Lifespan Development - Exam 4 Review

Chapters 16 and 17

Simpler

Twenty five years ago, determining whether someone was dead was ( ) than it is today, with the end of certain biological functions and the rigidity of the body signaling death.

Brain Death

A neurological definition of death which states that a person is brain dead when all electrical activity of the brain has ceased for a specified period of time. A flat EEG recording for a specified time is one criterion for this.

Higher/lower

The current definition of brain death held by most physicians includes the death of both ( ) cortical functions and ( ) brain stem functions.

Lower/continue

Because the brain’s ( ) portions monitor heartbeat and respiration, an individual whose higher brain areas have died may ( ) to breathe and have a heartbeat.

Lower/functioning

If the cortical brain death definition were adopted, physicians could claim a person is dead when they have no higher cortical functioning, even if the ( ) brain stem is ( ).

Advance Care Planning

The process of patients thinking about and communicating their preferences regarding end-of-life care.

Decreased/increased/decreased

Researchers have found that advance care planning ( ) life sustaining treatment, ( ) hospice use, and ( ) hospital use.

Living Will

A legal document that reflects the patient’s advance care planning. This was created by the organization “Choice in Dying” when they realized that some terminally ill patients might prefer to die rather than linger in a painful or vegetative state.

Improved/greater

A study of older adults found that advance care planning was associated with ( ) quality of care at the end of life, including less in-hospital death and ( ) use of hospice care.

Advance Directive

A document such as a living will that states an individual’s preferences regarding the administration of medical procedures in the event of a terminal illness or injury, such as whether life-sustaining procedures should or should not be used to prolong life when death is imminent. This document must be signed while the individual is still able to think clearly.

15/90

A study of end-of-life planning found that only ( ) percent of patients 18 years or older had signed a living well. ( ) percent of these participants said it was important to discuss their health care preferences with their family, but only 60 percent had done so.

Lower

A study revealed that completion of an advance directive was associated with a ( ) probability of receiving life sustaining treatments.

Physician Orders for Life-Sustaining Treatment (POLST)

A more specific document that involves the health-care professional and the patient or representative stating the wishes of the patient. This document translates treatment preferences into medical orders such as CPR, extent of treatment, and artificial nutrition.

Euthanasia

The act of painlessly ending the life of an individual who is suffering from an incurable disease or severe disability. It is sometimes called “mercy killing”.

Passive Euthanasia

A type of euthanasia involving the withholding of available treatment, such as withdrawing a life-saving device like a respirator or feeding tube.

Active Euthanasia

A type of euthanasia in which death is deliberately induced, as when a physician or a third party ends the patient’s life by administering a lethal dose of a drug.

Assisted Suicide

A physician supplies the information and/or the means of committing suicide (such as giving a patient a prescription for sleeping pills or muscle relaxants and instructions regarding the dosage required to produce a coma followed by death) but requires the patient to self-administer the lethal medication and to determine when and where to do this.

States

The United States has no official policy on assisted suicide and leaves the decision up to each of the ( ).

Increased/60-75 year old males

In one study, the percentage of assisted suicide cases reported to authorities ( ) in recent years and the individuals who died through assisted suicide were most likely to be ( ).

50

Over ( ) percent of people in the United States are in favor of euthanasia and physician assisted suicide, especially in the cases of those with a terminal illness.

Increasing/nine

While an ( ) number of states are legalizing assisted suicide, only ( ) states have legalized it so far.

60/33

Too often, death in America is lonely, prolonged, and painful. A study found that ( ) percent of dying patients were in pain in the last year of life and that nearly ( ) had symptoms of depression and confusion prior to death.

1) Preference for dying process

2) Pain-free status

3) Emotional well-being

What are three frequent themes identified in articles on a good death?

Hospice

A program committed to making the end of life as free from pain, anxiety, and depression as possible.

Palliative Care

Healthcare adopted by hospice programs that emphasize reducing pain and suffering and helping individuals die with dignity.

90

About ( ) percent of hospice care is provided in patients’ homes.

Increasing/85

An ( ) number of U.S. hospitals have expanded their provision of palliative care, with ( ) percent of mid- to large-size hospitals employing a palliative care team.

Process

Critics of the “good death” concept say that death itself has shifted from being an event at a single point in time to being a ( ) that takes place over years and even decades.

“Good Death” Concept

The idea of death that involves physical comfort, support from loved ones, acceptance, and appropriate medical care.

Controversial/calm

Euthanasia is ( ); those who favor euthanasia argue that death should be ( ), but those against euthanasia stress that it is a criminal act of murder.

Increasing

In 1900, most people died at home, but as the U.S. population has aged and become more mobile, an ( ) number of older adults die apart from their families.

80/minimized

More than ( ) percent of all U.S. deaths occur in institutions or hospitals, which has shifted the care of a dying older person away from the family and ( ) our exposure to death and its painful surroundings.

81/76

Today, the life expectancy for women is ( ) and for men is ( ).

50/most

In the past, almost ( ) of children died before the age of 10, with at least one parent dying before their children grew up. Now, death occurs ( ) often among older adults in the United States.

