On the epistemology of resilience in public health: a novel perspective in a changing world

This review proposes the foundations for an epistemology of resilience in public health, addressing the need for a theoretical framework to guide research and policy. Resilience, often ambiguously defined, is reexamined here as a critical attribute of public health systems, enabling them to adapt, absorb, and respond to routine and extraordinary demands without compromising universal and equitable service delivery. By integrating logical, sociological, historical, and philosophical perspectives, the paper delineates resilience as a structured and measurable concept, distinguishing it from common ambiguities in academic and policy discourse. It further introduces a set of foundational axioms to clarify the boundaries of resilience and support its operationalization within public health. These axioms emphasize the interplay between structural and functional dynamics, responses to internal and external stressors, and the importance of systems-level design over reliance on individual adaptations. This epistemological approach aims to bridge the gap between theory and practice, providing a robust basis for developing evidence-based policies that strengthen public health systems' ability to meet evolving challenges while promoting equity and universality.

Death Positivity in America: The Movement-Its History and Literature

Western society is in an era of death awareness, its most recent salience: A Positive Death Movement. This article traces the evolution of American death culture by describing key periods of change, starting with the 1700s and going through the 21st century, and overviews contemporary movement scholarship. Experts suggest our current epoch is one in which a diffuse collection of individuals and organizations advocate for approaching death differently. Movement proponents aim to modify society's "conventional" death framework, which is characterized as medicalized, institutionalized, impersonal, and lacking psychosocial emotional preparation and engagement.

Divergent Views and Experiences Regarding 'Completed Life' and Euthanasia in the Netherlands

A small proportion of older people in the Netherlands want to end their lives because they feel their lives to be 'completed' and no longer worth living. Currently, there is heated debate over whether or not these people should have the right to euthanasia. Drawing on previous research, we conduct a heuristic analysis of views and experiences of three different 'parties' involved in this debate, namely, the older people, their relatives and friends and medical professionals. The views of these three groups tend to be divergent and conflicting, posing a difficult dilemma to decision-makers.

Identity construction in the very old: A qualitative narrative study

People are living longer internationally, with a growing number experiencing very old age (≥95 years). Physical, psychological and social changes can challenge one's sense of self and disrupt existing identities. However, experiences of the very old in society are seldom researched and how they construct identity and negotiate a sense of self is little understood. Our study focuses on participants aged >95 years to understand how identity is conceptualised to negotiate a continued place in society. Qualitative interviews with 23 people were thematically analysed, underpinned by Positioning Theory. Five themes were generated: A contented life; reframing independence; familial positioning; appearance and physical wellbeing; reframing ill health. Participants saw themselves as largely content and, despite their world becoming smaller, found pleasure in small routines. Perceptions of self were reframed to maintain autonomy within narrow parameters. Past relationships and experiences/events were drawn on to make sense of ongoing ways of living. There were tensions around feelings of loss of autonomy and independence, with some valuing these over issues such as safety. This sometimes conflicted with views of others and small acts of resistance and subversion were acted out to maintain some sense of control. However, participants minimised progressive ill health. Findings provide insight into how the very old may utilise identity to negotiate, acquiesce, resist and challenge the world around them.

'I want to die on my own terms': Dominant interpretative repertoires of 'a good death' in old age in Dutch newspapers

RATIONALE

There is a paucity of empirical studies exploring how death and dying in old age are actually represented and debated within the Dutch society.

OBJECTIVE

This study examines the discourse used in Dutch newspapers on the good death and dignified dying. It analyses how different types of social actions and positions are construed, thereby describing how death and dying in old age are portrayed in newspaper media.

METHODS

173 newspaper articles between 2010 and 2020 were selected from five Dutch national newspapers. Data were thematically coded and scrutinised for discursive patterns in order to identify interpretative repertoires and their functions.

RESULTS

Four interpretative repertoires of good death and dying in old age were identified, all drawing on the assisted dying debate: Choice, Risk, Care, and Complexity. Each repertoire constructs a particular image of death and dying, varying from it being a personal choice; a last resort; a joint journey; to a contingent quest. The different repertoires imply distinct identities and actions. The Choice-repertoire construes older people as active subjects who autonomously determine their own death. The Risk- and Care-repertoires both construe older people primarily as passive and acted upon: either threatened by illness, decline and death; or protected and cared for by others and society. The Complexity-repertoire construes older people's situation as an object of reflection.

DISCUSSION AND CONCLUSION

The strong prevalence of the Choice-repertoire in Dutch newspapers construes good death and dignified dying in old age in a salient way, unrepresentatively highlighting assisted dying as the preferred imagined practice. It is hypothesised that reimaging the Care- and Complexity-repertoires in such a way that they construe older persons in a more active subject role could help depolarise the debate on death and dying in old age.

