death unit Flashcards
define death
the irreversible cessation of brain function that can be determined by the prolonged absence of spontaneous cardiac and respiratory functions
–> when your body loses vitality
define dying
the period during which the organism loses its vitality
define dying trajectory
the temporal pattern of the disease process leading to a patient’s death
what are the 4 types of dying trajectories
(1) sudden death (accident, severe medical event)
(2) terminal illness (ex. cancer)
(3) organ failure (ex. COPD, CHF)
(4) frailty (ex. Alzheimer’s)
define epidemiology
the study of a disease ; the study of how, why, when, and occurrence of the disease
define crude death rate
the number of deaths (from all causes) during a given year per 100,000 population as of July 1st of the same year
define age-specific death rate
the number of deaths in a particular age-group during a given year per 100,000 population in the same-group as of July 1st of the same year
define age-standardized death rate
the number of deaths per 100,000 population that would have occurred in a given area if the age structure of the population of that area was the same as that of a specified standard population
–> comparing death rates among populations
where does Canada rank among countries in crude death rates?
in the medium range
–> although Canada has a social/public system, there are very long wait times
what are the key mortality predictors?
- political economy
- air pollution
- religious involvement
- chronotype
- education
- loneliness
- hip fracture
- occupational status
- moderate exercise
** PARCEL HOM**
describe how education can predict mortality
the more education one has, the more they know about their body and healthy living
–> also likely to get a higher paying job, and thus have better supports in place
describe how occupational status can predict mortality
reference to the Whitehall study:
the higher position, the less stress –> longer predictor of life
the lower position, the more stress –> shorter predictor of life
describe how the political economy can predict mortality
depends on if the country has health care ; what is and isn’t covered by insurance
describe how loneliness can predict mortality
lack of social support can lead to individuals having a decline
describe how religious involvement can predict mortality
associated with longer lifespan
–> following a religion encourages optimism
–> religious community counteracts loneliness
describe how hip fractures can predict mortality
leads to severe mobility limitations, is difficult to recover from, and negatively impacts emotional health (fearful)
describe thanatology
the study of death and dying
–> also looks at the process of moving towards death
- includes the social and emotional aspects
what are some things that thanatology reveals?
- the reality of hope in death
- acceptance of dying
- reaffirmation of life (re-evaluate life goals)
what are the components of a society’s death ethos?
- funeral rituals
- treatment of the dying
- representation in the arts
- belief in the afterlife and ghosts (can also be soothing / coping mechanisms for patient and family)
- social conversations regarding talk of death and dying (ex. softer ways to talk about death; extent to which topics of death are taboo)
what are some sociocultural perspective on death and dying?
- tamed death
- invisible death
- social death
- death with dignity
- good death
define tamed death
death is viewed as familiar and simple; a transition to eternal life
–> associated with death euphemisms
define invisible death
the preference that the dying retreat from the family and spend their final days confined in a hospital setting
–> also includes when you don’t know how somebody died (ex. murdered, kidnapped)
define social death
the process through which the dying become treated as non-persons by family or health care workers as they are left to spend their final months or years in the hospital or nursing home
define death with dignity
idea that the period of dying should not subject individuals to extreme physical dependency or loss of control of bodily functions
–> prefer to have control over one’s own death ; doctor assisted suicide (?)
define good death
autonomy in making decisions about the type, site, and duration of care they receive at the end of life
–> includes doctor assisted suicide
–> not leaving things for your family to take care of after death
what are some shifts in Western attitudes towards death?
belief in eternal life (ancient Egypt) –> tamed death (Middle Ages) –> beautiful death (late 1800s) –> invisible / social death (current)
T/F: life’s ending may alter an individual’s identity and view of life
True.
–> review of your life ; may see themselves differently, change identity, make peace, etc.
how might people choose to give meaning to their life stories?
through legitimization of biography
when does the recognition of mortality usually occur?
when people reach awareness of finitude
what is awareness of finitude?
idea that you recognize that life is finite
–> often recognized when reaching the age of when a loved one died
what does Terror Management Theory suggest?
that people may change their health behaviours when thoughts of death are activated
–> also refers to the way that people deal with death
what behaviour is terror management theory associated with?
risk-taking behaviour
–> individuals may be ‘flauting it’ / tempting death as a way of trying to manage one’s terror about death (their own way of controlling anxiety)
why do people have a fear of death / death anxiety?
linked to viewing death as loss ; not knowing what will happen to you or your loved one’s after death ; knowing there’s a future with your loved one’s and you won’t be part of it
which age group shows the greatest and least fear of death?
greatest fear of death: middle-aged adults
average fear of death: young adults
lowest fear of death: older adults
define finitude
coming to grips with one’s eventual death
–> can include: making a will, settling finances, reminiscence
define reminiscence
–> reviewing memories (a process of finitude)
can include having conversations with loved ones, writing a journal or letters to loved ones
why do people reminisce at the end of their life?
may help to legitimize their life and help person keep ties with their children beyond death
what do thanologists think about the ‘stages of death’ model?
