L10 Flashcards
Death
irreversible loss of circulation and respiration or brain function
When is death premature?
if it occurs before age 70 or 75
Psychological definition of death
the possibility of the impossibility of any existence at all
2 aspects of an illness that vary from one disease to another
course and length
Palliative care
care intended to reduce pain and discomfort and improve quality of life in patients with chronic/terminal illness; standard form of care in nursing homes regardless of prognosis
Hospice palliative care
relief of suffering from terminal illness that begins after treatment stops and may extend beyond a person’s death to assist in bereavement
Goals of hospice palliative care
to provide warmth and personal comfort (e.g. psychological comfort and social support) at the end of life; to manage pain as invasive treatments stop
Where does hospice care occur?
palliative care units of hospitals, freestanding hospices, or in homes
Pro and con of home care
improved personal control and availability of support but can be problematic for family
Benefits of palliative care
lower pain, improved quality of life, lower anxiety and depression, reduction in disease symptomatology, prolonged survival, significantly lower healthcare costs
5 goals for medical staff in providing end-of-life care
informed consent, safe conduct, significant survival, anticipatory grief, timely and appropriate death
Main goal of end-of-life care
help the patient achieve death with dignity
Disparities racialized individuals face in end-of-life care
lower use of palliative care services, worse symptom control, less likely to have end-of-life wishes documented or respected
Difficulties medical staff and formal care providers face
emotionally draining, unpleasant custodial work, not curative care, less interesting/stimulating
Medically assisted dying
a physician knowingly and intentionally provides a person with the knowledge and/or means required to end their life, including counselling about lethal doses of drugs, prescribing, or supplying them
Euthanasia
deliberately ending a person’s life to relieve suffering
Bill C-14 (2016)
restricts MAiD to mentally competent adults who have a serious and incurable illness illness, disease or disability; are in an advanced state of irreversible decline; and face a reasonably foreseeable death
Bill C-7 (2020)
removes the requirement for MAiD that death be reasonably foreseeable
Most common illnesses that lead to MAiD
cancer, neurological disorders, respiratory diseases
Concerns about medically assisted dying
incompatibility with care provider’s ethics; errors in diagnoses or prognoses; coercion by family members or physicians; suicide contagion effect; disproportionate impact on vulnerable groups; impact on the bereaved
What is the only group with a heightened risk in assisted dying?
people with AIDS
Main factor motivating MAiD requests
functional decline or inability to participate in meaningful activities
5 stages of dying
denial, anger, bargaining, depression, acceptance
Death acceptance
a realization of the inevitability of death that is often neither happy nor sad and sometimes void of feelings
What do people do in death acceptance?
detach themselves from events and things they used to value
2 coping strategies used by hospice patients
denial and acceptance (interdependent and fluctuating)
Middle knowledge
denying death and minimizing the bleakness of a prognosis while making plans for one’s death
Psychological factors that become more salient as someone approaches death
sense of integrity, continuity of relationships, reduction of conflicts, wish/goal fulfillment, reminiscence, symbolic immortality, generativity, spirituality/religiosity
What is driving a person approaching death to achieve certain goals?
