Lecture 9 - Death & Dying Flashcards
What is the definition of death?
The irreversible cessation of brain function that can be determined by the prolonged absence of spontaneous cardiac and respiratory functions
What is the definition of dying?
The period during which the organism loses its vitality
What are the recent changes in definition of death?
Instead of “irreversible cessation” the law now describes it as “irreversible loss of the brain’s ability to control and co‐ordinate the organisms’ critical functions”
What are some signs of death?
Increased sleeping, confusion, irregular breathing, hallucinations, reduced vision, decreased urine output, skin appearance changes, cold hands & feet, decline in walking ability, eating & recognizing loved ones
What is dying trajectory?
Pattern of the disease process leading to a patient’s death
What are the 4 patterns of dying trajectories?
Sudden death, terminal illness, organ failure, and frailty
What is the sudden death trajectory?
Functioning well before rapidly declining
What is the terminal illness trajectory?
Advanced notice of a life-threatening illness, functioning declines fast
What is the organ failure trajectory?
Up & downs in functioning until a fatal failure
What is the frailty trajectory?
Usually when the body can no longer function because of advanced cognitive impairment & another disease causes the fatality like a cold
What is anorexia-cachexia syndrome?
An individual loses appetite at the end of life (anorexia) and muscle mass (cachexia)
Dying patients may face symptoms, such as nausea, difficulty swallowing, bowel irregularities, dry mouth and edema
Psychological symptoms, including anxiety, confusion, and dementia
What is a crude death rate?
The number of deaths during a given year per 100,000 population
What is age-specific death rate?
The number of deaths in a particular age group during a given year per 100,000 population (provides mortality rate for that age group)
What is the 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 (removes age bias by using a normal distribution to be able to compare different populations)
What is the leading cause of death for age 1-24?
Accidents, suicide & cancer
What is the leading cause of death for age 25-44?
Accidents, suicide, cancer, & heart disease
What is the leading cause of death for age 45-64?
Cancer, heart disease, & accidents
What is the leading cause of death for age 65+?
Cancer, heart disease, & stroke
How does marriage impact mortality?
Married people tend to have lower mortality rates compared to people who have never married (observed for both men and women across all adult age groups)
What is the myth of 10,000 steps?
Myth that was debunked as Abbasi found that walking does decrease mortality but walking over 7,500 steps and pace of walking does not provide additional benefits
What are the disadvantages of being an evening person?
Related to increased mortality risk later on & Didikoglu found that they are more likely to engage in unhealthy behaviors
How does education impact mortality rate?
Education tends to lower mortality rate because they are more likely to engage in healthy behaviors
How does occupational status impact mortality?
People with lower status jobs die younger because of unhealthy habits, obesity, etc.
What are other factors that impact mortality?
Air pollution, loneliness, political economy, religious involvement, exercise, chronotype, or hip fracture
What are some examples of death ethos?
The prevailing philosophy of death in a culture, funeral rituals, treatment of the dying, death in the arts, & conversations about death & dying
What were the Middle Ages view of death (old)?
Tamed death, natural & familiar part of life
What are the Western views of death?
End of the self, feared, & kept at a distance
What is invisible death?
Current Western attitude of a desire for death to be away from the family & be confined to hospitals
What is social death?
The dying become treated as non-persons by family or health care workers as they are left in a hospital or nursing home for their final years
What is death with dignity?
Idea that death should not involve extreme physical dependency or the loss of control of bodily functions
What is a good death?
Opportunity for patients to have autonomy in making decisions about the type, site, and duration of the care that they receive at the end of life
What are the two parts of adjusting to a sense of identity?
Identity assimilation – downplay or even deny death
Identity balance –acceptance with greater ease and calmness
What is legitimization of biography?
The way that people die can define their identity: steps to leave a legacy that will continue to define oneself after one is gone (ex. Memoirs)
How does death portray media?
Death is prevalent in the media demonstrating the fear of death (ex. Netflix documentaries of natural disasters or murders)
What are the stages of death?
Denial, anger, bargaining, depression, & acceptance
Who is Kubler-Ross?
Wrote a book on dying & death - for a terminally ill person to reach acceptance it is important to create an environment of open communication
Who is Ernest Becker?
Wrote the Denial of Death that highlighted Western views to avoid death
What influence did Kubler & Ernest have?
Together these works helped reshape cultural attitudes and medical practices surrounding death
What is the psychological process of dying?
