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Background: The number of older adults living with companion animals (pets) is increasing worldwide. While evidence revealing positive relationships between companion animals and healthy aging is well established, there is a dearth of research regarding companion animal death and subsequent human grieving. Some emerging research suggests that grief over companion animal death is often discounted or even unrecognized (disenfranchised) by others. The extent and consequences of disenfranchised grief (DG) are poorly understood. This study deepens our understanding of older adults’ experiences of DG in relation to companion animal death., Methods: Participants from Alberta, Canada, were recruited through social media platforms to participate in an online questionnaire that collected demographic information and standardized measures of companion animal attachment, bereavement, and DG., Results: The majority of the 98 participants were between 60 and 70 years of age, female, and living alone. Following their companion animal’s death, 38.1% identified a decrease in physical activity, and 47% reported that their emotional health had declined. One-third identified that they needed to be careful about who they disclosed their grief, as they were not certain that they would be supported. This group had a significantly greater likelihood of perceived decrease in physical health, and they were more likely to score higher on the Pet Bereavement Questionnaire., Conclusions: This study adds weight to the emergent body of evidence highlighting companion animal bereavement as a legitimate and impactful health and well-being issue. The study found that DG is experienced by a sizable group of older adults following their companion animal’s death and that many participants perceived that socially legitimized recognition of loss and accompanying bereavement resources were lacking. These shortfalls contribute to health risks that negatively affect older adults’ ability to successfully age in the community.

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., Author(s): Donna M. Wilson [sup.1] , Kathleen Bykowski [sup.1] , Ana M. Chrzanowski [sup.2] , Michelle Knox [sup.3] , Begoña Errasti-Ibarrondo [sup.4] Author Affiliations: (1) grid.17089.37, 0000 0001 2190 316X, [...]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

At the beginning of July 2022, when public health restrictions were lifted, we deployed a country-wide e-survey about how older people were managing now after COVID-19 pandemic-related anxiety. Our responder sample was stratified by age, sex, and education to approximate the Canadian population. E-survey responders were asked to share open-text messages about what contemporaries could do to live less socially isolated lives at this tenuous turning point following the pandemic as the COVID-19 virus still lingered. Contracting COVID-19 enhanced older Canadians' risk for being hospitalized and/or mortality risk. Messages were shared by 1189 of our 1327 e-survey responders. Content analysis revealed the following four calls to action: (1) cultivating community; (2) making room for what is good; (3) not letting your guard down; and (4) voicing out challenges. Responders with no chronic illnesses were more likely to endorse making room for what is good. Those with no diploma, degree, or certificate least frequently instructed others to not let their guard down. While COVID-19 is no longer a major public health risk, a worrisome proportion of older people across the globe are still living socially isolated. We encourage health and social care practitioners and older people to share messages identified in this study with more isolated persons. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

A qualitative study was undertaken to identify what triggers grief in the first two years following the death of a beloved family member, determine how often triggered grief occurs, and gain lived insight into what can be done (if anything) to manage triggers and also triggered grief. Four themes highlighting an uncertain process associated with grief triggers were identified: (a) my whole life was grief, (b) frequently hit by "hard-grief" triggers, (c) reaching a balance with grief and grief triggers to absorb the losses and reshape life, and (d) shifting to good and welcome memories, triggers that keep the person alive. These themes are described, with quotes illustrating their relevance for advising bereaved people about the grief triggers they may encounter. This evidence adds to a limited body of evidence on grief triggers and offers new insights for developments in grief theory and bereavement programs or services. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population. Methods: This study was guided by the research question: "What are the care needs and care priorities of senior citizens with end-stage COPD?" An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006. Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others. Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

Context: Approximately 20% of North Americans and 25% of Europeans reside in rural areas. Planning and providing end-of-life (EOL) care in rural areas presents some unique challenges. Purpose: In order to understand these challenges, and other important issues or circumstances, a literature search was conducted to assess the state of science on rural EOL care. Methods: The following databases were searched for articles published from 1988 through 2003: EMBASE, Medline, CINAHL, AHMED, Psychinfo, ERIC, HealthStar, Sociological Abstracts, and Cochrane. All articles were systematically reviewed. Findings: Thirty-six research articles were identified. Only 1 randomized controlled trial was located. Most research was single site, small sample, and exploratory/descriptive in design. Four distinct foci in this body of research were noted: (1) identifying and describing differences between urban and rural EOL care; (2) exploring rural EOL care; (3) assessing the EOL needs and wishes of terminally ill or dying persons, their family members, and health care professionals in rural areas; and (4) exploring EOL education for rural EOL care providers. Conclusions: Although rural EOL care research is not extensive, the existing literature is helpful for realizing the importance of EOL care in rural communities, as well as for conceptualizing and planning EOL care in rural communities. One of the chief considerations for rural EOL care is that dying at home is a common wish, with home-based nursing care a key factor for this to become a reality. Another chief consideration is ensuring all rural health care professionals are both prepared for and supported while delivering EOL care.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]