6. Death, dying and bereavement Flashcards
What are the challenges of chronic illness?
- Adjusting to symptoms and disability (and learning about them and treatment)
- Maintaining a reasonable emotional balance
- Preserving sense of competence
- Sustaining relationships
- Preparing for uncertain future
Use the social cognitive transition model of adjustment to show what happens when expectation isn’t confirmed?
- Protective buffering (denial) - hold onto our assumptions and expectations
- To adapt, there is discomfort and threat
- After a while (with some support from people around you) people adjust
- Assumption will be adjusted, and you never really go back to normal
What is the psychological impact of long-term conditions (LTC)?
- 2-3 times more likely to develop depression
- If you have 3+ conditions, you are 7 times more likely to have depression
- Mental health problem increases the risk of physical ill health
- Co-morbid depression (depression + other illness) doubles the risk of CHD in adults
- Adults with physical and MH problems are less likely to be employed
How many years younger to people with MH problems e.g. schizophrenia and bipolar disorder die than the general population?
16-25 years younger
What does the common sense model of illness self-regulation describe?
The processes of internal adaptation in someone when they experience a discontinuity in their physical sense
- interpretation - coping - appraisal -
What is concrete and abstract thinking?
- Concrete - thinking on the surface. Concrete are the implicit things that we have absorbed from the world around us - no effort required.
- Abstract - thinking in depth. Abstract are the explicit things that we are told directly and have to consider - effort required.
Is psychological distress inevitable after given bad news about health?
- No
* Growth is possible and associated with less distress in the short-term + better overall physical and mental health
What percentage of people die in hospital, and what percentage of people would actually like to die in hospital?
- Reality - 57%
* % that would like to - 3%
What is palliative care for?
- Providing terminally ill people with compassionate care
- Addressing medical, psychological, social and spiritual aspects of dying
- Relieving/managing symptoms rather than curing disease
In a study conducted by Higginson et al., what percentage of seriously ill people wanted to prioritise improving quality of life or extending life?
- Quality of life - 60-80%
* Extending life - 2%
List the sequence of 5 reactions of a person facing death (as described by Kübler-Ross)?
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
What does the stage of denial involve?
- Person won’t believe this is happening
- May lie and tell themselves it’s temporary
- Psychological defence to cushion the impact of the source of grief
What does the stage of anger involve?
- Why me?
- Generalised rage at the world
- Isolated and furious
- Thoughts of unfairness and betrayal
- Outbursts of anger in unrelated situations
What does the stage of bargaining involve?
- Person thinks they can fix things by doing certain things
- May feel guilt and it’s their responsibility to fix things
- Attempt to strike bargains with God, spouses or parents e.g. “I’ll be a good person, if i get another chance”
What does the stage of depression involve?
- Person is absorbed in the intense emotional pain
- Overwhelmed with feelings of helplessness and sadness
- Anticipatory grief - grieving for the loss before it actually happens
What does the stage of acceptance involve?
- “This did occur, but I have great memories”
* Loss is accepted and we work on alternative to coping with and minimising the loss
What are the weaknesses of the stage theories?
- Do not account for variability in people and their responses
- Focus on emotional responses and neglect cognitions
- Fail to consider social, environmental or cultural factors
- Pathologies people who do not pass through stages
- Acceptance might not be achieved
What is bereavement?
Situation of a person who has recently experienced the loss of someone significant in his or her life
What does bereavement involve?
Changes in orientation towards loss or restoration (can oscillate from one to the other).
Loss:
• Preoccupation
• Thinking and yearning for the person lost
• Seeking out places as reminders or searching for the person
Restoration: • Adjustments to lifestyle • Coping with day-to-day life • Building a new identity • Distracting away from painful thoughts
What percentage of people usually adjust to bereavement by the second year?
85%
Does everyone have a large sense of distress and disorganisation early on in the loss of a person?
No, 15-50% of people just have minimal grief
What does the duration of severity of a person’s grief depend on?
- How attached they were to the deceased person
- Circumstances and situation of the death
- How much time they had to work through anticipatory mourning
What increases the likeliness of chronic grief (depression, anxiety, PTSD)?
- Sudden or unexpected death
- Death of a child
- High level of dependency in the relationship
- Person who is in bereavement has a history of psychological problems, poor support and additional stress
