Death and Dying

Question 1

End of life concerns

Answer 1

• Despite medical advances those with terminal illness tend to experience pain and discomfort when they die
• With advanced age/illness most people wish
• To be free of pain and symptoms
• To be treated with dignity and respect
• To maintain a sense fo autonomy and control over their last days
• To be informed of their prognoses and have time to put their affairs in order
  To avoid becoming burdens to their families
• Thing that are often overlooked
• They value independence and want to maintain control over their lives and want to continue participating in activities they enjoy
• They need to satisfy their spiritual needs

Question 2

Spirituality/Religious beliefs

Answer 2

• Death typically involves finding meaning in the life one has lived and in your own death and dying
• Most religions mention some kind of afterlife which helps reduce death anxiety
• Christianity and Islam teach about reuniting with loved ones after death
• Buddhism and Hinduism teach about a cycle of life, death, rebirth

Question 3

The good death

Answer 3

• An older adults death
• From the POV of the senior
• From the POV of the family
• From the POV of society
• The what, how, where, with, when, and why of the death

Question 4

What are the 5 stages of grief

Answer 4

• Denial and isolation
• Anger
• Bargaining
• Depression
• Acceptance

Question 5

Denial and Isolation in grief

Answer 5

• Most typically occurs when a patient is informed prematurely or abruptly
• Often temporary and replaced by partial acceptance
• Denial may also be expressed with disbelief

Question 6

Anger in grief

Answer 6

• Often starts with “why me”
• Important to think of the reasons for the anger and understand it, not take it personaly

Question 7

Bargaining in grief

Answer 7

• Employed as an act of agreement
• Acts as an attempt to postpone the inevitable
• Includes an implicit promise that the patient will not ask for anything else if granted (maybe a reward for good behaviour, sets a self imposed deadline, most don’t keep the implicit promise)

Question 8

Depression in grief

Answer 8

• Often the feeling of a great loss
• Comes in two forms: Receptive and preparatory
• Both types vary in how they manifest, so they are managed differently

Question 9

Acceptance in grief

Answer 9

• Patient often wants to be left alone
• Has found peace and acceptance with circle of interests diminishing
• Very few actually reach acceptance: most try to fight/avoid death

Question 10

Grief

Answer 10

• Intrapersonal dimension of coping with loss
• Involuntary reaction the the loss
• Emotional response to the loss
• It shouldn’t be a matter of if you grieve but more about when you grieve

Question 11

Mourning

Answer 11

• The process of incorporating the experience of loss
• Outward acknowledgment of the loss
• Ongoing, active process of moving toward accommodation

Question 12

Bereavement

Answer 12

• The state of loss

Question 13

Death of spouse

Answer 13

• Women live longer
• Being widowed increases the likelihood of dying
• Hard to find purpose
• Can set off a chain of secondary stressors
• Widowhood is a process

Question 14

Grieving styles

Answer 14

• Range on a continuum from intuitive to instrumental

Question 15

Intuitive Griever

Answer 15

• They put more energy into the affective domain and invest less into the cognitive
• Profoundly painful feelings
• These grievers tend to spontaneously express their feelings through crying
• Want to share their inner experiences with others

Question 16

Instrumental griever

Answer 16

• They put more energy into the cognitive domain rather than the affective
• Painful feelings are tempered
• Grief is more of an intellectual experience
• Instrumental grievers may channel energy into this activity
• They may also prefer to discuss problems rather than feelings