Chapter 14 Death and Dying

Death and Society Death as Enemy; Death Welcomed A continuum of societal attitudes and beliefs Attitudes formed by –Religious belief; Modern science and technology; direct & indirect experience © 2012 Pearson Education, Inc. All rights reserved.

Death in Old Age The past –Death common among all ages; Living to old age rare; Most deaths from acute illness Today –Longer life expectancy –Most death from disease in old age –Most deaths from one or more chronic illness © 2012 Pearson Education, Inc. All rights reserved.

Death in Old Age: Three Typical Death Trajectories 20% –Will die from fatal illness (i.e. cancer) 25% –Will die from illness (i.e., emphysema) 40% –Will die from illness (i.e. Alzheimer’s) © 2012 Pearson Education, Inc. All rights reserved.

The Experience of Dying Five Concerns at Life’s End –Avoiding a drawn-out death –Getting pain relief –Control of treatment options –Staying in touch with loved ones –Fear of becoming a burden © 2012 Pearson Education, Inc. All rights reserved.

The Experience of Dying Age Differences in Feelings About Death –Older people –85+ Gender differences –Older women more fearful than older men More fear of pain More fear of artificial means of life © 2012 Pearson Education, Inc. All rights reserved.

The Experience of Dying Religious belief –Mild or uncertain religious belief Have most fear of death –Strong or no religious belief Have least fear of death © 2012 Pearson Education, Inc. All rights reserved.

Institutional Death Medical personnel trained to keep people alive Most institutions function on medical model principles Medical education –Focus on acute care © 2012 Pearson Education, Inc. All rights reserved.

Institutional Death Training needed? –Palliative care –End-of-life treatment –Psychological issues at end of life –Unique needs of older people –Unique needs of minority elders © 2012 Pearson Education, Inc. All rights reserved.

Stages of Death and Dying (Kubler- Ross) Denial: “not me” Anger: “why me?” Bargaining: “yes me...but” Depression: “yes me” Acceptance: “my time is close and it’s ok” © 2012 Pearson Education, Inc. All rights reserved.

Hospice Care Hospice Program Goals –Control pain –Allow a simple death –Give love and care Types of Hospice in USA Hospice Program Goals © 2012 Pearson Education, Inc. All rights reserved.

Figure 14.1 Growth in U.S. Hospice Programs: 1974–2007 © 2012 Pearson Education, Inc. All rights reserved.

Figure 14.2 Total Hospice Patients Served, by Year © 2012 Pearson Education, Inc. All rights reserved.

Palliative Care Comfort care –Provide relief to terminally ill person through symptom and pain management –Maintain high quality of life as long as life lasts Can be provided through hospice Most exist in acute care hospitals Some in patient’s home © 2012 Pearson Education, Inc. All rights reserved.

Palliative Care for the Elderly Broadens health care options –Acknowledges limits of curative medicine Accepts death as a part of life –Takes time Follows natural course of individual’s death –Treats the whole person Includes caregivers and social support system © 2012 Pearson Education, Inc. All rights reserved.

Palliative Care for the Elderly: Challenges Funding limits on some services –Caregiver services –Bereavement counseling Health care worker and public lack of knowledge about palliative care © 2012 Pearson Education, Inc. All rights reserved.

Palliative Care for the Elderly Strategies to meet challenges –Gradual shift from treatment to palliative care Two stage program –Health & social support for families home care Home care workers; Respite care –Partnership between formal and informal care resources © 2012 Pearson Education, Inc. All rights reserved.

Ethical Issues Is it ethical to stop treating illness? Does decision not to treat with machines cause death? How much information should health providers give a dying person? When should a doctor allow a person to die? © 2012 Pearson Education, Inc. All rights reserved.

Advance Directives Various types Lets health care providers and families know what the older person wishes Federal and state laws govern advance directives Federal level –Patient Self-Determination Act 1990 © 2012 Pearson Education, Inc. All rights reserved.

Types of Advance Directives Minorities and Advance Directives –Power of Attorney Right to make financial or health care decisions on behalf of older person if they lose mental capacity –Living will Wishes at the end of life Written legal document © 2012 Pearson Education, Inc. All rights reserved.

Use and Challenges of Advance Directives People put off creating them! –May not be knowledgeable; Don’t know value –Don’t want to think about poor health or death Whites more willing than African-American to discuss wishes –African-Americans in long term care least likely to have AD © 2012 Pearson Education, Inc. All rights reserved.

Euthanasia & Physician-Assisted Suicide Passive Euthanasia –Not actively causing death –Allowing death to happen –May or may not result in death Active Euthanasia –Actively helping someone achieve a painless death © 2012 Pearson Education, Inc. All rights reserved.

Figure 14.3 A Sample POLST Paradigm Form from Oregon © 2012 Pearson Education, Inc. All rights reserved.

Figure 14.3 A Sample POLST Paradigm Form from Oregon © 2012 Pearson Education, Inc. All rights reserved.

Physician Assisted Suicide Is active euthanasia, or “mercy killing” Public is ambivalent Request usually from someone in pain or depressed Only places that have societal support –Switzerland, the Netherlands, Belgium, the state of Oregon and the state of Washington © 2012 Pearson Education, Inc. All rights reserved.

Physician Assisted Suicide: Oregon Does not allow active euthanasia Does allow a type of physician assisted suicide Death with Dignity Act, 1997 –Allows physicians to prescribe drugs that help a person end own life © 2012 Pearson Education, Inc. All rights reserved.

Mourning and Grief Each culture and society has own rituals and process of mourning Common purpose in all Bereavement –Feeling of loss through death of a loved one –The objective fact that someone has died Bereavement leads to grief © 2012 Pearson Education, Inc. All rights reserved.

Mourning and Grief Three Stages of Grief (Lindemann, 1944) –Initial response phase Shock & disbelief –Review phase Search for meaning of the death –Recovery phase Looking for social contact © 2012 Pearson Education, Inc. All rights reserved.

Mourning and Grief Phases and Stages of grief and grief work not the same for everyone May last for years in some cases May come in cycles; Is never truly over Patterns of grief influenced by –How person died; Sudden/over time; Relationship; Age of deceased/bereaved © 2012 Pearson Education, Inc. All rights reserved.