title: Pathways in end-of-life care for older people: care managers' reasoning.
abstract: Seven care managers employed by a large municipality in Sweden were interviewed concerning their reasoning regarding end-of-life care for older people. Data were analyzed using a hermeneutic approach. The results showed that end-of-life care was considered to constitute a small part of the care managers' work and was something they did not focus on in general when assessing care needs. Two different pathways to death--the natural and the medical--were identified. In the natural pathway, death was invisible and the care was more routine-oriented. In the medical pathway, death was visualised and the care more individualised. Neither of the pathways paid attention to communication or existential needs. Thus, there is a need for a palliative pathway to death based on the philosophy of palliative care, which could provide guidance for care managers and promote opportunities for older people to achieve a dignified dying and death.
authors.affiliation: School of Health and Medical Sciences, Orebro University, Orebro, Sweden. jane.osterlind@esh.se
authors.forename: Jane
authors.initials: J
authors.lastname: Osterlind
authors.forename: Görel
authors.initials: G
authors.lastname: Hansebo
authors.forename: Göran
authors.initials: G
authors.lastname: Lantz
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ternestedt
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005260:Female; D005851:Geriatric Nursing / Q000458:organization & administration*; D017408:Guidelines as Topic; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D013548:Sweden; D013727:Terminal Care / Q000458:organization & administration*