11: Dying & Death

Question 1

T or F: most deaths occur in old age

Answer 1

T

Question 2

T or F: most death in old age follow a slow trajectory

Answer 2

T

Question 3

Palliative Care

Answer 3

Providing relief from the symptoms, pain, physical, mental, and social distress of a terminal diagnosis
- offered alongside curative or other treatments
- hospice, hospital, home

Question 4

Goal of palliative care

Answer 4

to improve QOL for both the person and the family

Question 5

palliative care is part of the ______ model

Answer 5

medical model

Question 6

the _____ approach is increasingly being adopted

Answer 6

Wholistic: “a component of comprehensive care throughout the life course.”

Question 7

Good death
WWWWWH

Answer 7

what: natural (heart attack) vs AIDs, cancer .etc

how: quick/painless vs slow, agonizing

where: home, in bed vs hospital in ICU

who: loved ones vs alone/strangers

when: old age, timely, prepared vs very old age

why: meaningful, expected, accepted vs meaningless, senseless

Question 8

issues with deaths occuring in hospital or long-term care facilities

Answer 8

• Expensive
• Focus on keeping the person alive rather than improving the QOL
• Against ‘aging in place’

Question 9

place of death
+ cancer
+ dementia

Answer 9

The traditional place people with severe diseases go and for the end-of-life care
- cancer = home
- dementia = nursing home/hospital

Question 10

Stages of Psychological Reactions to Dying (BAADD)

*Kubler-Ross (1969)

Answer 10

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
   * may skip, overlap, back and forth

Question 11

Grief

Answer 11

Sense of deep sorrow after a loss

Question 12

mourning

Answer 12

expression of grief in public

Question 13

bereavement

Answer 13

the state of having recently experienced grief

Question 14

T or F: grief will eventually get better and human will power will overcome it

Answer 14

F: sometimes never ends, though decreases in intensity

Question 15

Anticipatory grief

Answer 15

• starts before and in anticipation of the death
• Common in partners of older adults with a fatal disease

Question 16

Disenfranchised grief

Answer 16

• Deemed illegitimate and therefore unacknowledged
• insignificant relationship between the grieving person

Question 17

Complicated grief

Answer 17

• Long and severe
• Inability of recovering and resuming their life

Question 18

Loss of a partner, family, friend in Old Age may result in

Answer 18

○ Social isolation
○ Financial problems
○ Depression

Question 19

Emerging Ethical Issues

Answer 19

· Share of information (who, when, how)
· Right to die
· Cease of care vs. assisting in death
○ dying person is incapable, joint
decision of family, healthcare
professionals
· Assisted suicide/euthanasia

Question 20

Assisted suicide vs physician-assisted suicide

Answer 20

assisted suicide: requires support of family members, often assisted by healthcare professional

physician-assisted suicide: you take it YOURSELF
- Asking for a lethal medicine and advice on how to take

Question 21

Active voluntary euthanasia

Answer 21

intervening actively to end a person’s life at their request
-health care professional administrates the medicine

Question 22

medical assistance in dying (MAID)

Answer 22

Either assisted suicide or active voluntary euthenasia
· Until 2019 about 5000 person received MAID; about 80% older adult (>65), no sex differences

Question 23

thanatologist

Answer 23

specialists in the study of dying or death

Question 24

social death

Answer 24

the perception or behavior of others that indicates that they view/treat a person as physically dead when the physical body has not yet died
- physical death sometimes precedes social death (not acknowledging death until funeral occurs)

Question 25

life expectancy for M and F

Answer 25

M: 79.9y F: 84.0y

Question 26

what do most people die of in old age

Answer 26

diseases - cancer - heart disease -chronic lung disease - stroke -diabetes

Question 27

trajectory of dying

Answer 27

the pattern or course of dying over time (ex. sudden death or slow decline)

Question 28

long dying trajectory

Answer 28

more typical of death in old age - often occurs in a long-term care facility (nursing home)

Question 29

shorter dying trajectory

Answer 29

more often takes place at home or in hospital

Question 30

Erikson's theory of ego development claims the last stage of life leads to a life review ... what is this

Answer 30

a dying person overlooks their life, seeks conviction that their life had meaning and purpose, and prepares for death

Question 31

ego integrity

Answer 31

the acceptance of the notion that one's life cycle is something complete and unique

Question 32

Tornstam's gerotranscendence suggests....

Answer 32

seniors have the potential to redefine themselves in old age and rise above the constraints and demands of social expectations - become more accepting of life's mysteries and uncertainties - find enjoyment in the little things - emphasize family connections, past, present & future

Question 33

The Changing Lives of Older Couples study (2006) found 5 responses to partner loss

Answer 33

1. Chronic grief (defined as low pre-loss depression, high post-loss depression after 6 to 18 months) 2. Common grief or recovery (low pre-loss depression and high post-loss depression at 6 months with improvement at 18 months) 3. Resilience (low pre- and low post-loss depression at 6 and 18 months) 4. Depressed-improved (high pre-loss depression and low post-loss depression at 6 and 18 months) 5. Chronic depression (high pre-loss depression and high post-loss depression at 6 and 18 months)

Question 34

ADVANCE DIRECTIVES can help when family/healthcare providers need to make the decision to allow a patient to die, .... what is this

Answer 34

= a precise statement of the desired treatment and care, including what medical actions are to be taken under what conditions, and a declaration of who has the right to decide in the situation when the writer of the advance directive can no longer express their wishes

Question 35

power of attorney

Answer 35

legal document that gives someone (typically a lawyer, adult family member, friend) the right to make a decision on behalf of the ill person if they lose their mental

Question 36

Do-not-resuscitate (DNR) order

Answer 36

A person may request that resuscitation not be attempted if the person’s heart stops; the dying persons physician may then place a do-not-reuscitate (DNR) order on the patients medical care chart

Question 37

Hospice care and Palliative Care

Answer 37

Includes pain management, symptom management, social/psychological/emotional/spiritual support and caregiver support - Ensures family receives support

Question 38

Palliative care in indigenous communities

Answer 38

- Often lack access to palliative care programs -Ending life in a hospital cuts off the patient from support networks - prefer to die in their own community with family and friends

Question 39

Babitz and colleagues suggestions to ease the distress of indigenous patients in a hospital setting

Answer 39

1. Interpreters can assist communication between staff, family and patient 2. Hospitals need rooms large enough for extended family members to visit the dying person 3. Hospitals need to allow family members time to spend with the dying persons 4. Healthcare professionals need to understand the values and cultural preferences of an indigenous elder

Question 40

Caring for their dying relative at home require

Answer 40

- support of family members, often assisted by healthcare professionals

Question 41

MAID

Answer 41

-physician/nurse practitioner helps a person die either by assisting the patients suicide by euthanasia -June 2016, the gov. of Canada legislated guidelines for MAID -Prior to this, physician could not legally assist your suicide nor could they cause your death if you asked

Question 42

What happened in the first 2.5 years of MAID implementation:

Answer 42

- Just over 1% of all deaths were due to MAID - Average age: 72 -Most deaths took placed in hospital or patients home -Most common underlying medical issues: cancer (63 %) circulatory or respiratory diseases (16 %) neurodegenerative diseases (12 %)

Question 43

T or F: increasingly, religion and tradition have less influence on funerary rituals in Canadian society

Answer 43

T

Question 44

T or F: death occurs less often in old age today than in the past

Answer 44

F: more often - used to be kids a lot