HPsyHD S8 (Done) Flashcards
How does death vary by age, gender and socioeconomic status?
Age:
Highest deah rates in older groups
67% of death in 75+
Gender:
Women on average live about 5 years longer
Socioeconomic:
Less wealthy experience greater disease and earlier death
What are the 3 main patterns of dying?
Gradual:
Slow decline due to progressive disease
Catastrophic:
Death due to a sudden and unexpected event
Premature death:
Death in children and young adults due to accidents or illness
What is the typical initial reaction to news that you have a terminal illness?
Shock, numbness, disbelief and confusion
Hard to take in what is said
What are Kubler and Ross’s stages of grief?
Give a brief description of each
Denial:
“It’s not true/Can’t be happening to me”
Refusal to discuss illness/future
Anger:
“Why me!” - Anger at illness
“The doctors are to blame!” - Anger at others
Search for alternative treatment?
Bargaining:
“I’ll go to church every day!” - Bargaining with god
“I’ll do anything if you enter me into this clinicl trial” - Bargaining with doctors
Depression:
Depression and hopelessness arise
Could be in response to reality finally sinking in
Acceptance:
Patient accepts condition and plans for the future/moves on with the rest of their life
How must doctors respond to those in the Denial phase of grief?
Can be a coping mechanism
Must respect desire “Not to know”
Offer written information for patient to look at with family
Denial may be a barrier to care, make sure to review at a later time ‘when ready’
Define ‘Grief’
A set of psychological and physical rections to bereavement
A normal reaction of overwhelming loss in which normal functioning ceases
Define ‘Mourning’
Process of adapting to loss
E.g. Funeral rituals
Describe the grieving process
Stages:
Disbeleif and shock
Developing awareness
Resolution
Additionally:
Everyone experiences this differently
Reassuring to know it is a normal thing and will pass
Common elements include Anger and blaming others
What are the effects of bereavement?
Older persons:
Particularly loss of spouse may increase risk of illness and mortality
General:
Physical symptoms (SOB, palpitations, GI dysfunction, reduced immune function)
Behavioural symptoms (Insomnia, irritability, withdrawal)
Emotional symptoms (Depression, anxiety, anger, guilt)
Cognitive symptoms (Lack of concentration, memory loss, preoccupation, hopelessness, hallucinations)
Describe the resolution of grief
85% adjust to bereavement and experience minimal grief after 2 yrs
15% experience Chronic grief, Anxiety, depression, PTSD after 2 years
What are the risk factors for chronic grief?
Prior bereavement
Poor mental health
Type of loss (young person, nature of death, caring status)
Lack of social support, stress from other sources
Expression of grief discouraged
Ending of grief discouraged
How is medical practice often inconsistent with patient wishes regarding death?
Most people want to die at home, but instead die in hospitals
56% to 67% express wnating to die at home, but only 35% die at home or in a care home
Relatives are often unable to provide home care as they ack support and advice
What are the aims of palliative care?
Improve quality of life
Manage emotional and physical symptoms
Support patients to live productively
Give patients some control
How do physicians react to death?
How is coping with death best achieved by a physician?
Can have a serious impact:
- Feelings of failure, guilt, sadness, anger, reminder of mortality*
- Risk of burnout*
- Unsure how to express emotions*
Coping:
- Death not always a defeat*
- Aknowledge loss with relatives, talk to colleagues/family*
What are the stges of the sexual response cycle?
Desire
Arousal
Orgasm
Rest
