Dying

Question 0

What are the most common causes of death in England & Wales?

Answer 0

Cardiovascular (~1/3)

Cancer (~1/3)

Respiratory

GI/GU

Question 1

Give some examples of diversity in death.

Answer 1

Women tend to live longer than men on average

Death rates highest in older age groups

Less wealthy people die sooner - due to poorer health

Question 2

What are some patterns of dying?

Answer 2

Clark & Seymour

GRADUAL = slow decline in ability and health 
CATASTROPHIC = through sudden/unexpected events 
PREMATURE = in children/young adults through accidents/illness 

note: this can vary even if the underlying cause of death is the same

Question 3

What are the 5 stages of grief? How can this manifest?

Answer 3

Kübler-Ross model

DENIAL

• coping mechanism
• refusal to discuss illness/the future (can cause problems)
• numbness, disbelief, confusion

note: respect desire “not to know”; offer written information for patient to look at with family and check & review over time

ANGER:
- blame, search for alternative medicines/opinions

BARGAINING:
- religion, money, etc.

DEPRESSION:
- sense of loss

ACCEPTANCE

Question 4

Define the different stages of bereavement.

Answer 4

Loss -> grief -> mourning -> funeral rituals

Grief = set of psychological & physical reactions to bereavement

Mourning = process of adapting to loss

Funeral rituals = past v.s. future, remembering person

note: bereavement associated with increased risk of illness & mortality; especially in older people who lose their spouse (?Takutsubo’s cardiomyopathy, reduced social support)
note: psychological interventions for grief do little except in high risk people

Question 5

What are the different stages in the grieving process?

Answer 5

Engel

Disbelief/shock -> Awareness -> Resolution

Question 6

What are some of the signs and symptoms of bereavement?

Answer 6

PHYSICAL:

• shortness of breath
• palpitations
• fatigue
• digestive symptoms
• reduced immune function

BEHAVIOURAL:

• insomnia
• irritability
• crying
• social withdrawal

EMOTIONAL:

• depression
• anxiety
• anger
• guilt
• loneliness

COGNITIVE:

• lack of concentration
• memory loss
• preoccupation
• hopelessness
• visual & auditory hallucinations
• disturbance of identity

Question 7

What are some of the risk factors for chronic grief? How can the grieving process be complicated?

Answer 7

Chronic grief -> anxiety, depression, PTSD

Risk factors:

• prior bereavement
• mental health
• type of loss
• lack of social support
• added stresses

Grieving process can be complicated if the expression of grief is discouraged/ending of grief discouraged

Question 8

What are some of the reasons why most people die in hospital despite wanting to die at home?

Answer 8

Relatives feel unable to provide home care

Lack of support & advice

Concerns about pain management

…+++???

Question 9

What are some of the aims of palliative care?

Answer 9

Improve quality of life

Manage emotional & physical symptoms

Support patients to live productively

Give patients some control