a desire for meaning and purpose
Personal meaning
a sense of purpose, direction, order, reason for existence, personal identity, and greater social consciousness
2 types of autobiographical activities
reminiscence and life review
Reminiscence
volitional and non-volitional act of recollecting memories of one’s self in the past
Life review
return of memories and past conflicts at end of life; a spontaneous reconciliation of one’s life
2 cross-generational methods
symbolic immortality and generativity
Symbolic immortality
a sense of continuity or immortality obtained through symbolic means
Examples of symbolic immortality
raising a child, teaching or mentoring, giving back or making a difference, connecting with nature, creative acts, spiritual/religious beliefs
Generativity
a concern for establishing and guiding the next generation
Religiosity
endorsing or subscribing to an organized system of beliefs, practices, rituals, and symbols
External vs. internal religiosity
external and self-serving motivations; meaning-based and altruistic motivations
Spirituality
personal quest for understanding answers to ultimate questions about life, meaning, and relationship to the sacred or transcendent
Death anxiety
worry, dread, and terror over the prospect and/or process of dying
2 reasons why older adults are more likely to think about death but less likely to fear it
having accumulated more experience with loss and death; having lived a long life and accepting death as natural
Survivor’s acceptance
accepting the reality that our loved one is physically gone and recognizing that the new reality is permanent (different from being ok with what happened)
Characteristics of grief
flexible, non-linear, personal, unique
Complicated grief
when the grieving process does not progress as expected: persistent and debilitating symptoms that last longer than a year
3 typical symptoms of complicated grief
prolonged acute grief with intense yearning and sorrow; frequent troubling thoughts about the death; excessive avoidance of reminders of the loss
Prolonged grief disorder
persistent grief response following the death of a loved one for at least 1 year following the loss
Symptoms of prolonged grief disorder
yearning for the deceased and/or preoccupation with them, distress, emotional/social challenges
Integrated grief
lasting form of grief in which loss-related thoughts, feelings, behaviors are integrated into a person’s ongoing functioning without dominating
Health-survival paradox
women experience higher rates of disability and poor health despite living longer than men
Well-being paradox
older adults report less stress, greater happiness, and higher life satisfaction compared to younger adults especially in wealthy countries even with increasing physical/cognitive decline
Success
prosperous achievement of something attempted; the attainment of an object according to one’s desire
How do aging adults define successful aging?
physical activity, income, health, social interactions, sense of purpose, self-acceptance, personal growth, autonomy
How do aging adults define life satisfaction?
physical activity, income, health, social interactions (basic needs); a precursor to successful aging
2 aspects of successful aging
optimizing life expectancy and minimizing physical/psychological/social morbidity
3 factors in the biopsychosocial perspective on successful aging (Rowe and Khan)
avoiding disease and disability; active engagement in life (including social relations); high cognitive and physical function
What is the suggested addition to the biopsychosocial perspective on SA?
positive spirituality
How is successful aging achieved?
selective optimization of existing abilities through practice and technologies; compensation for loss of abilities by engaging in new strategies
Markers of success
feelings of wisdom and acceptance of death
What feelings does failure involve?
regret, bitterness
Wisdom
the coordination of knowledge and experience to improve well-being
Socio-emotional selectivity theory
people are increasingly motivated to find meaning as they shift their priorities in the 2nd half of life
SA according to the socio-emotional selectivity theory
a redirected focus on what matters most in life
Predictors of successful aging
earlier reports of successful aging, financial status, physical functioning, social support and social resources, happiness and life satisfaction, emotional well-being and security, personal meaning, sense of purpose and inner peace, spirituality
How does stress impact aging in women?
high levels of perceived stress > shorter than average telomeres > at least one decade of additional aging compared to low stress women
2 behaviors correlated with telomere length
physical activity and good nutrition
Goal of anti-aging science
to make aging a chronic condition we can treat
Primary vs secondary aging
changes that occur due to biological factors vs environmental factors that are controllable
Relationship factors that contribute to cognitive decline
low social activity, small network size, loneliness, low emotional support
Factors that increase risk of social isolation
being older, male, lower income, more chronic conditions and functional impairment
Ageism
discrimination and social oppression due to a person’s age
Limitation of Rowe and Khan’s model of successful aging
ignores experiences across lifespan and omits other indicators of success
Schulz and Heckhausen model of successful aging
defines it as the development and maintenance of primary control (efforts in managing and controlling one’s environment)
4 dimensions of Indigenous experiences with aging
health and wellness, empowerment and resilience, engagement and behavior, connectedness
2 strongest predictors of successful aging
not smoking and good social support
4 conditions of dignity
lack of pain and suffering; independence; control; integrity
4 common patterns on adjustment after trauma
resilient, recovered, chronic, delayed
