End-of-Life Care for Rural-Dwelling Older Adults and Their Primary Family Caregivers

Background:An outbreak of Ebola disease was declared in Lagos, South West Nigeria, on 23rd July 2014. Later, the outbreak spread to the south south and south eastern part of the country. The last cases occurred on August 31, 2014 and the country was certified to be Ebola free on 20th October, 2014. This paper describes the experiences and implications of the Ebola outbreak for Nigerian women.Subjects and Methods:Identification and listing of cases and contacts was done in Lagos, Port Harcourt and Enugu. Socio demographic information was collected.Results:Women made up 55% of Ebola cases and 56.6% of contacts traced. Of the 8 deaths reported 50.0% (4) were women, of which 75.0% (3) were health care providers. The sex specific case attack and fatality rates for males and females were 2.2% versus 2.3% and 45.5% versus 33.3% respectively. The women restricted their movement in order to avoid the infection. The outbreak affected their utilisation of health care services and livelihood.Conclusion:Women were exposed occupationally and domestically due to their care giving roles. In health facilities, they were directly involved in the care or encountered persons who had been in contact with persons with Ebola. In the homes, they were at the forefront of nursing the sick. There is the need to ensure women have access to information, services and personal protective equipment to enable them protect themselves from infection. Education and engagement of women is crucial to protect women from infection and for prompt outbreak containment.

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“…Women are also traditional birth attendants, putting them at a greater risk of contracting the deadly virus. [17]…”

Section: Discussionmentioning

confidence: 99%

Gender dimensions to the Ebola outbreak in Nigeria

et al. 2016

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“…This indicates that caregivers are more likely to experience collapse when they are living apart from their care recipient. In addition, caregivers who live a great distance from care services have a hard time accessing them [ 57 ]. Rural caregivers, especially, cannot conveniently visit the doctor and hospital and therefore are more likely to experience negative physical symptoms [ 58 , 59 ].…”

Section: Introductionmentioning

confidence: 99%

A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective

Williams

Sethi

Duggleby

et al. 2016

Int J Equity Health

105

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BackgroundA little-studied issue in the provision of care at home by informal caregivers is the increase in older adult patients with chronic illness, and more specifically, multiple chronic conditions (MCC). We know little about the caregiving experience for this population, particularly as it is affected by social location, which refers to either a group’s or individual’s place/location in society at a given time, based on their intersecting demographics (age, gender, education, race, immigration status, geography, etc.). We have yet to fully comprehend the combined influence of these intersecting axes on caregivers’ health and wellbeing, and attempt to do this by using an intersectionality approach in answering the following research question: How does social location influence the experience of family caregivers of older adults with MCC?MethodsThe data presented herein is a thematic analysis of a qualitative sub-set of a large two-province study conducted using a repeated-measures embedded mixed method design. A survey sub-set of 20 survey participants per province (n = 40 total) were invited to participate in a semi-structured interview. In the first stage of data analysis, Charmaz’s (2006) Constructivist Grounded Theory Method (CGTM) was used to develop initial codes, focused codes, categories and descriptive themes. In the second and the third stages of analysis, intersectionality was used to develop final analytical themes.ResultsThe following four themes describe the overall study findings: (1) Caregiving Trajectory, where three caregiving phases were identified; (2) Work, Family, and Caregiving, where the impact of caregiving was discussed on other areas of caregivers’ lives; (3) Personal and Structural Determinants of Caregiving, where caregiving sustainability and coping were deliberated, and; (4) Finding Meaning/Self in Caregiving, where meaning-making was highlighted.ConclusionsThe intersectionality approach presented a number of axes of diversity as comparatively more important than others; these included gender, age, education, employment status, ethnicity, and degree of social connectedness. This can inform caregiver policy and programs to sustain health and well-being.

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“…Added to this specialist drugs that provide relief from pain and agitation such as midazolam, clonazepam and morphine not being able to be prescribed due to lack of specialist palliative care doctors, means that some patients are not able to receive the care they may have more easily received in urban areas . Families choosing to travel extended distances for treatment have social, emotional and financial outcomes adding an extra burden of care and influence crucial quality of life decisions at end life . These can be the deciding factors as to whether patients are able to continue treatment or not …”

Section: Geography Ageing Rural Populations and Palliative Care Pracmentioning

confidence: 99%

“…Like many countries Australia has an ageing population, with the ratio of ageing to younger people in rural areas significantly higher than in urbanised centres . The effects of internal migration, limited employment opportunities, lack of services and erosion of infrastructure present issues for rural health care providers with an increasingly older population requiring assistance towards end of life …”

Section: Introductionmentioning

confidence: 99%

Factors affecting rural volunteering in palliative care – an integrated review

Whittall

Lee

O'Connor

2016

Australian J Rural Health

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To review factors shaping volunteering in palliative care in Australian rural communities using Australian and International literature. Identify gaps in the palliative care literature and make recommendations for future research. A comprehensive literature search was conducted using Proquest, Scopus, Sage Premier, Wiley online, Ovid, Cochran, Google Scholar, CINAHL and Informit Health Collection. The literature was synthesised and presented in an integrated thematic narrative. Australian Rural communities. While Australia, Canada, the United States (US) and the United Kingdom (UK) are leaders in palliative care volunteer research, limited research specifically focuses on volunteers in rural communities with the least occurring in Australia. Several interrelated factors influence rural palliative care provision, in particular an increasingly ageing population which includes an ageing volunteer and health professional workforce. Also current and models of palliative care practice fail to recognise the innumerable variables between and within rural communities such as distance, isolation, lack of privacy, limited health care services and infrastructure, and workforce shortages. These issues impact palliative care provision and are significant for health professionals, volunteers, patients and caregivers. The three key themes of this integrated review include: (i) Geography, ageing rural populations in palliative care practice, (ii) Psychosocial impact of end-end-of life care in rural communities and (iii) Palliative care models of practice and volunteering in rural communities. The invisibility of volunteers in rural palliative care research is a concern in understanding the issues affecting the sustainability of quality palliative care provision in rural communities. Recommendations for future Australian research includes examination of the suitability of current models of palliative care practice in addressing the needs of rural communities; the recruitment, training, ongoing education and support of volunteers in rural palliative care provision to ensure equitable care for all communities in Australia regardless of location.

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End-of-Life Care for Rural-Dwelling Older Adults and Their Primary Family Caregivers

Cited by 23 publications

References 34 publications

Gender dimensions to the Ebola outbreak in Nigeria

Gender dimensions to the Ebola outbreak in Nigeria

A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective

Factors affecting rural volunteering in palliative care – an integrated review

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