponential growth. This paper reviews the common understanding and assumptions about these two distinct histories and asks: why have these national responses been so different when the populations at the center of them are so similar? Among several reasons offered for these differences two unique factors that promote the institutionalization of the elderly are commonly omitted. These are: the gendered nature of institutionalized elderly populations and the stigma and social burden of death and dying. These two influences, separately and together, are either overlooked or underestimated for their impact on historical and policy outcomes. It is crucial for the future of elder care and research that these factors are recognized so that policies have a precise – and more helpful - focus on the actual challenges faced by these populations.

Access to palliative care is commonly considered as solely a health services challenge rather than a community challenge. Successive healthcare reports continue to pose the question of access and its solution in terms that ask what a service can do rather than what an ally a service can become. However, the question is not what can we do for disadvantaged communities, but rather, what can we do together with them as fellow providers of palliative care. The first part of this article reviews the most common recommendations offered for increasing access to palliative care. The second part advocates an alternative way to address this challenge by employing the key practice methods of a new public health / health promotion approach to palliative care.

BackgroundReducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital.AimTo evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital.Design and settingA cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017.MethodPatients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome.ResultsThere was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, PConclusionThe complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.