War, famine, and pandemics

Individuals are more conscious of death in times of…

Avoiders/deniers

People who live in the United States are death ( ) and ( ).

1) The tendency of the funeral industry to gloss over death (ex. making the dead person look good in an open casket funeral)

2) The persistent search of the “fountain of youth”

3) The rejection and isolation of the aged

4) The medical community’s emphasis on prolonging biological life rather than on diminishing human suffering

What forms can the denial of death in the United States take on?

Ritual

Most societies throughout history have had philosophical or religious beliefs about death, with most also having a ( ) that deals with death.

Not/spirit

In most societies, death is ( ) viewed as the end of existence - although the biological body has died, the ( ) is believed to live on.

Elisabeth Kubler-Ross

Divided the behavior and thinking of dying persons into five stages: denial and isolation, anger, bargaining, depression, and acceptance

Denial and Isolation

The first stage of dying in which the person denies that death is really going to take place. This is a common reaction to terminal illness, though it can pop back up when the person is confronted with financial considerations, unfinished business, and worry about the well-being of surviving family members.

Anger

The second stage of dying in which the dying person recognizes that denial can no longer be maintained. This denial often gives way to anger, resentment, rage, and envy. A person in this stage may become increasingly difficult to care for as anger may become displaced and projected onto physicians, nurses, family members, and even God.

Bargaining

The third stage of dying in which the person develops the hope that death can somehow be postponed or delayed. Some persons enter into a bargaining or negotiation, often with God, as they try to delay their death.

Depression

The fourth stage of dying in which the dying person comes to accept the certainty of death. A period of depression or preparatory grief may appear in this stage. Kubler Ross says that trying to cheer up a dying person in this stage should be discouraged, as this stage is needed to eventually accept one’s death.

Acceptance

The fifth and final stage of dying in which the person develops a sense of peace, an acceptance of his or her fate, and in many case, a desire to be left alone. Kubler Ross describes this as the end of the dying struggle, or the final resting stage before death.

1) Not backed by Kubler-Ross’s research or by independent research

2) The stage interpretation neglects variations in patients’ situations

What are some of the criticisms of Kubler-Ross’s theory on dying?

It called attention to the needs of people who are attempting to cope with life-threatening illnesses as well as the quality of life of dying persons and their families

What is an important aspect of Kubler-Ross’s theory on dying?

Less/least

In a study, individuals with ( ) than three months to live who had found purpose and meaning in their lives felt the ( ) despair in their final weeks, while dying individuals who saw no reason for living were the most distressed and wanted to hasten death.

Spirituality

In a majority of studies, ( ) helped to buffer dying individuals from severe depression.

Better/longer

Nursing home residents who were given options for control felt ( ) and lived ( ) than their counterparts who had no control over their environment or activities.

Denial

( ) may be a fruitful way for some individuals to approach death; it can, however, be adaptive or maladaptive.

1) They can close their lives in accord with their own ideas about proper dying

2) They can complete some plans and projects, make arrangements for survivors, and participate in decisions about a funeral and burial

3) They can reminisce about their lives with those they love

4) They have a better understanding of what is happening within their bodies and what the medical staff is doing for them

What are some of the advantages of a dying person having an open awareness of their death?

Know

Most psychologists believe that dying individuals and their loved ones should ( ) they are dying or that their loved one is dying.

1) Establish your presence

2) Eliminate distractions

3) Keep your visit short if the person you are visiting feels weak

4) Don’t insist on acceptance if the person is in denial or vice versa

5) Allow the dying person to express guilt and anger and encourage their expression

6) Ask about the outcome of their illness, alternatives, and unfinished business

7) Ask the dying person if there is anyone they would like to see

8) Encourage the person to reminisce

9) Talk to them whenever they wish to talk

10) Express your regard for the person by expressing love or saying goodbye

What are some effective strategies for communicating with a dying person?

Strengths/preparation

Experts believe that conversations with a dying person should focus on their ( ), ( ) for the remainder of life, and their internal growth.

Grief

The emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love.

1) Pining or yearning for the lost person

2) Separation anxiety

What are some important dimensions of grief?

Negatively/grief

In one study, meaning was ( ) associated with depression but positively associated with ( ) in suicide survivors.

More

One study found that college students who lost someone close to them in campus shootings and had experienced severe PTSD four months after the shootings were ( ) likely to have severe grief one year after the shootings.

Complicated Grief or Prolonged Grief Disorder

Grief that involves enduring despair and remains unresolved over an extended period of time.

7 to 10

( ) percent of bereaved individuals experience prolonged or complicated grief.

Age/emotional

The ( ) of the bereaved individual and the level of ( ) dependence on the deceased person affects the likelihood of having prolonged grief.

More

For most individuals, grief becomes ( ) manageable over time, with fewer abrupt highs and lows.

Diminish/increase

As time passes, pining and protest over the loss tend to ( ), although episodes of depression, apathy, separation anxiety, and loss may remain or ( ).

1) Major depressive disorder

2) Cognitive decline

3) Neuroticism

Complicated or prolonged grief was associated with which negative physical and mental health consequences?

