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Death and Dying: A Family Affair

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Death and Dying: A Family Affair Lecture 12/6/04 Lifespan Understanding of Death Newborn to 3 years: Infants do not understand the concept of death. – PowerPoint PPT presentation

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Title: Death and Dying: A Family Affair


1
Death and Dying A Family Affair
  • Lecture 12/6/04

2
Lifespan Understanding of Death
  • Newborn to 3 years
  • Infants do not understand the concept of death.
  • As they develop attachment to a caregiver, they
    can experience loss or separation and
    accompanying anxiety.

3
Lifespan Understanding of Death II
  • Children 3 5 years
  • Have little or no idea of what death really
    means.
  • Confuse death with sleep.
  • Rarely get upset by being told that a person has
    died.
  • Believe the dead can be brought back to life by
    magic or by giving them food or medical
    treatment.
  • Often believe that only people who want to die,
    or who are bad or careless, actually die.
  • May blame themselves for the death of someone
    they knew well, illogically reasoning that the
    event may have happened because they disobeyed
    the person who died.

4
Lifespan Understanding of Death III
  • Middle Late childhood
  • Children 6 9 believe that death exists but only
    happens to some people.
  • Children 9 years and older recognize that death
    is final universal.

5
Lifespan Understanding of Death IV
  • Adolescence
  • Death regarded as something very remote.
  • The subject of death may be avoided, glossed over
    or kidded about.
  • Some adolescents do show concern for death,
    trying to understand its meaning confront their
    own death.
  • Notions of death become more abstract.
  • Develop religious philosophical views about the
    nature of death and whether there is life after
    death.

6
Lifespan Understanding of Death V
  • Adulthood
  • An increased consciousness about death
    accompanies individuals awareness that they are
    aging, which usually intensifies in middle
    adulthood.
  • Middle-aged adults fear death more than young
    adults or older adults do.
  • Older adults think about death more than do young
    middle-aged adults.
  • Older adults have more direct experience with
    death as their friends relatives become ill
    die.
  • Older adults examine the meaning of life and
    death more frequently than younger adults.
  • Death may be less emotionally painful for older
    adults.

7
Other Types of Death
  • Social death Failure to recognize a person as
    being among the living.
  • A woman who enters a nursing home, and is never
    acknowledged again by members of her family.
  • Nurses who do not respond as often to the call
    lights of the terminally ill as those who may
    recover.
  • Psychological death A state where self-awareness
    is absent (confusion, disorientation) or
    individuals no longer consider themselves
    living.
  • A patient with Alzheimer's disease.
  • A person may become severely depressed which may
    lead to a lack of interest in living
    experiencing.

8
Suicide Statistics and Death
  • Persons over 65 have the highest completed
    suicide rate of any group. Within this age group
    persons 80-84 have the highest rate.
  • Most aged suicides occur in the midst of their
    1st depressive episode.
  • Cohort and gender issues younger older have a
    higher rate than did their grandparents at the
    same age. White males.
  • Suicide risk factors male, increasing age,
    white, unmarried, psychiatric illness history
    of suicide attempts.

9
Advance Care Planning Definitions
  • ACP refers to means by which preferences
    regarding life-sustaining treatments are
    communicated so that medical treatment decisions
    can be made prior to medical crisis.
  • Advance directives are written documents
    typically executed by a competent individual in
    the presence of witnesses to communicate his/her
    preferences regarding life-sustaining treatments.
  • Living wills stipulate what treatments a person
    would like to withhold, or what measures he or
    she wants.
  • Health care proxies are used to appoint an agent
    who will have authority to make medical treatment
    decisions for a person.

10
Advance Care Planning Findings
  • Intra-individual life-sustaining treatment
    preferences are stable for up to two years.
  • ACP may reduce stress among patients, caregivers,
    and other family members.
  • Regarding agreement studies between patients and
    proxy decision makers
  • proxies have difficulty making substituted
    judgments.
  • agreement is poor, even when guided by formal
    ACPs.
  • agreement is highest for the most extreme
    (coma-no chance) and least extreme (current
    health) scenarios.

11
Family Perspectives of a Good Death
  • Health care professionals work to ensure
  • Pt has physical comfort and emotional support.
  • Shared decision making.
  • Pt is treated with respect.
  • Information and emotional support is provided to
    family members.
  • Care is coordinated across settings.

12
Place of Death Family Perspectives
  • In Tenos national probability sample
  • 68.9 of decedents died in an institutional
    setting either a hospital or nursing home.
  • Of the 31.1 who died at home
  • 36.1 died without any nursing services
  • 12.4 had home nursing services
  • 51.5 had home hospice services

13
Place of Death Family Perspectives on Quality
of Care
  • In Tenos national probability sample
  • unmet needs for dyspnea or shared decision
    making with a physician did not differ by
    setting.
  • in comparison with hospice, pts in nursing homes
    or at home with home health services reported
    unmet needs for pain and being treated with
    respect.
  • Staff and family educational needs were higher
    in nursing homes and hospitals.

14
Family Caregiving and the Stress Process
  • Negative outcomes
  • Regardless of life-limiting illness, burden,
    depression, low life satisfaction and poor CG
    health are worse among CGs of pts with more care
    needs.
  • Feel on duty almost 24 hours/day.
  • Positive outcomes
  • Passing on a tradition of care.
  • Satisfaction.
  • Sense of personal growth, meaning, and purpose.

15
Family Caregiving and Religiousness / Spirituality
  • Persons who tend to turn to religion as a source
    of coping with distressing life events are
  • Elderly
  • Poorer
  • Less well educated
  • African American
  • Widowed
  • Female
  • More religious to begin with
  • Religiousness mediates the relationship between
    race and perceived caregiver rewards and well
    being.

16
Family Caregiving and Bereavement
  • Among spousal CGs, relief is a common result of
    bereavement when
  • The CR had a severe illness
  • the relationship was characterized as high
    stress
  • the role of caregiver was perceived as a strain
  • Family tension and difficulty in providing care
    predicts difficulty in coping with bereavement.
  • Bereavement reactions differ by cultural context,
    with whites perceiving more relief and AAs
    perceiving greater loss (Owen, Goode, Haley,
    2001).

17
Future Research Needs
  • Need to further study the relationship between
    CULTURE, caregiving, stress process, and
    religious and spiritual coping.
  • Policy issues, including the Medicare hospice
    benefit and palliative care needs.
  • More intervention studies across treatment
    settings.
  • Caregiving context prior to bereavement and
    consequent adjustment to bereavement.
  • Need for mixed method studies of decision making,
    including ACP and placement prior to death.
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