Life Cycle - Ageing and Death

Aging

A lifelong process involving physical, psychological and social changes that occur as people grow older

Erikson's final psychosocial stage

Ego Integrity vs Despair

Ego Integrity

Feeling whole, satisfied and accepting of one's life and approaching death

Characteristics of Ego Integrity

Serenity, contentment, fulfillment, wisdom and acceptance of death

Despair

Feeling life was wasted, filled with regret and fearing death

Characteristics of Despair

Bitterness, anger, regret, contempt for others and fear of death

Successful aging according to Erikson

Achievement of Ego Integrity

Peck's contribution to aging

Expanded Erikson's theory with three developmental tasks of old age

Ego differentiation vs work-role preoccupation

Finding self-worth beyond career and occupational roles

Body transcendence vs body preoccupation

Focusing on abilities and achievements instead of physical decline

Ego transcendence vs ego preoccupation

Focusing on future generations and legacy rather than oneself

Mnemonic for Peck's tasks

Work → Body → Legacy

Active Aging (WHO)

Optimizing opportunities for health, participation and security to enhance quality of life as people age

Three pillars of Active Aging

Health, Participation and Security

Optimism

Positive outlook that promotes resilience and wellbeing in older adults

Self-efficacy

Belief in one's ability to manage challenges and life situations

SES (Socioeconomic Status)

Higher SES is associated with better health, resources and wellbeing

Nutrition

Supports physical health, disease prevention and healthy aging

Exercise

Maintains physical function, independence and overall health

Social engagement

One of the strongest predictors of healthy aging and wellbeing

Benefits of social engagement

Reduced loneliness, depression and better mental and physical health

Friendships in late adulthood

Older adults tend to maintain fewer but closer friendships

Functions of friendships in old age

Provide intimacy, companionship, acceptance, community connection and support during loss

Relationship with adult children

Strongly influences physical and mental health of elderly parents

Support flow in aging families

Support increasingly flows from adult children to aging parents

Closest parent-child relationship in old age

Often the mother-daughter relationship

Benefits of grandchildren

Provide emotional support, purpose and a wider support network

Characteristics of successful aging

Positive outlook, social engagement, purpose, adaptation and acceptance

Thanatology

The scientific study of death and dying

Phases of dying

Agonal Phase → Clinical Death → Mortality

Agonal Phase

Initial stage when the body can no longer adequately support life

Clinical Death

Heart, breathing and brain activity stop but resuscitation may still be possible

Mortality (Biological Death)

Permanent and irreversible death

Brain Death

Irreversible cessation of all brain and brainstem activity

Persistent Vegetative State (PVS)

Loss of cerebral cortex activity while brainstem function remains

Death with dignity

Respectful, compassionate care that allows informed end-of-life decisions

Key principles of death with dignity

Support, compassion, respect, honesty and informed choice

Factors influencing thoughts about dying

Cause of death, personality, coping style, family behaviour, healthcare providers, spirituality and culture

Principles of communicating with dying people

Be truthful, listen actively, acknowledge feelings and maintain realistic hope

Most preferred place of death

Home, provided adequate caregiver support exists

Hospice care

Comprehensive support focusing on comfort and quality of life rather than cure

Key features of hospice care

Palliative care, family support, team care, home-like environment and bereavement support

Palliative care

Care aimed at comfort and symptom relief rather than curing disease

Voluntary passive euthanasia

Withdrawal or withholding of life-sustaining treatment

Voluntary active euthanasia

Direct action to end life at the patient's request

Assisted suicide

Providing means for a patient to end their own life

Advance medical directive

Legal document outlining a person's healthcare wishes when they can no longer decide

Living will

Document specifying preferred medical treatment at end of life

Grief

Emotional response to loss

Bereavement

State of having lost someone through death

Mourning

Social and cultural expression of grief

Kübler-Ross Five Stages of Grief

Denial, Anger, Bargaining, Depression and Acceptance

Denial

Refusal or difficulty accepting the reality of loss

Anger

Feelings of frustration, resentment and questioning why the loss occurred

Bargaining

Attempting to negotiate or imagine ways the loss could have been prevented

Depression

Profound sadness and emotional pain resulting from the loss

Acceptance

Acknowledgement of reality and adaptation to life after loss

Limitation of Kübler-Ross theory

Stages are not universal, not sequential and are best viewed as coping strategies

Worden's Four Tasks of Grieving

Accept the reality, process the pain, adjust to absence and maintain connection while moving forward

Task 1 of Worden's model

Accept the reality of the loss

Task 2 of Worden's model

Process the pain of grief

Task 3 of Worden's model

Adjust to a world without the deceased

Task 4 of Worden's model

Maintain a lasting connection while continuing life

Dual Process Model of Grief

Alternating between confronting loss and adapting to life changes

Loss-oriented coping

Focusing on emotions, memories and pain associated with loss

Restoration-oriented coping

Managing life changes and adapting to new roles after loss

Three phases of grief process

Avoidance → Confrontation → Restoration

Avoidance phase

Shock, numbness and emotional anesthesia immediately following loss

Confrontation phase

Most intense period of emotional grief and distress

Restoration phase

Gradual rebuilding of life and adjustment after loss

Sudden death

Often associated with shock, disbelief and difficulty understanding reasons for the death

Prolonged death

Often allows anticipatory grieving and emotional preparation

Anticipatory grief

Grieving that begins before an expected death occurs

Difficult grief situations

Loss of a child, loss of a parent, loss of a spouse and bereavement overload

Bereavement overload

Experiencing multiple significant losses within a short period

General bereavement support

Sympathy, understanding, listening and being present

Grief intervention examples

Support groups, counselling and assistance with daily living

Resolving grief

Allow emotions, seek support, remember the deceased and gradually re-engage with life

Asian perspective on grief (Sophie Woo, 2017)

Healing is facilitated by time and space for emotional expression

Two crucial factors in healing grief

Time and emotional expression

Widowhood

One of the most stressful life events and often associated with loneliness and adjustment difficulties

Sources of support for widowed individuals

Family, friends, support groups, religious activities and volunteer work

Never-married childless older adults

Often develop meaningful relationships with friends, relatives and younger generations to maintain support and connection