Might start when someone becomes aware of their mortality (ex. man’s father dies at 66, the son may start a mental countdown when he reaches that age)
What is terror management theory?
People have panic & dread the thought of their life ending
Suggests that when people are aware of death they experience a wide range of beneficial effects
How has attitudes in health care changed about death?
Advances in medical technology & shifting attitudes towards death have made healthcare provides more attentive
More focused on advocating for the rights of people dying
What is an advanced directive?
A document where a patient expresses their wishes for end-of-life care
What is a DNR?
Directs health care workers not to use resuscitation if the patient experiences cardiac or pulmonary arrest
What is overtreatment?
Occurs when patients do not have their DNRs respected but instead receive active life support that includes resuscitation
What is Medical Assistant in Dying?
The practice where a medical professional administers a drug that causes death
Who is Sue Rodriguez?
Women with ALS in 1992 argued that not being able to have MAiD infringed on her rights
When was MAiD legalized?
In 2015 Supreme Court of Canada ruled in favour of Gloria Taylor’s right to assisted suicide
Legal in Canada in 2016
What are the qualifications for MAiD in Canada?
- Be eligible for government-funded health insurance in Canada
- Be over 18
- Have a grievous & irremediable
- Voluntarily request MAiD free from external pressure
- Give informed consent & be aware of all options
What is the complexity of MAiD?
Determining “Grievous and irremediable” condition can be complex in practice & establishes safeguards must be followed to ensure ethical and legal compliance
What are the 3 groups that might be included in the MAiD criteria?
Mature minors, people who want to make advanced requests, & people who have a mental disorder
What is hospice palliative care?
End‐of‐life care that is provided in the home or hospice that provides medical and supportive services, designed to address the physical, emotional, social, and spiritual needs of the patient, & hospice services align closely with patient priorities
What is the history of hospice?
First one was in London England in 1967, movement spread to Canada in early 1970s
What is the difference between MAiD and palliative care?
MAiD is not a component of hospice palliative care (MAiD is a right in Canada & palliative care is not)
What is bereavement?
Process during which people cope with the death of another person
What are the biological aspect of bereavement?
Chest tightness, shortness of breath, fatigue, sleep disturbances, digestive issues and weakened immunity
What are the psychological aspects of bereavement?
Anger, depression, anxiety, emptiness and a constant focus on the deceased
What are cognitive changes of bereavement?
Difficulty concentrating, memory problems and a tendency to withdraw from social activities
What are the sociocultural aspect of bereavement?
Disruption in social roles and altered support network
What can child loss cause?
Devastation, increased depression, guilt, physical health issues, & increased risk of mortality
What are some sources of comfort during bereavement?
Religious beliefs, viewing death as peaceful escape from suffering & feeling the presence of loved ones provides reassurance
What is the psychodynamic view of bereavement?
Caregivers can benefit from anticipatory grief, the individual must mourn, & must break emotional ties to loved ones form new relationships
What is the attachment view of bereavement?
View that the bereaved can continue to benefit from maintaining emotional bonds to the deceased
What is the dual-process model of coping with bereavement?
Proposes that dealing with the practical side of loss is just as important for someone’s healing as dealing with the emotional pain & they alternate between the 2 to adjust to grief
Attachment style & personality factors can impact the individual’s response
What is the loss-oriented side of the dual-process model of coping with bereavement?
Doing grief work, breaking bonds & ties by relocating, & denying/avoiding changes
(ex. removing yourself from things that remind you of the loss)
What is the restoration-oriented side of the dual-process model of coping with bereavement?
Attending to life changes, doing new things, want to be distracted from grief, denying/avoiding grief, taking on new roles, identities & relationships
(ex. arranging funeral service, paying bills their partner used to pay, & paying their late partner’s taxes)
What is identity change during bereavement?
Identity assimilation – avoiding excessive focus on the loss, which is a healthy form of denial (ex. maintaining identity as a wife after husband’s death)
Identity accommodation – achieve a more balanced sense of identity by gradually integrating the death into their identity
What is repressive coping?
Pushing painful thoughts out of conscious awareness
How do older adults deal with bereavement?
Older adults demonstrate a unique ability to manage the fear of death
Ability to move forward while keeping memories of lost ones intact may be a key factor in the resilience of older adults
These individuals have developed strategies for incorporating the pain of loss into their lives and are able to find positive new paths forward