Algorithmic discovery of dynamic models from infectious disease data

Theoretical models are typically developed through a deductive process where a researcher formulates a system of dynamic equations from hypothesized mechanisms. Recent advances in algorithmic methods can discover dynamic models inductively-directly from data. Most previous research has tested these methods by rediscovering models from synthetic data generated by the already known model. Here we apply Sparse Identification of Nonlinear Dynamics (SINDy) to discover mechanistic equations for disease dynamics from case notification data for measles, chickenpox, and rubella. The discovered models provide a good qualitative fit to the observed dynamics for all three diseases, However, the SINDy chickenpox model appears to overfit the empirical data, and recovering qualitatively correct rubella dynamics requires using power spectral density in the goodness-of-fit criterion. When SINDy uses a library of second-order functions, the discovered models tend to include mass action incidence and a seasonally varying transmission rate-a common feature of existing epidemiological models for childhood infectious diseases. We also find that the SINDy measles model is capable of out-of-sample prediction of a dynamical regime shift in measles case notification data. These results demonstrate the potential for algorithmic model discovery to enrich scientific understanding by providing a complementary approach to developing theoretical models.

Development and Implementation of the Family Caregiver Decision Guide

Care provided by family is the backbone of palliative care in Canada. The critical roles performed by caregivers can at the same time be intensely meaningful and intensely stressful. However, experiences of caregiving can be enhanced when caregivers feel they are making informed and reflective decisions about the options available to them. With this in mind, the purpose of this five-phase research project was to create a Family Caregiver Decision Guide (FCDG). The Guide entails four steps: thinking about the current caregiving situation, imagining how the caregiving situation may change, exploring available options, and considering best options if caregiving needs change. The FCDG was based on available evidence and was developed and refined using focus groups, cognitive interviewing, and a feasibility and acceptability study. Finally, an interactive version of the Guide was created for online use ( https://www.caregiverdecisionguide.ca ). In this article, we describe the development, evaluation, and utility of the FCDG.

The ageing and de-institutionalisation of death-Evidence from England and Wales

Increasingly, age of death is postponed until very old age, and care of those who are dying is challenged by medical co-morbidities and the presence of dementia. Although most people would prefer to die at home, currently in England and Wales only about 20 per cent of those aged 65 years and over die at home, and this proportion falls to about 10 per cent among those aged over 85 years. To explore recent and likely future trends in age and place of death, mortality statistics from 2006 to 2013 were analysed and projected to 2050 using age- and gender-specific rates. Results confirmed recent increasing age at death and indicated a trend for increasing proportions of older people to die at home. Projections indicated large increases in home-based deaths, particularly for men aged 65 and over. Consistent with people's wishes, there may be a partial return to the view that dying at home is a normal experience. Resource allocations are likely to need to shift to support people dying at home and their formal and informal carers.

Different macaque models of cognitive aging exhibit task-dependent behavioral disparities

Deficits in cognitive functions that rely on the integrity of the frontal and temporal lobes are characteristic of normative human aging. Due to similar aging phenotypes and homologous cortical organization between nonhuman primates and humans, several species of macaque monkeys are used as models to explore brain senescence. These macaque species are typically regarded as equivalent models of cognitive aging, yet no direct comparisons have been made to support this assumption. Here we used adult and aged rhesus and bonnet macaques (Macaca mulatta and Macaca radiata) to characterize the effect of age on acquisition and retention of information across delays in a battery of behavioral tasks that rely on prefrontal cortex and medial temporal lobe networks. The cognitive functions that were tested include visuospatial short-term memory, object recognition memory, and object-reward association memory. In general, bonnet macaques at all ages outperformed rhesus macaques on tasks thought to rely primarily on the prefrontal cortex, and were more resilient to age-related deficits in these behaviors. On the other hand, both species were comparably impaired by age on tasks thought to preferentially engage the medial temporal lobe. Together, these results suggest that rhesus and bonnet macaques are not equivalent models of cognitive aging and highlight the value of cross-species comparisons. These observations should enable improved design and interpretation of future experiments aimed at understanding changes in cognition across the lifespan.

Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care--Qualitative Research within a Population-Based Cohort Study

INTRODUCTION

Increasing longevity means more people will be dying in very old age, but little is known about the preferences of the 'oldest old' regarding their care at the end of life.

AIMS

To understand very old people's preferences regarding care towards the end of life and attitudes towards dying, to inform policy and practice.

METHODS

Qualitative data collection for n = 42 population-based cohort study participants aged 95-101 (88% women, 42% in long-term-care): topic-guided interviews with n = 33 participants and n = 39 proxy informants, most with both (n = 30: 4 jointly + separate interviews for 26 dyads).

RESULTS

Death was a part of life: these very old people mainly live day-to-day. Most were ready to die, reflecting their concerns regarding quality of life, being a nuisance, having nothing to live for and having lived long enough. Contrasting views were rare exceptions but voiced firmly. Most were not worried about death itself, but concerned more about the dying process and impacts on those left behind; a peaceful and pain-free death was a common ideal. Attitudes ranged from not wanting to think about death, through accepting its inevitable approach to longing for its release. Preferring to be made comfortable rather than have life-saving treatment if seriously ill, and wishing to avoid hospital, were commonly expressed views. There was little or no future planning, some consciously choosing not to. Uncertainty hampered end-of-life planning even when death was expected soon. Some stressed circumstances, such as severe dependency and others' likely decision-making roles, would influence choices. Carers found these issues harder to raise but felt they would know their older relatives' preferences, usually palliative care, although we found two discrepant views.

CONCLUSIONS

This study's rare data show ≥95-year-olds are willing to discuss dying and end-of-life care but seldom do. Formal documentation of wishes is extremely rare and may not be welcome. Although being "ready to die" and preferring a palliative approach predominated, these preferences cannot be assumed.