Does Aging and Disease Increase the Importance of Cognitive Strategies? Social and Temporal Comparisons in Healthy Younger and Older Adults and in Younger and Older Cancer Patients.

Social and temporal comparisons may help the individual anchor his or her self-image in a social and temporal context. In the Life-Span Theory of Control, comparisons are included in the repertoire of secondary control strategies individuals may apply when primary control strategies are obstructed, for example, by age-related losses or physical decline. The aim of this study was to explore differences in prevalence and effects of social and temporal comparisons in younger and older adults and healthy and diseased individuals ( n = 34). Semistructured interviews were conducted and analyzed using a mixed-methods approach combining qualitative and quantitative data analysis. The results revealed that older adults engaged in more comparisons than younger adults and that the outcomes of comparisons were more positive for older adults, particularly older cancer patients. The results indicate that comparisons may be applied more often by older and diseased individuals in the service of maintaining well-being.

A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care.

BACKGROUND: Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far. METHODS: This study tested the feasibility of an intervention based on key elements of the "Bereavement support standards for specialist palliative care services" in a Danish specialised palliative home care team. We followed the UK Medical Research Council's guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors. RESULTS: The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. CONCLUSION: The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.

[Are old and young cancer patients being treated differently?]. / Gøres der forskel på aeldre og yngre kraeftpatienter?

INTRODUCTION: Research suggests that cancer patients' age may affect the quality of their treatment. Yet, there is little knowledge of how and why age affects treatment quality. This study explores staff attitudes and perceptions of age-related differences in treatment and care at a Danish oncology department. MATERIAL AND METHODS: Qualitative analyses of nine semi-structured interviews with strategically selected staff members were conducted using a grounded theory-inspired approach. The interviews were independently coded by four raters through a process of meaning condensation and meaning was structured into core-categories. RESULTS: Although eight of nine participants denied that age was a reason for differential treatment, all nine participants gave examples of age-related differences in treatment. Younger patients were generally offered: 1) more intensive treatment, 2) more consultation time with physicians, 3) allocation to physicians with higher seniority, and 4) increased continuity in the staff assigned to them. The differences were explained as due to: a) differences in patients' physical health and b) sympathy for younger patients' life situation and needs. DISCUSSION: Two co-dominant values were identified: 1) "equality in treatment and care" and 2) "normative life course expectations" of serious disease belonging to old age and thus being more tragic for young individuals (life script model). Values of equality are explicit and govern formal health care system guidelines, while values related to the staff's life course expectations are more implicit and may account for some age-related differences in treatment quality.