they believe that it’s a very Western model & not an accurate theory
–> stages of death do not always occur in order
–> some stages of death may never occur
T/F: Each person responds to death in the same way
false
ex. some may want the whole truth, others may not
define advance directives
living will or are also called power of attorney (varies across Canada) ; individuals can and should document them
what are the risks associated with advanced directives?
can sometimes result in ‘scamming’ the dying
–> sometimes the money is used selfishly instead of paying for the funeral or LTC expenses
define advance directive
document that describes your preferences for future care if you are unable to speak for yourself
what is a Do Not Resuscitate (DNR) order?
directs health care workers not to use resuscitation if the patient experiences cardiac or pulmonary arrest
define overtreatment
when patients with DNRs receive active life support that includes resuscitation and do not have their DNR orders respected
describe Medical Assistance in Dying (MAiD)
1) a physician (or nurse practitioner) directly administers a drug that intentionally causes death
2) a physician or nurse practitioner prescribes a drug that the eligible person take themselves to end their life
when did MAiD become legal in Canada?
in 2016
what are the 2 main tracks for MAiD?
1) death is reasonably foreseeable
2) advanced request (ex. dementia, mental illness)
why is MAiD controversial with dementia?
there are restrictions for when your can request for MAiD:
- unable to request for when one no longer recalls certain information (ex. remembering their children)
- must be of healthy mind to make the choice
- generally must be a terminal illness –> dementia is technically terminal, but people don’t die directly from it, they die from the effects of it
what is hospice palliative care?
holistic, person-centred end-of-life care
–> begins with diagnosis & treatment
what is the difference between hospital and hospice?
hospital: life-prolonging care
hospice: palliative end-of-life care
what do patients receive in hospice care?
they are attended to with regard to their needs for physical comfort and psychological and social support and are given the opportunity to express their spiritual needs and have them met
what is palliative care?
care designed not to treat an illness, but to provide physical and emotional comfort to the patient + support and guidance to his or her family
define double effect
an ethical situation in which an action (such as administering opiates) has both a positive effect (relieving a terminally ill person’s pain) and a negative effect (hastening death by suppressing respiration)
what is the most stressful form of bereavement?
the loss of a child
describe bereavement from a biopsychosocial perspective
Biological:
- stress on the body
Psychological:
- range of negative emotions
- impaired attention and memory
Sociocultural:
- altered position in family and community
- financial burden
- change in support network
–> all impact an individual’s response to bereavement
define bereavement
the process during which people cope with the death of another person
–> the sense of loss following a death
define attachment view of bereavement
the bereaved can continue to benefit from maintaining emotional bonds to the deceased individual
what are the potential bereavement related disorders that might become included in the DSM?
- bereavement mania
- persistent complex bereavement disorder (PCBD)
what are the two main theories of bereavement?
1) traditional view
2) attachment view
–> the views impact an individual’s thought about the deceased
describe the traditional view of bereavement
belief that death should be ‘worked through’
–> grief that goes on for more than a year is abnormal
describe the attachment view of bereavement
individual maintains their bond with the deceased
–> belief that keeping possessions is normal
–> the feeling of having an ongoing bond with the deceased is not thought to be pathological
describe the dual-process model in terms of bereavement
proposes that practical adaptations to loss (restorative) are as important to adjustment as the emotional (loss)
what produces the best outcomes of bereavement?
flexible adaptation
define grief
the powerful sorrow that an individual feels at the death of another
define mourning
the ceremonies and behaviours that a religion or culture prescribes for people to employ in expressing their bereavement after a death
what is the dual-process model of coping with bereavement?
the practical adaptations to loss are regarded as important to the bereaved person’s adjustment as the emotional (“loss”)
2 processes that oscillate:
1) loss-oriented
2) restoration-oriented
what is the difference between loss-oriented and restoration-oriented
loss-oriented:
- doing grief work
- breaking bonds and ties
- relocating
- denying/avoiding restoration changes
restoration-oriented:
- attending to life changes
- seeking distraction from grief
- doing new things
- denying and avoiding grief
- taking on new roles/identities/relationships
what are the different types of grief?
- complicated grief
- absent grief
- disenfranchised grief
- incomplete grief
describe complicated grief
grief that impedes a person’s future life
describe absent grief
a situation in which overly private people cut themselves off from the community and customs that allow and expect grief
–> can lead to social isolation
describe disenfranchised grief
a situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions
describe incomplete grief
a situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving
–> the grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery
when do most bereaved people recover?
within a year
what is the order for the most common patterns of adjustment?
1) resilience (46%)
2) chronic grief (16%)
3) common grief (10%)
4) depressed-improved (10%)
5) chronic depression (8%)
why is it common to place blame after someone died?
the bereaved sometimes blame:
- the deceased
- themselves
- distant others
–> blame is not always rational
–> examples:
- for medical measures not taken (medical staff directed)
- laws not enforced (political/government directed)
- unhealthy habits not changed (deceased directed)
what are some ways that the bereaved may try to seek meaning?
- preserving memories (ex. displaying pictures, telling anecdotes)
- attend support groups when friends are unlikely to understand (ex. parent groups for murdered children)
- creating/helping organizations that are devoted to causes (ex. fighting cancer)
- starting a charity
