Palliative Care Professionals' Perceptions and Communication About Sexual Expression of Older Adults at End of Life: How Biases Compromise Holistic Care.

BACKGROUND AND OBJECTIVES: The sexuality of older people, which has historically been invisible, is increasingly represented and promoted in the media. However, the sexuality of the oldest older adults showing signs of frailty remains obscure and subject to ageist and ableist biases. Studies on sexual expression at the end of life have shown that sexuality and the need for support related to it remain important for many people. RESEARCH DESIGN AND METHODS: This article examines the perceptions and attitudes of professionals regarding the sexuality of older adults in palliative care, based on an exploratory qualitative study. Participants were recruited from several palliative care teams working either in hospital or in home settings in Canada. RESULTS: Professionals (n = 16) held two main views of sexuality: broad and holistic or narrow and genital-focused. Perceptions of sexuality in later life were either described as a continuation of or distinct from middle adulthood. No matter what views were held, most professionals did not discuss sexuality with their patients at the end of life. DISCUSSION AND IMPLICATIONS: The lack of communication about sexuality may be largely due to professional's ageist, ableist, and heterosexist views regarding the sexuality of this population group. Results confirm the relevance of providing palliative care training about diverse sexual experiences and the importance of supporting older adults at the end of life with respect to their intimate and sexual needs. Such an approach is in line with the holistic vocation of palliative care.

COVID-19, promotion and provision of palliative care: reaching out, accounting for linguistic diversity.

The combined forces of economic globalization and international migration have resulted in specific challenges to palliative care systems. The COVID-19 pandemic has and is still greatly affecting elder populations as well as those across the age continuum living with long-standing chronic conditions or with pre-existing diverse unmet needs. While health promotion and palliative care may appear to be conceptually opposing fields, we argue that palliative care can and should fit under the umbrella of the health promotion continuum. This commentary seeks to discuss the importance of linguistic literacy and communication imperatives in the context of access to palliative care, given the broad, diversified and sensitive scope of care. While the pandemic has demonstrated that the public health responses of migrant host societies are deeply intertwined with policies as well as local rules and constraints, the promotion and provision of safe, timely and appropriate palliative care can be achieved through a sensitive assessment of differential contexts of diversity. The pandemic has painfully illustrated the need for a strong, respectful and equitable working partnership within the professions as well as with the civic society in order for the palliative needs of those exposed to a sustained risk not to be forgotten.

Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use.

OBJECTIVES: This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care. DESIGN: A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. SETTINGS AND PARTICIPANTS: Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MEASURES: Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. RESULTS: The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. CONCLUSIONS/IMPLICATIONS: Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.

[Palliative care practices at home: instead of social exclusion of older people in later life?]. / Les pratiques de soins palliatifs à domicile: lieu d'exclusion sociale des personnes âgées en fin de vie?

The understanding of palliative care practices at home (PCH) is limited by the lack of available scientific knowledge. This is explained by the fact that its practices are relatively recent and they question our relationship with death and dying individuals. This study aims to contribute to the advancement of knowledge about PCH with the elderly. More specifically, with a perspective of social exclusion, it aims to understand how practices either do or do not produce social exclusion with seniors receiving palliative care. Nineteen participants from two local community services centers were interviewed and six multidisciplinary meetings were attended for observation. This study suggests that positive representations concerning the elderly in palliative care and recognition of their autonomy can avoid social exclusion, including its symbolic and identificatory dimensions. However, standardization of practices seems to contribute to institutional exclusion and foster nonrecognition.