11. Death, Dying, and Bereavement

Elder Abuse

Any action or inaction by any person that causes harm to an older person

• interactions between sexism and ageism — women more likely to experience

Perpetrators for women vs. men

Women: family

Men: an acquaintance or stranger

Public Interest - Policies

• increased interest in abuse and neglect due to an aging population

• future studies should explore and evaluate policies and practices that help ensure safety of the older population

Death:

Biological vs. Social

• assuming the frail, very old person was not a part of the society anymore

• socially isolated… social death? (stopping opinion giving, etc.)

Younger deaths vs. older deaths

Younger: attributed to accidents

Older: attributed to disease (tests for accidents and drugs can easily be overlooked in the autopsy)

Care surrounding death

What type of care is this?

Palliative care

“Good Death”

How

Where

With Whom

When

Why

• quick and painless

• at home, in bed

• loved ones

• during old age, timely, prepared

• meaningful, expected, accepted

“Bad Death”

How

Where

With Whom

When

Why

• slow, agonizing, without dignity

• in hospital, in intensive care unit

• alone or with strangers

• in very old age, untimely, unprepared

• meaningless, senseless

Kubler-Rose

Stages of Psychological Reactions to Dying (5)

1) denial

2) anger

3) bargaining (with God)

4) depression (most dangerous, but treatable)

5) acceptance

KR - Stages of Psychological Reactions to Dying:

1) Denial

• “not me”

• believing the doctors has the wrong X-rays/ someone else’s tests

KR - Stages of Psychological Reactions to Dying:

2) Anger

• “why me?”

• blaming God

KR - Stages of Psychological Reactions to Dying:

3) Bargaining

• “yes me, but…”

• may promise to be a good patient if they get better

• bargaining with God

KR - Stages of Psychological Reactions to Dying:

4) Depression

• “yes” with great sadness

• mourning present and future losses (as 2 separate stages)

• beginning to say goodbyes

KR - Stages of Psychological Reactions to Dying:

5) Acceptance

• “my time is close now, it’s okay”

• saying goodbye and die in peace

Kubler-Rose’s Stages of Psychological Reactions to Dying:

Linear?

People can ‘skip’, ‘go back and forth’, or’ overlap’ stages

• not linear

• scientific view of dying — “this is how it should happen” - doesn’t always work out this way

Grief

Sense of deep sorrow after a loss (individual)

Mourning

Expression of grief in public

Bereavement

The state of having recently experienced grief (state of grief that an individual is in — no good or bad grief)

Complex (Maladaptive) Grief:

Anticipatory Grief

• starting before the person dies

• common in partners of older adults with a fatal disease

Complex (Maladaptive) Grief:

Disenfranchised Grief

• deemed illegitimate and therefore unacknowledged

• insignificant relationship between the grieving person and the deceased (grief is real, but it is not taken seriously — ex. mourning celebrities)

Complex (Maladaptive) Grief:

Complicated Grief

• long and severe

• inability of recovering and resuming normal life

• (normal life does not necessarily mean resuming the way life was before the loss)

Historical view of dying vs. now

Historical: cessation of cardiac and respiratory function

Now: cessation of brain function (brain death)

Thanatologists

• specialize in the study of dying and death

• distinguish physical death from social death

Social Death

Perception or behaviour of others when they view or treat a person as if physically dead when the physical body has not died yet

Longer life expectancy = ?

Higher rates of chronic disease in old age (cancer, heart disease, chronic lung disease, stroke, and diabetes)

Glaser and Strauss; 2 awareness contexts for dying:

A Closed Awareness

• professionals, the patients, and the family may all know that death will occur soon

• no one discussed this “secret”

Glaser and Strauss; 2 awareness contexts for dying:

An Open Awareness

• all people communicate about the impending death

• research and modern medical care support this context today

Activity Theory

When people retire, they have the highest life satisfaction if they find new things to do (says nothing about death, but support living life to the fullest)

Disengagement Theory

Says that people want to disengage from social roles as they age (retirement and withdrawal from social responsibilities lead to high life satisfaction)

Kavanaugh’s Description of the Grieving Process (1972)

Steps (7) and linear?

1) shock and denial

2) disorganized

3) volatile reactions

4) guilt

5) a sense of loss and loneliness

6) relief

7) reestablishment

Linear, time-limited model

Worden; “Tasks of Grieving” Model (4)

With a focus on “grief work”!!

1) accepting the reality of the loss

2) experiencing the pain of grief

3) adjusting the loss

4) investing in new roles and relationships

5 Responses to the Loss of a Partner

1) chronic grief

2) common grief or recovery

3) resilience

4) depressed-improved

5) chronic depression

Smaller number of men or women remarry after their partner dies?

Smaller number of women

Nirvana

Promotion of spiritual enlightenment in this life and eternal bliss for the enlightened being

Palliative Care Includes…

• pain management and symptoms management

• social, psychological, emotional, and spiritual care

• caregiver support

Caxaj and Colleagues (2018)

Study on Palliative Care in Indigenous Communities

Priorities include…

• family connections throughout the dying process

• building capacity for palliative care to provide more relevant and culturally appropriate care

• flexibility and multi-sectorial partnerships to address the complexity of day-to-day needs for patients and families

Active Euthanasia

Causing death (taking deliberate action to cause a patient’s death)

Passive Euthanasia

Allowing death (withholding or withdrawing medical treatment, allowing the patient to die naturally)

Gloria Taylor (Assisted Suicide)

• first person in Canada to win the right to die with the help of a doctor

• was the lead plaintiff in the Carter v. Attorney General of Canada

Cultural Diversity in Rituals:

What have we seen an increase in?

• increasing personalization of dying, death, and bereavement

• emphasis has shifted from the body and soul to the psychological “self”