Bereavement Flashcards
How is life expectancy calculated?
Calculated by using age-specific death rates of population – mortality rates for each specific age
Comparison of odds (lnOR) of decreased mortality across several conditions associated with mortality - what seems to affect mortality the most?
Social relationships - i.e. levels of social support and of interaction
Also smoking and alcohol
Period expectation of life at birth (years) from 1841-2012 - what is the general trend?
Life expectancy steadily increasing (over 80 years old for women now) until 2010 where it has slowed down
Women higher than men
What is the relationship between Healthy Life expectancy & Life expectancy?
Healthy Life expectancy is lower e.g. in England 70-75 compared to 80-87
What is the link between deprivation/SES and HLE/LE?
Most deprived lower HLE/LE
Highest HLE areas in England? (3)
Rutland
Wokingham
Buckinghamshire
Lowest HLE areas in England? (3)
County Durham
Tameside
Blackpool
Mortality for males and females in Tower Hamlets vs in London and England?
Much higher
Most people die in a public institution - how many % in 1998 and 2007-9?
70% in 1998
82% 2007-9
How many people die each year in the UK?
2001 - 532,498
2014 - 501,424
About 80% of those deaths are certified by a doctor
What do people die from? Name the top 5 causes according to WHO.
- 6% IHD
- 7% CVD
- 8% LRTI
- 9% HIV/AIDS
- 8% COPD
What do people die from? Name the top 5 causes according in the UK in MALES.
14.8% IHD
7.0% Dementia
6.9% URT & Lung CA
5.9% Chronic LRT
diseases
5.8% CVD
What do people die from? Name the top 5 causes according in the UK in FEMALES.
13.3% Dementia
9.4% IHD
7.8% CVD
5.6% Chronic LRT
diseases
5.5% Pneumonia & Flu
What is the Glasgow Effect?
Scotland experiences high levels of ‘excess’ mortality over and above that of socioeconomic profile. Compared with England & Wales, 5,000 more people die every year in Scotland than should be the case.
Why might there be excess mortality in Scotland? (4)
Overcrowding, urban change, de-industrialisation,
inadequate measures of poverty
Trend in mortality in males in England, Tower Hamlets and London over the last 10 years.
- 1% decrease in Eng
- 0% decrease in TH
- 3% decrease in London
Trend in mortality in females in England, Tower Hamlets and London over the last 10 years.
- 9% decrease in Eng
- 6% decrease in TH
- 8% decrease in London
What is the main increase in life expectancy due to?
Due to fall in infant mortality
What varies life expectancy? (7)
Gender, socioeconomic status, geographic location, ethnicity, employment and working conditions, morbidity and social relationships
Define loss.
The experience of parting with something that one values.
Define grief.
The emotional or affective process of reacting to a loss (involves many emotions, actions and expressions).
Define bereavement.
The state of having suffered a loss / what we go through when someone dies.
Define mourning.
The outward expression of loss and grief.
How can we influence bereavement through the care we provide while the person is alive?
Preparing the family for expected deaths, give information, providing support / identifying where
additional support needed, respecting patient and family’s wishes /“no regrets”
How can we influence bereavement through the care we provide immediately after death?
Giving the family time at the bedside where possible, sensitive approach / offer condolences, issuing MCCD (accurately) to facilitate rapid burial where required, efficient completion of cremation forms
We sometimes need to meet with bereaved
relatives to answer questions and concerns. Such as…?
Aspects of medical treatment that are playing on their minds / questions they didn’t ask at the time, inaccurate prognosis given, concerns re cause or circumstances of
death
What are the Five Stages of Grieving ((Elizabeth Kubler-Ross 1969)?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Attachment Theory (John Bowlby 1969) - three stages of detachment and four phases of grief?
- Protest
- Despair
- Detachment
Four phases of grief: - Numbing
- Tearful and searching
- Disorganisation and despair
- Re-organisation
Apply the Psychosocial Transitions (Murray Parkes 1971) theory to grief.
Grief is psychosocial transition i.e. readjusting to life without the person who has died. Formally shared habits have to be relearned and new roles developed.
What is the Four Tasks of Mourning (Worden 2001) theory?
- Accept the reality of the loss
- Work through the pain of grief
- Adjust to the dead person being gone
- Emotionally relocate the person who has died and move on
Dual Process Model (Stroebe and Schut 1995) is made up of “loss orientated” and “restoration orientated”.
What does the former consist of? (4)
Grief work
Intrusion of grief
Breaking bonds
Denial / Avoidance
Dual Process Model (Stroebe and Schut 1995) is made up of “loss orientated” and “restoration orientated”.
What does the latter consist of? (4)
Attending to new changes
Doing new things
Distraction
New identity, relationships
What may affect bereavement? (11)
- Gender (conflicting evidence)
- Religion / Culture (Religious / Cultural rituals may improve bereavement experience)
- Relationship to the deceased (loss of spouse / child, including adult child)
- Nature of relationship (dependent, ambivalent, socially hidden)
- Personality
- Poor physical and psychological health
- History of depression (Evidence equivocal)
- Circumstances of death (rapid or protracted)
- Disenfranchised grief
- Multiple losses / Concurrent crises
- Availability of (perceived) social support
What to look out for as a doctor i.e. to assess if the grief is “normal” vs “complicated/prolonged/pathological”?
- History of losses (NB Genogram)
- Family’s perceptions (e.g. dissatisfaction with care, reluctance to accept poor prognosis)
- Sudden / unexpected death
- Your instincts
Give some examples of unusual psychiatric symptoms & grief.
Auditory/visual/olfactory/tactile hallucinations
Hoarding
Intrusive/ruminative thoughts
Intense preoccupations
BUT these can all potentially be normal.
In which patients should you consider prolonged grief disorder (PGD)?
In people with ongoing separation distress beyond the first 6-12 months of bereavement.
PGD occurs in approximately how many % of bereaved individuals?
10%
What increases the risk of PGD? (3)
death of a partner or child
loss to unnatural or violent circumstances
among people vulnerable to mental health conditions
Grief vs. Depression – how to tell them apart?
What are the similarities?
intense sadness and changes in sleep/appetite.
Grief vs. Depression – how to tell them apart?
What are the differences?
Grief - more likely to be able to feel positive some of the time but then can quite suddenly feel very sad if connected to the loss, can potentially have positive thoughts about the future even if hard to hold onto them. A process more than a state of being – feelings can swing between sadness, anger and guilt and will change over time.
Depression – pervasive low mood/energy/low enjoyment. A prolonged time course. Can have feelings of guilt/worthlessness not related to the loved one’s death. Thoughts of death not related directly to loved one (i.e. not only the feeling that would rather not go on without the loved one). More likely to have slow speech/movement and difficulty carrying out day to
day activities. In severe depression can experience psychotic symptoms that are not linked to grief.
Is loss from suicide (of trauma/violence) different – if so how?
- The specific circumstances of the loss
- The survivors questions – ‘why?’ and ‘what could I have done?’
- Stigma and isolation
- Family and community tensions
- Lack of privacy due to possible investigations & subsequent practical concerns
What is the dimensions of loss theory (le Poidevin)?
Identity – How has the loss affected self-esteem?
Emotional – Are they at ease with expressing feelings?
Spiritual -What meaning has been ascribed to the loss?
Practical- How are everyday practicalities managed?
Physical - What is the impact on physical health?
Lifestyle - Has the loss caused financial problems?
Family/community- What support is available?
