Approaching Death by rt3463df

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									Approaching Death
   Death and Dying
                 Death and Dying
   “Immortality” of youth
       Denial of mortality
   Anxiety
    Historical and Cultural Views
   ability to accept death
   specific meanings (stop breathing,
    heartbeat, brain death)
   individual variation
   cultural variation (spiritual, natural,
    welcome event)
   Western history: natural event
       20th Century: withdrawn from daily life experiences
       care of dying
   Disposition of deceased: dramaturgical (Fulton &
    Metress, 1995: language of funeral directors)
       “interment” vs. burial
       “casket” vs. coffin
       “remains,” “diseased,” “loved one” vs. corpse, dead
       “lying in repose” vs. dead
   “denial” of death, “social”death: avoidance
   Cultural denial of death?
       Behaviours? Avoidance?
         Collectively?
         Individually?

     Reasons?
     Effects of avoidance?
     Feelings about death? Regrets?
     A “good” death?
    Research on Death and Dying

 Kubler-Ross (1970)
 Openness, disclosure
 thanatology: study of death
 five emotional stages
       Denial, anger, bargaining, depression,
        Inconsistencies in Stages

 appearance, reappearance of denial,
  anger, depression during dying process
 age of dying person
 young: separation from loved ones
 adolescents: focus on quality of present
       effect of condition on appearance social
   young adult: rage and depression
       end of life at beginning
 middle adulthood: concern about
  obligations, responsibilities
 late adulthood: contextual
     death of spouse
     illness, pain, dependency
     acceptance relatively easy
 Health Care Policy for the Dying
 “Medicalization” of death vs. “normative”
  part of life?
 Perspectives, definitions of death?
 Death anxiety?
 Preparation for death?
           Hospice Care
    vs. “Medicalization” of Death
 “good death”: swift, comfortable, dignity,
  loved ones present
 more common prior to extreme medical
 alternative to hospital care
   London, 1950s: first hospice
     Provide medical care, no artificial life support
      systems to terminally ill
     Allow visitors, free movement
     Cushion fear, loneliness of impending death
   Problems:
     Rapid growth: need for well-trained personnel
     Legal, ethical questions: premature death?
     Potential burn-out of professionals, volunteers
      (personal involvement, intimacy)
Living Will, Passive Euthanasia

 specify how much medical care in terminal
 inaction (e.g., no respirator) that allows
  person to die in natural course of illness
 ethics: quality of life?
 The Right to Die: Assisted Suicide
      and Active Euthanasia

 providing means to person to end life
 intentionally terminating life of suffering
 Netherlands: legal euthanasia
 North America: Jack Kevorkian
     assisted suicide? Value of life?
     legal restrictions?
   Patient experiencing unbearable pain
   Patient conscious
   Death request voluntary
   Patient must have time to consider alternatives
   No other reasonable solutions to problem
   Death cannot inflict unnecessary suffering on
   Must be more than one person involved in
    euthanasia decision
   Only doctor can euthanize the patient
           Death Anxiety

 (Conte, Weiner, & Plutchik, 1982)
 Death Anxiety Questionnaire
 fear of unknown
 fear of suffering
 fear of loneliness
 fear of personal extinction
 nursing home residents, seniors, university
 ages 30 to 80 years
 no differences in mean scores (M=8.5)
 no correlation with sex, education
 separate study: adolescents had higher
  scores than older participants
     emotional stresses
     cognitive maturity (meaning of death)
   Cicirelli (1999) higher death anxiety in:
     Younger
     Lower SES
     Female
     White
     External locus of control
     Less religiousness
       Quality of End of Life
 Singer et al. (1999): Canadian sample
 Receiving adequate pain and symptom
 Avoiding inappropriate prolongation of
 Achieving sense of control
 Relieving burden
 Strengthening relationships with loved
        Bereavement and Grief
   Mourning: expression of grief
   Prescribed rituals: funerals
       Auger (2000): 4 functions
           Provide supportive relationship for bereaved
           Reinforce reality of death
           Acknowledge open expression of feeling of loss and grief
           Mark a fitting conclusion to life of person
   Social support
   network of familial
   small memorial services
   failure to express grief: depression
 Phases of Mourning (Parkes, 1972)
 shock
 longing
 depression, despair (anger)
 recovery (perspective)
    Current Perspective (Lund, 1996)

   stress with resiliency
   adjustment related to self-esteem, coping skills
   diversity
       between individuals: thoughts, feelings, behaviours
       within individuals: simultaneous negative (anger,
        loneliness) and positive (personal strength) feelings
   no stages:
     rapidly changing feelings
     dealing with personal limits
     fatigue, loneliness
     learning new skills
     new relationships
     no specific time markers
           Achieving Recovery
   cultural facilitation of mourning:
     meaningful rituals
     emotional support: friends listening
     practical help

   lengthy process
     waves of sorrow: anniversary reactions
     healthy response
      Bereavement overload

 elderly at risk
 several deaths in rapid succession
 unable to complete mourning process for
  one death before another occurs
   Anticipatory Grief
     expected death
     dying person, mourners share affection
     helps dull pain of loss
   Sudden death (no anticipatory grieving)
     Most difficulty in coping
     loss of young person vs. at end of long, full
     emotions: guilt, denial, anger, sorrow
     Social/Cultural Supports for

