The influence of long-term care culture on awareness of impending death

• Author / Creator

  Cable-Williams, Beryl

• Despite their proximity to death because of advanced old age and disability necessitating institutionalization, the oldest-old have rarely been the recipients of a comprehensive palliative approach to care or the focus of palliative care research. This lack has been attributed prognostic uncertainty in the context of chronic progressive diseases and poor resident-to-staff ratios.
  Research has not been undertaken to examine the influence of beliefs and values about dying and death, or contextual factors on the end-of life care provided there. This research study addresses this gap using a two-stage mixed methods approach. In the first stage, all LTC residents who died over a 12 month period in three LTC facilities were described based on a review of decedent records. In the second stage, ethnographic methods were used to uncover cultural influences on the development of an awareness of impending death.
  Sixty-eight percent of deaths were of the oldest old, and 63.1% were of women. Advance directives had been completed for 97.3% of the 182 decedents. Ninety percent of deaths occurred in the LTC facility. Death was most commonly attributed to dementia and pneumonia, or other progressive, chronic conditions. Impending death was identified it seemed certain that death would occur within a few days or hours.
  
  Thematic analysis of the ethnographic data revealed that a generalized awareness of human mortality was maintained until within a few days of death. Clinical awareness of impending death was acknowledged when significant changes in the dying resident’s status necessitated a change in care routines. Four themes related to the influence of LTC culture on awareness of impending death were identified: (a) the belief that LTC facilities are places for living, not for dying, (b) the context of limited resources (c) the belief that that no one should die alone, and (d) the belief that no one should die in pain.
  This report concludes with a discussion of the findings of this research study in relation to the existing discourse on LTC facilities as places for living, and the absence of a palliative care discourse that is appropriate in the context of age-related frailty.

• Subjects / Keywords

  • Long-term care facility
  • Palliative care
  • End-of-life care
  • Oldest-old
  • Advanced old age
  • Nursing homes

• Graduation date

  Fall 2011

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3N404

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.