Week 11

Question 1

1. _______ is the one certainty in life
2. What did Cicero say?
3. T/F: death is viewed as a close event in older people

Answer 1

1. death
2. to learn to die is the aim of philosophy
3. F. it is viewed as a distant event even in old age

Question 2

1. What is biological vs social death?
2. T/F: social death begins much earlier than physical death

Answer 2

1. bio = how the body will physically decline with age
   social = assuming the frail very old person is not part of society anymore. the perception or behaviour of others that indicates they view or treat a person as if physically dead when the physical body has not yet died
2. T.

Question 3

1. most people who die at old age from the time the disease seems out of control is a (slow or fast) trajectory. What does this indicate?
2. What is the most common cause of death for older people?

Answer 3

1. slow. means we need a diff type of care to treat them
2. malignant neoplasms = a cancerous tumour

Question 4

1. what is a slow trajectory of death?
2. What is a short trajectory of death?

Answer 4

1. means a long and possibly painful time that people are aware of death in the near future. There must be palliative care for these people
2. takes place at a home or hospital

Question 5

1. what is palliative care?
2. What is the goal of palliative care?
3. What model is this care part of? Why is this a problem

Answer 5

1. providing relief from the symptoms, pain, physical, mental and social distress of a terminal diagnosis
2. to improve quality of life for both patient and family
3. medical model. too much focus on pain and other physical symptoms and signs. A Wholistic approach needs to be adopted

Question 6

Explain a good death for each below:
What?
How?
Where?
With whom?
When?
Why?

Answer 6

What? = heart attach, natural death
How? = quick, painless
Where? = at home, in bed
With whom? = loved ones
When? = during old age, timely, prepared
Why? = meaningful, expected, accepted

Question 7

explain a bad death for each below:
What?
How?
Where?
With whom?
When?
Why?

Answer 7

What? = cancer, AIDS, ALS, alzeimers
How? = slow, agonizing, without dignity
Where? = in hospital, intensive care unit
With whom? = alone/strangers
When? = very old age, untimely, unprepared
Why? = meaningless, senseless

Question 8

1. Why are deaths in hospitals or long term care facilities an issue?
2. deaths are very ___________

Answer 8

1. expensive, focus on keeping the person alive rather than improving quality of life, against aging in place (at home= better quality) philosophy
2. medicalized

Question 9

1. The type of disease is a factor for the ________ of death. Explain this.
2. T/F: older people have the greatest fear of death than other age groups

Answer 9

1. location. Ex: cancer = home, dementia = nursing home/hospital
2. F. result is mixed. Older people do not think about death more than young people because they know they will die, but their focus is on living

Question 10

1. What are the 5 stages of psychological reactions to dying?
2. T/F: these stages are fixed

Answer 10

1. denial
   anger
   bargaining
   depression
   acceptance
2. F. you can skip, go back and forth or overlap stages

Question 11

define each:
grief =
mourning =
bereavement =

Answer 11

grief = sense of deep sorrow after a loss
mourning = expression of grief in public
bereavement = state of having recently experienced grief; complex and personal can start before death, sometimes never ends but decreases in intensity, become physical

Question 12

T/F: bereavement only starts after death
T/F: bereavement is strictly a mental decline

Answer 12

F. can start before
F. can become physical

Question 13

1. What is maladaptive grief?
2. What are the 3 types?

Answer 13

1. a crippling disorder brought on by complicated grief and has to do with your thoughts and actions following a significant loss. Most often, these are disabling, constant thoughts and destructive behaviours that affect your overall wellbeing.
2. anticipatory = Grief starts before and in anticipation of the death.Common in partners of older adults with a fatal disease

disenfranchised = grieving for Michael Jackson, but you have never met him- something that society causes. Deemed illegitimate and therefore unacknowledged. insignificant relationship between the grieving person and the deceased

complicated = Long and severe.
Inability of recovering and resuming their life

Question 14

T/F: some losses can be a relief

Answer 14

T. for women in unpleasant marriages, long and stressful period of caregiving

Question 15

What are 4 emerging ethical issues involving end of life?

