Understanding death and dying

Why is it important to discuss death?

• death is a universal experience but often avoided in training

• Healthcare has shifted from cure to care

• OTs are positioned to bring presence, adaptation, and purpose at the end of life

“Being Mortal” main takeaway

Modern medicine often overemphasizes prolonging life.

True patient centered care means asking “What matters most to you now?”

Case studies show how early conversations improve quality of life

Signs of approaching death

• decreased appetite, mottled skin, irregular breathing

• Withdrawal, symbolic language, restlessness

• OT role: comfort, support, legacy work

Kubler Ross Five Stages

Denial, anger, bargaining, depression, acceptance

Applying the five stages in OT

Meet emotional needs through adaptive engagement

Use storytelling memory work, gentle routine changes

Normalize grief responses

Death and bereavement across cultures

Culture shapes how death is viewed and expressed

Practices vary ancestor worship, timeline, family roles

OT role: observe, ask, respect

African American Christian

Death may be viewed as a homegoing with prayer, scripture, music, church, family support

Latino/Hispanic Catholic

Family presence, prayer, rosary, last rites, candles, and spiritual rituals, may be important

Mexican Tradition

Dia de los Muertos honors deceased loved ones through photos, altars, flowers, food, and memory

Jewish Tradition

Emphasis on reverence for the body, timely burial, mourning practices, and family/community support.

Muslim Tradition

Death is seen as a return to Allah. Modesty, prayer, body care, and timely burial matter

Hindu tradition

Death may be viewed as part of the cycle of life, death, and rebirth, with prayer and sacred rituals.

Buddhist Tradition

a calm environment, chanting, meditation, and limited disturbance after death may be important

Secular

meaning may center around autonomy, comfort, legacy, relationships, and quality of life

Cultural competence at the end of life

Are there customs or rituals we should honor?

Who needs to be present?

Are there spiritual or cultural practices that are important to you?

Is there anything we should avoid?

Would you like a chaplain or another spiritual leader contacted?

Create a space for spiritual and cultural expression

OT’s role in end of life care

Maintain dignity and autonomy

Adapt activities to ability

Reframe OT from performance based to presence based

Ethical and clinical tensions

Balancing rehab goals with palliative needs

Respecting patient wishes and limitations

Collaboration with care team and family

Legacy and meaning work

Letters, memory books, recordings

Photos, life review, rituals

OTs support closure and connection