Chapter 14: Death, dying & Bereavement
-death involves an interaction of physiological, social, and psychological factors
-all cultures develop beliefs & practices regarding death
-death measured in physical terms but psychosocial factors (will to live) can influence
biological event
-support systems, enthusiasm for life prolonged life to a point - correct answer--dying is
associated primarily with old age
aging does NOT cause death bc younger ppl also die
major factors are medical advances and increased life expectancy
-most deaths occur from chronic disease over time period
-aging & death are often denied
what is death viewed as in our society - correct answer--an unnatural event that is to be
fought off as long as medically possible
-bc of death-denying & death-deyfing attitudes/practices
-rescue/cure take precedence over compassionate care & relief of suffering
what has death become - correct answer--privatized, medicalized, postponable & distorted
from natural event into end point of unTx or inadequately treated disease
goals of medicine seem too frequently to run counter to the interest of the human spirit, with
medicine failing the people it is supposed to help
when there isn't a discrete problem that can be fixed, what is a person who is going downhill
& slowly dying viewed by medicine as - correct answer--viewed as "uninteresting" making
death unwelcome in health care
-medicine may care for but not cure pt at end of prolonged illness & dying may seem more
unnatural than if the person had been allowed to die earlier in the progression of the disease
-chronically ill pt's have experienced intractable suffering
what is more difficult today in our culture - correct answer--a peaceful death
-denies age & death bc complexity of drawing a clear line bw living & dying
,-result of technology & societal/professional ambivalence about whether to fight/accept
death
-harder task is to respect such care as profoundly as we honor curing
Where did most ppl die at home in preindustrial societies - correct answer--before, death
was quick
-most ppl died at home w/community doing rituals w/death
Where's the preference in dying - correct answer--at home, w/out pain, surrounded by
friends and fam
-have higher QOL
-this preference declines as death becomes near bc of pt's desire for more aggressive Tx or
the absence of fam caregivers to ensure comfortable death at home
Non-hispanic whites more likely to prefer to die at home than AA & latinos
-even if pt able to die at home, last few months of life are characterized by hospital stays -
correct answer--deaths of OA in hospitals have decreased
-dying in nursing homes & regular home increased
-shift to more deaths at home & in nursing homes
Growing congruence in what - correct answer---concept of person-environment fit
-bw pt's preferred & actual location of death
-level of congruence increased if pt:
-used hospice services (in/out pt)
-have fam supports/care
-higher SES
-choose hospice as preferred location
-have DNR
-discrepancies in preferred vs actual location bc incongruence bw fam & pt
-lower likelihood pt will die where preferred if fam not in agreement
-preferences can shift over time
-depends on availability of in home services & hospice
,when is congruence lower - correct answer--when home is preferred location
BUT pain not well controlled, prognosis is unclear, & pt's admitted to hospital
What's most important to ppl who are dying - correct answer--achieving painless death
-too many dying pt's experience unTx pain
50% of hospital deaths preceded by stay in ICU hooked up to machines (results of adults &
fams not discussing end of life preferences)
Attitudes toward death
-what are many americans uncomfortable with - correct answer--uncomfortable w/discussing
death
-use "sleep, pass away, rest" instead of death
-ppl behave as tho it only occurs to others, not them
-fear/denial are natural responses to inability to comprehend out own death
-association of aging w/death explains why ppl are attracted to antiaging medicines
-ppl talk about death on rational/intellectual level NOT discuss & prepare for their own or
those of loved ones
What reflect the basic paradox around death - correct answer--acceptance and denial
-where we recognize it's universality but can't comprehend/imagine our own dying
Fears of death among 50-86y/o are associated w/anxieties over aging & encountering
ageism
-ppl fear inability to predict what future might bring & process of dying (particularly a painful
death more than death itself) - correct answer--OA choose QOL in decision making (may
differ by age, race, ethnicity & SES)
ex) African americans are less likely than older whites to communicate their end of life care
wishes or make prior legal arrangements for such care
-want lifesaving tech & to do in hospitals
-less likely to use hospice compared to whites
what terms do african americans use vs HCP - correct answer-HCP: end of life
African americans: passed or passed on
-bc common belief that immortal soul carries on journey of life after death
, What influences responses to death & dying - correct answer--AGE!!
