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Biomedical subjects

M Bern-Klug

Publications and source records attributed to M Bern-Klug.

7 recordsLinked to original sources
PubMed2001

The need to revise assumptions about the end of life: implications for social work practice.

During the 20th century the experience of dying changed dramatically. At the beginning of the 1900s, dying and death were integral parts of the life experience of most people at any age. Many deaths occurred at home following a short course of illness largely unaffected by the limited medical care available. At the beginning of the 21st century, in many cases, the process of dying has become invisible. Today, most deaths occur in old age. Social workers have a key role as "context interpreters" in helping people at the end of life and their families understand the natural course of the illness, the process of dying, and the advantages and drawbacks of medical interventions. An expanded role for social workers in helping people comprehend the medical and social contexts within which they face end-of-life decisions is discussed.

Advance Directives↗
PubMed2000

End-of-life decision making for nursing home residents with dementia.

PURPOSE: To describe families' decision-making processes, both cognitive and affective, regarding end-of-life treatments for nursing home residents with moderately severe to very severe dementia. DESIGN: Naturalistic inquiry provided the framework for this descriptive, qualitative study. METHODS: Four focus groups were conducted in selected nursing homes, in the central part of the United States for a qualitative study. Twenty-eight family members of residents with moderately severe to severe dementia shared their decision-making experiences. Open-ended questions were asked in each focus group. Data were analyzed using content analysis. FINDINGS: Five themes were identified that describe the context of decision making: emotional effect, insult-to-life story, two faces of death, values and goals regarding end-of-life treatments, and the unrecognized trajectory of dying. Family members made decisions in an emotional climate of overwhelming burden and guilt, because their loved one's life had been robbed of personhood, the changes associated with decline from a dementia-related illness were unrecognized as part of a trajectory of dying, death was both a tragedy and a blessing. CONCLUSIONS: Family members had poignant, unresolved emotional needs stemming from their loved one's illness and nursing home placement. Participants were unprepared to make end-of-life treatment decisions and lacked the informational and emotional support of a consistent provider to help with decisions. Family members need assistance in processing difficult and painful emotions, understanding the trajectory of disease, what decisions might impede a natural death, and comfort or palliative care options.

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PubMed2000

Planning end-of-life care for patients with dementia: roles of families and health professionals.

We examined families' end-of-life decision making and their interactions with health professionals. Twenty-eight family members of institutionalized dementia patients participated in four focus groups. We found that participating family members were not well prepared for their decision-making roles, and that they: 1) experienced substantial burdens and loss in caring for institutionalized elders; 2) had limited understanding of the natural progression of dementing conditions; 3) were uncomfortable in setting goals for their relatives' end-of-life care; 4) had little experience with death, and were ambivalent about the anticipated death of their relative; and (5) reported that they had little substantive communication with health professionals regarding end-of-life care planning. We concluded that many of the needs of such families could be addressed through improved application of the principles of advance care planning, including regular structured discussions, involvement of surrogate decision-makers, and anticipation of clinical decisions. Health professionals should take the lead in 'normalizing' the discussion of death.

Advance Care Planning↗
PubMed1999

What families know about funeral-related costs: implications for social work practice.

Social workers provide essential services in the area of end-of-life care to individuals who are dying and their families. Results reported here suggest that social work's role be expanded to provide basic information about local final arrangement (funeral and burial) options and costs. This study was undertaken to determine the knowledge and experience level of people responsible for funeral and cemetery arrangements and to investigate factors affecting familiarity with final costs. Survey responses from 163 survivors of older adults in Kansas City showed that adult children play an important role in the final arrangements of a parent and that half the survivors responsible for final arrangements had no idea what to expect in terms of costs.

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PubMed1999

Income characteristics of rural older women and implications for health status.

This review examines the relationship between rural residence, income, and health status for older women in the U.S. little published research has focused on the interaction between financial status and the specific health-related needs of these rural women. Both descriptive data from the 1990 U.S. Census and empirical data from the health care literature are analyzed. Gender, rural residence, and poverty are identified as risk factors for reduced access to health care services, lower rates of health care service utilization, and poorer health outcomes.

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