   Similarities, differences, roles?
              Finding Comfort

   social support: friends listening, sympathizing,
    not ignoring pain, complex emotions in recovery
   recognize bereavement is lengthy process
    (months, years): sorrow, memory are integral
    parts of recovery
   over time: bereaved should become involved in
    other activities, but not be expected to forget
    loved one
   successful recovery: deeper appreciation of
    growth, development of all human relationships
         Adult Development from
         Adolescence to Old Age
   Multidimensional, multidirectional change,
    throughout lifespan
 Final Exam
 December 12: 2 hours
 Chapters 8, 10, 11, 12 (50 Multiple
  Choice), lecture material (5/7 short
               Successful Aging
 Survival in late adulthood
 Quality of life, satisfaction
     Transcend physical limitations
     Mental health, optimal adaptation
         Positiveoutlook
         Self-understanding

   Components
     Absence of disease, disability
     No risk factors
   Maintaining high cognitive and physical
       Active and competent
   Engagement with life
       Productive activity, involvement with other
   Not avoidance of aging: maintaining
       Consistent with reality of aging:
          Successful aging is the norm
          “paradox of well-being” (Mroczek & Kolarz, 1998)
               32,000 US adults surveyed
               Assumed objective difficulties
               Generally fel good about selves and situation
               30-40% over 65 report selves as “very happy”
   Positive affect: highest for older
    reflects personality (extroverts)
    set point perspective
        - temperament sets boundaries for
    levels of well-being throughout life
        - extroverts: more successful dealings
    with others
              - positive interpretations of life
             Successful Aging
   Hardiness and thriving (Perls, 1995)
     Genetic determiners of “hardiness” in oldest
     Adaptive capacity (ability to overcome
      disease or injury)
     Functional reserve: how much of organ
      required for adequate performance
      (determines ability to deal with disease)
   Beyond age 97, chances of dying at a
    given age lower than expected
         Mortality   rate (#deaths/# in age group)
              exceeds 1.0 if entire group dies in less than one year
     Indicates oldest members of our species tend
      to be healthier than traditional views of aging
      would predict
     Additional support from medflies
         Chance     of dying at any age peaks at 50 days
         If survive to 100 days, chance of dying at any
          given day @5%
   More hardy
     Slower rate of progress of symptoms of
      disease than in less hardy
     Threshold for disease lowers more slowly
 Symptoms of age-related disease (e.g.,
  Alzheimers) appear later (b vs. a)
 Morbidity, mortality, disability compressed into
  shorter period
         Possible explanations for
   Longevity genes: increased resistance against
    oxygen radicals
       Slow rate of damage
   Low complement of deleterious genes
       E.g., Apolipoprotien E (apo-E) related to risk of
       Gene for protein apo-E less prevalent in oldest-old
            18% of 90-103 year-olds
            25% of under-65 year-olds
 Adaptive capacity (ability to cope with and
  overcome disease or injury) higher in more-
 Functional reserve (how much of an organ is
  required for its adequate performance) higher
   Autopsy studies of “healthy” oldest-old
     No outward signs of disease, but level of
      neurofibrillary tangles would indicate
      dementia in younger brain
     Excess reserve of brain function compensates
      for processes damaging the brain
     Two Basic Principles of Normal
   Variability of aging rates
       Longitudinal studies (e.g., Baltimore Study)
          Aging  rates vary remarkably (60 year olds like 40;
           some 40 year-olds like 60, physically)
          Differences in appearance mirrored on
           physiological tests
          Variability increases as age increases
          Individual aging rates vary across years, and
           across physical systems
   Variability of Aging Patterns
       Several aging paths:

       Cross-sectional research
          Some   functions decline in a regular way over time
          Other functions are stable, unchanged or decline
           only in terminal phase of life
   Physiological loss, but only when an age-
    related illness is experienced
      E.g.,heart disease correlated with a decline in
       heart pumping capacity with age
      Without heart disease, pumping capacity as well at
       age 70 as at age 30
   Terminal Loss Pattern
      Loss  in a normally stable function may be sign of
       impending death
      E.g., immune system: # of lymphocytes (white
       blood cells) stable normally stale
           Decline occurred in minority of Baltimore Study sample
           Reported good health; good physical exams
           At next follow-up for study – subgroup more likely to have
   Loss occurs, but body compensates for the
       E.g., brain: neural loss but robust individual cell
        growth (new dendrites, new connections) may help
        preserve thinking and memory

   Physical Aging: not only loss
       Stability
       Resiliency
       Capacity for growth

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