Social science & medicine
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To gain an insight into the burden of dementia in an aging society, life expectancy with dementia and its counterpart dementia-free life expectancy (DemFLE) in The Netherlands are presented. Sullivan's method was used to calculate DemFLE. For elderly living either independently or in homes for the elderly prevalence figures on dementia were obtained from the Rotterdam Elderly Study (RES; n = 7528); for elderly in nursing homes the SIG Nursing home Information System was used. ⋯ The percentage of life expectancy without dementia however, is always lower for women, because of their higher total life expectancy. This indicates that the burden of dementia in absolute and relative terms is higher for women. Most years with dementia are spent at home, indicating that the burden of dementia rests mainly on the shoulders of informal caregivers.
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As medical technology prolongs life and facilitates the early diagnosis of terminal illnesses such as AIDS, the concept of anticipatory grief requires further scrutiny. The original concept of anticipatory grief has become widely accepted. This paper, however, argues that the uncritical acceptance of this concept rests primarily on the authority of the biomedical model, which has focused analysis on the predictable symptomatology of the grief process, integrating this understanding into health care. ⋯ The paper discusses the relevance of understanding the conceptual confusion which exists in the literature between "anticipatory grief" and "forewarning of loss". It is argued that grief may be the response to a loss of meaning, and that the psychological process of adjustment to loss requires individuals to engage in the reconstitution of purpose and meaning in their lives. Distinguishing between what is being expressed for past and present losses and what responses occur when individuals focus on various aspects of their future may shed light on some of the inconsistent and contradictory findings surrounding research on anticipatory grief.
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Social science & medicine · Oct 1996
Comparative StudyHow reliable are relatives' retrospective reports of terminal illness? Patients and relatives' accounts compared.
To assess the accuracy of relatives' recollections of patients' terminal illness 71 out of 77 caring relatives were re-interviewed about 4 months after they and the patients had given regular interviews throughout care. Current and retrospective ratings of problems and feelings have been compared for agreement, using the kappa index. Several volunteered symptoms showed poor agreement, notably pain, anorexia and depression (kappa = 0.03-0.21), but vomiting, dyspnoea and immobility ratings agreed moderately well (kappa = 0.43-0.68). ⋯ Patients stated knowledge of diagnosis, awareness and acceptance of dying matched the relatives' retrospective assessments moderately well (kappa = 0.70, 0.50 and 0.41). This study and other available evidence indicate that relatives' retrospective reports of terminal illness, measured against current ratings, are moderately reliable for some items but can vary or be potentially misleading over other aspects, including pain. This could affect evaluations of care.
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Social science & medicine · Oct 1996
The relation of self-reported back pain to psychosocial, behavioral, and health-related factors in a working population in Switzerland.
Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. ⋯ All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.
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Using patient-controlled analgesia (PCA) after surgery, a patient can obtain pain-relieving injections of morphine without the direct involvement of a nurse or doctor. The present study was a response to the conventional view that patients value PCA because of the control which it affords them over their own treatment. Twenty-six patients underwent semi-structured interviews postoperatively, shortly after discontinuation of PCA. ⋯ Instead, PCA was valued as a way to avoid the difficulty of disclosing pain or securing pain relief within the usual nurse-patient relationship. In turn, PCA strained the nurse-patient relationship where it impeded either the patient's or the nurse's wish for the nurse to take responsibility for pain relief. The results showed that the professionally and theoretically constructed concept of PCA as a method of self-control over pain is inconsistent with patients' experience of it.