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Editor's e-Note
November is National Hospice and Palliative Care Month, a time to explore the benefits of quality end-of-life care and look to new methods and movements that can ease and enhance an inevitable life passage. The end-of-life doula movement is one such approach. This month’s E-News Exclusive explains the origin of doulas used during the birthing process and how similar comforts and services can be applied at the end of life. The process is a team effort with social workers often crafting the care plan along with physicians, nurses, chaplains, family and friends, and neighbors. Read more about the movement and its benefits at perhaps the most challenging of life’s passages.

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— Marianne Mallon, editor
e-News Exclusive
The End-of-Life Doula Movement
By Francesca Arnoldy

In ancient Greece, doulas were servants who supported women through childbirth. The reemergence of doula work began in earnest during the 1960s, this time featuring trained professionals providing emotional, informational, and physical support. The essence of being “of service” remains.

Doulas establish relationships with clients, gaining trust and developing rapport, clarifying the goals, fears, and wishes of each expectant family. Then, during labor, a birthing doula provides continuous support—wiping a brow, holding a hand, fetching ice water, rubbing an achy back, suggesting positions and breathing techniques, whispering encouragements, and ensuring all invited are operating within their preferred roles. As a laboring woman weathers the ups and downs, the doula remains steady and calm, believing in the woman and in the process.

More recently, doulas have begun offering support to people at the end of life as well. Dying and death offer many striking similarities to birthing. There’s unpredictability. There’s a unique unfolding of events. Time fades away, as do the usual distractions of daily life. As doulas, we tune in. We listen more deeply. We feel compelled to take each moment as it comes, knowing we cannot make assumptions. Clients face intensity, doubt, and suffering, which takes many forms, including spiritual, emotional, physical, intellectual, and psychological. There’s difficulty. There are heightened feelings and reactions. Dynamics shift and sway, threatening our sense of foundation—the anchor to our past, present, and future.

Both birthing and dying become a sort of liminal space, thresholds to mystery. Doulas honor them as such. They are rites of passage that have three distinct features. As people enter into the rite, the initial experience is one of severance. We exit the usual pace of our schedules. We separate from our responsibilities. We put life on hold.

In early labor, women generally return to or remain at home (in their comfort zone), giving full attention to the beckoning task at hand. They shift between working through intermittent contractions and preparing for their journeys into motherhood (gathering supports, nourishing themselves, arranging, and organizing).

Full story »
Tech & Tools
Anger, Anxiety, Insomnia: Tweets From Twitter Users Could Predict Loneliness

Loneliness is estimated to affect roughly 1 in 5 adults in the United States. It also stands as a public health crisis because loneliness has been tied to depression, cardiovascular disease, and dementia, among other conditions. As such, a team of researchers at Penn Medicine came together to determine what topics and themes could be associated with loneliness by accessing content posted by users on Twitter. By applying linguistic analytic models to tweets, the researchers found users who tweeted about loneliness post significantly more often about mental well-being concerns and things such as struggles with relationships, substance use, and insomnia. Findings from this work, published in BMJ Open, could lead to easier identification of users who are lonely and providing support for them even if they don’t explicitly tweet about feeling alone.

“Loneliness can be a slow killer, as some of the medical problems associated with it can take decades to manifest,” says the study’s lead author Sharath Chandra Guntuku, PhD, a research scientist in Penn Medicine’s Center for Digital Health. “If we are able to identify lonely individuals and intervene before the health conditions associated with the themes we found begin to unfold, we have a change to help those much earlier in their lives. This could be very powerful and have long-lasting effects on public health.”

By determining typical themes and linguistic markers posted to social media that are associated with people who are lonely, the team has uncovered some of the ingredients necessary to construct a “loneliness prediction system.”

Read more »
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