Disenfranchised Grief

An individual’s grief over bereavement involving a socially ambiguous loss that can’t be openly mourned or supported. This type of grief can occur in individuals mourning the deaths of people whose circumstances were stigmatized. This grief can be hidden or repressed for many years only to be reawakened by later deaths.

Dual-Process Model

A model of coping with bereavement that has two main dimensions: (1) loss-oriented stressors and (2) restoration-oriented stressors.

Loss-Oriented Stressors

Stressors in the dual-process model that focus on the deceased individual and can include grief work and both positive and negative reappraisals of the loss.

Restoration-Oriented Stressors

Stressors in the dual-process model that involve the secondary stressors that emerge as indirect outcomes of bereavement, such as changing identity and mastering additional skills that once rested in the hands of the deceased loved one.

Better

One study found that individuals who engaged in more restoration-oriented coping were ( ) adjusted both early and later in the bereavement process than those who relied more heavily on loss-oriented coping.

More/prolonged

Deaths that are sudden, untimely, violent, or traumatic are likely to have ( ) intense and ( ) effects on surviving individuals and make the coping process more difficult for them.

1) Sense making (ex. seeking medical explanations for their child’s death)

2) Benefit finding (ex. finding a positive consequence of the death, like making donations)

3) Continuing bonds (ex. reminiscing about the child)

4) Identity reconstruction (ex. changes in relationships, work, and home after the death)

What were the four meaning-making processes used in bereavement meetings conducted with 53 parents who lost their children?

Beneficial

One ( ) aspect of grieving is that it stimulates many individuals to try to make sense of their world.

Vigorously

When a death is caused by an accident or a disaster, the effort to make sense of it is pursued more ( ).

Three

Approximately ( ) times as many women as men are widowed.

Income

Women experienced a decline in ( ) in the two years following the death of their spouse, while men experienced a decline in emotional and mental health following the death of their spouse.

First

In a cross-cultural study, depression peaked in the ( ) year of widowhood for both men and women.

High/6 to 10

In a cross-cultural study, women eventually reached depression levels similar to married individuals, while widowed men in all countries except Europe continued to have ( ) levels of depression ( ) years after their spouse’s death.

1) Positive reframing

2) Active distraction

3) Help-seeking

4) Turning to God

Women are more likely to use which coping strategies when grieving the loss of their spouse?

1) Avoidant strategies

2) Seeking connection with late spouse

Men are more likely to use which coping strategies when grieving the loss of their spouse?

Higher/men

One study revealed that being widowed was associated with a ( ) risk of mortality, with the mortality risk being higher for ( ) if the death was unexpected.

Lonelier

The poorer and less educated widows are, the ( ) and more at risk for health problems they tend to be.

Diminished

In a study of 80 or older widows, the loss of a spouse, especially for men, was related to ( ) life satisfaction over time.

More

Widowed persons who did not expect to be reunited with their loved ones in the afterlife reported ( ) depression, anger, and intrusive thoughts 6 to 18 months after their loss.

Cremation

A majority of deaths in both the United States and Canada are followed by ( ), with those numbers being expected to rise in the coming years.

Most/south

Cremation is ( ) popular in the Pacific region of the United States and least popular in the ( ).

Japan

In what country is cremation the most popular?

Because critics view embalming as grotesque and believe they are profiting off of death.

Why has the funeral industry been a target of controversy in recent years?

Family/community

The ( ) and the ( ) have important roles in mourning in some cultures.

Integrity versus Despair

The eighth and final stage of Erikson’s psychosocial development model in which individuals in late adulthood reflect on the past and either piece together a positive review or conclude that one’s life has not been well spent.

Life Review

A prominent aspect of the integrity versus despair stage that involves looking back at one’s life experiences and evaluating, interpreting, and often reinterpreting them.

Death/quietly

Aging researcher Robert Butler argues that the life review is set in motion by looking forward to ( ) and that the life review sometimes proceeds ( ) but at other times, can be quite intense.

Regrets

One aspect of life review involves identifying and reflecting on not only the positive aspects of one’s life, but also ( ) as part of developing a mature wisdom and self-understanding.

Reduced

An important factor in the outlook of older adults who showed a higher level of emotion regulation and successful aging was ( ) responsiveness to regrets.

Should not

Researcher indicates that adults (should/should not) dwell on regrets, especially since opportunities to undo regrettable actions decline with age.

Reminiscence Therapy

Therapy that involves discussing past activities and experiences with another individual or group, which may include the use of photographs, familiar items, and video or audio recordings.

Decreased/improved/increased

According to research, reminiscence therapy led to ( ) symptoms of depression and anxiety, ( ) life satisfaction, ( ) social engagement, and better mood for older adults, especially those with dementia.

Activity Theory

A theory of aging stating that the more active and involved older adults are, the more likely they are to be satisfied with their lives. It supports the idea that when older adults are active, energetic, and productive, they age more successfully and are happier than they are if they disengage from society.

Greater

Many individuals will achieve ( ) life satisfaction if they ( ) their middle-adulthood roles into late adulthood.

More/greater

A study of Canadian older adults revealed that those who were ( ) physically active had ( ) life satisfaction and lower levels of depression than their physically inactive counterparts.