Answer 15

1. share of information
2. right to die
3. cease of care vs. assisting in death = the family, healthcare professionals decide this when the dying patient is not capable
4. assisted suicide/euthanasia

Question 16

Define each:
assisted suicide =
active voluntary euthanasia =
medical assistance in dying =

Answer 16

assisted suicide = asking for a lethal medicine but you take it your self
active voluntary euthanasia = health care professional administrates the medicine
medical assistance in dying = either of above

Question 17

1. about _______ people received MAID as of 2019.
2. ___% of older adults (with or without) sex differences

Answer 17

1. 5000
2. 80%, without

Question 18

1. What issues arise due to the institutionalization of dying?
2. How can an ‘active’ and ‘high quality’ social network can help a dying person and their family?

Answer 18

1. loss of autonomy
2. options for homecare, feel or sense of purpose, material advantages because people get access to resources

Question 19

T/F: reaction to death is the same across cultures and individuals

Answer 19

F.

Question 20

Thanatologists

Answer 20

specialists in study of death and dying

Question 21

1. In the past, high _______ mortality rates, _________ diseases and high _________ death rates during _______- ________ years made death in all age groups a common event
2. What is the life expectancy for F vs. M?

Answer 21

1. infant, childhood, female, child-bearing
2. M = 79.9, F = 84

Question 22

Explain Erikson’s theory of ego development for life review and ego integrity for older people

Answer 22

life review: dying person looks over their life, seeks conviction that their life has had meaning and purpose, prepare for death

ego integrity: accepts that one’s life cycle is something complete and unique

Question 23

What is Tornstam’s gerotranscendence suggest seniors will do (3)?
What is gerotranscsndence?

Answer 23

1. become more accepting of life’s mysteries and uncertainties
2. find enjoyment in the little things
3. emphasize family connections past, present and future

• it means process of growing old in a healthy and adaptive way where you accept it

Question 24

What are the 5 responses to a grieving partner?

Answer 24

1. chronic grief = low pre-loss depression, high post-loss depression after 6-18 months
2. common grief or recovery = low pre-loss depression and high post-loss depression at 6 months with improvement at 18 months
3. resilience = low pre and low post-loss depression at 6 and 18 months
4. depressed improved = high pre-loss depression and low post-less depression at 6 and 18 months
5. chronic depression = high pre-loss depression and high post-loss depression at 6 and 18 months

Question 25

explain each issue of treatment for dying patients
1. allowing a patient to die
2. power of attorney
3. do not resuscitate (DNR)
4. Hospice care and palliative care
5. palliative care in indigenous communities

Answer 25

1. allowing a patient to die = death follows the decision of the family and healthcare provider and persons lacking mental capabilities rely on someone else
2. power of attorney = A legal document that gives someone, usually a lawyer, adult family member, or friend to make the decisions on behalf of the ill person if the person loses his or her mental capacities
3. do not resuscitate (DNR) = A person may request that resuscitation not be attempted if the persons heart stops. The dying persons physician may then place a do-not-resuscitate (DNR) order on the patients medical care chart
4. Hospice care and palliative care = Palliative care tries to relieve symptoms and help patients enjoy their last days.
5. palliative care in indigenous communities = Often lack access to palliative care programs. Ending life in a hospital cuts off the patient from support networks. Elders prefer to die in their own community with family and friends. Researchers can for more funding; removal of federal, provincial and territorial jurisdiction barriers; and culturally appropriate services

Question 26

What are 4 suggestions for relieving the stress of indigenous people in a hospital setting?

Answer 26

1. interpreters
2. large rooms for full family
3. allow family to spend time with patient
4. professionals need to understand the values and cultural preferences of indigenous elders