-previous experience w/death of loved ones
-gender
ex) Women (death anxiety increases in 50's)
anxiety is low & stable in OA for both genders
-older women report more anxiety & fear of dying but less fear of the unknown than males
-variations may reflect gender diff in religiosity, womens greater ability to express emotions &
fears
who talk/think more about death & seem less afraid of their own death than midlife &
young-old adults - correct answer--those who report lower subjective (felt) age & longer
perceived time till death predicted lower rates of psychological distress
-impending/nearing death can be source of anxiety in old age
-sense of meaning in life may lessen fears of death
Factors that justify OA lessened fear of death - correct answer-1. Decreasing social value &
bereavement overload
-after internalized society's ageism, may see lives as having ever-decreasing value
-lower positive expectation of future
-if lived past age they expected, may think they're living on "borrowed time"
-dealing w/others death help socialize OA towards their own
having "bereavement overload" by deaths of fam/friends lead to more likely to talk/think
about death & develop effective coping like humour
2. Awareness of One's mortality
3. Religion & belief in afterlife
Awareness of one's mortality - correct answer--stimulates need to find meaning in one's
life/death by life review (legitimization of biography)
-sudden death more tragic than a slow one bc they desire time to see loved ones, reminisce,
say goodbye, etc
-OA tend to be concerned about their death on relatives
-age of person who died is factor in how survivors react to death
-death involves an interaction of physiological, social, and psychological factors
-all cultures develop beliefs & practices regarding death
-death measured in physical terms but psychosocial factors (will to live) can influence
biological event
-support systems, enthusiasm for life prolonged life to a point - correct answer--dying is
associated primarily with old age
aging does NOT cause death bc younger ppl also die
major factors are medical advances and increased life expectancy
-most deaths occur from chronic disease over time period
-aging & death are often denied
what is death viewed as in our society - correct answer--an unnatural event that is to be
fought off as long as medically possible
-bc of death-denying & death-deyfing attitudes/practices
-rescue/cure take precedence over compassionate care & relief of suffering
what has death become - correct answer--privatized, medicalized, postponable & distorted
from natural event into end point of unTx or inadequately treated disease
goals of medicine seem too frequently to run counter to the interest of the human spirit, with
medicine failing the people it is supposed to help
when there isn't a discrete problem that can be fixed, what is a person who is going downhill
& slowly dying viewed by medicine as - correct answer--viewed as "uninteresting" making
death unwelcome in health care
-medicine may care for but not cure pt at end of prolonged illness & dying may seem more
unnatural than if the person had been allowed to die earlier in the progression of the disease
-chronically ill pt's have experienced intractable suffering
what is more difficult today in our culture - correct answer--a peaceful death
-denies age & death bc complexity of drawing a clear line bw living & dying
,-result of technology & societal/professional ambivalence about whether to fight/accept
death
-harder task is to respect such care as profoundly as we honor curing
Where did most ppl die at home in preindustrial societies - correct answer--before, death
was quick
-most ppl died at home w/community doing rituals w/death
Where's the preference in dying - correct answer--at home, w/out pain, surrounded by
friends and fam
-have higher QOL
-this preference declines as death becomes near bc of pt's desire for more aggressive Tx or
the absence of fam caregivers to ensure comfortable death at home
Non-hispanic whites more likely to prefer to die at home than AA & latinos
-even if pt able to die at home, last few months of life are characterized by hospital stays -
correct answer--deaths of OA in hospitals have decreased
-dying in nursing homes & regular home increased
-shift to more deaths at home & in nursing homes
Growing congruence in what - correct answer---concept of person-environment fit
-bw pt's preferred & actual location of death
-level of congruence increased if pt:
-used hospice services (in/out pt)
-have fam supports/care
-higher SES
-choose hospice as preferred location
-have DNR
-discrepancies in preferred vs actual location bc incongruence bw fam & pt
-lower likelihood pt will die where preferred if fam not in agreement
-preferences can shift over time
-depends on availability of in home services & hospice
,when is congruence lower - correct answer--when home is preferred location
BUT pain not well controlled, prognosis is unclear, & pt's admitted to hospital
What's most important to ppl who are dying - correct answer--achieving painless death
-too many dying pt's experience unTx pain
50% of hospital deaths preceded by stay in ICU hooked up to machines (results of adults &
fams not discussing end of life preferences)
Attitudes toward death
-what are many americans uncomfortable with - correct answer--uncomfortable w/discussing
death
-use "sleep, pass away, rest" instead of death
-ppl behave as tho it only occurs to others, not them
-fear/denial are natural responses to inability to comprehend out own death
-association of aging w/death explains why ppl are attracted to antiaging medicines
-ppl talk about death on rational/intellectual level NOT discuss & prepare for their own or
those of loved ones
What reflect the basic paradox around death - correct answer--acceptance and denial
-where we recognize it's universality but can't comprehend/imagine our own dying
Fears of death among 50-86y/o are associated w/anxieties over aging & encountering
ageism
-ppl fear inability to predict what future might bring & process of dying (particularly a painful
death more than death itself) - correct answer--OA choose QOL in decision making (may
differ by age, race, ethnicity & SES)
ex) African americans are less likely than older whites to communicate their end of life care
wishes or make prior legal arrangements for such care
-want lifesaving tech & to do in hospitals
-less likely to use hospice compared to whites
what terms do african americans use vs HCP - correct answer-HCP: end of life
African americans: passed or passed on
-bc common belief that immortal soul carries on journey of life after death
, What influences responses to death & dying - correct answer--AGE!!
-previous experience w/death of loved ones
-gender
ex) Women (death anxiety increases in 50's)
anxiety is low & stable in OA for both genders
-older women report more anxiety & fear of dying but less fear of the unknown than males
-variations may reflect gender diff in religiosity, womens greater ability to express emotions &
fears
who talk/think more about death & seem less afraid of their own death than midlife &
young-old adults - correct answer--those who report lower subjective (felt) age & longer
perceived time till death predicted lower rates of psychological distress
-impending/nearing death can be source of anxiety in old age
-sense of meaning in life may lessen fears of death
Factors that justify OA lessened fear of death - correct answer-1. Decreasing social value &
bereavement overload
-after internalized society's ageism, may see lives as having ever-decreasing value
-lower positive expectation of future
-if lived past age they expected, may think they're living on "borrowed time"
-dealing w/others death help socialize OA towards their own
having "bereavement overload" by deaths of fam/friends lead to more likely to talk/think
about death & develop effective coping like humour
2. Awareness of One's mortality
3. Religion & belief in afterlife
Awareness of one's mortality - correct answer--stimulates need to find meaning in one's
life/death by life review (legitimization of biography)
-sudden death more tragic than a slow one bc they desire time to see loved ones, reminisce,
say goodbye, etc
-OA tend to be concerned about their death on relatives
-age of person who died is factor in how survivors react to death
