aging mid 4

thanatologists

researchers in field of death and dying

where did people used to die in comparison to now

- people typically died in their home with their family, making death less scary
- now 75% + of death occur isolated in the hospital - much scarier

young kids understanding of death before 5

- don't understand death and think it is temporary, like sleeping
- see death as a way of punishment for doing something bad - blame selves

problems with telling children that someone who has died is just sleeping

misunderstandings may have emotional consequences
- think its their fault
- may fear going to sleep once realize grandma isn't waking up

adolescence perception of death

personal and fable: beliefs that they are unique and special, lead to a sense of invulnerability
- reason adolescence is at such high risk for fatal car accidents

young adult perception of death

personal fable
- mad at everyone if become terminally ill during a peak point in your life

perception of death in middle adulthood

death anxiety peaks
- start to lose more people around them, have more health risks, anxiety

perception/reaction to death in late adulthood

more pre-occupied with thoughts of death, but less afraid of death - more accepting

advantages of knowing you have a terminal illness

- can complete plans or projects - things you wanna do before death
- can make arrangements for family - best way to make sure your wishes are met
- can make amends: go out with clean conscious and peace
- can live out the rest of their lives

disadvantages to knowing you are terminally ill

- depression/fear of unknown
- can alter how others treat you: pity

Elizebeth Keubler-Ross

- one of first thanatologist
- considered self a old country doctor
- would talk to terminally ill patients in middle of night because thats when they wanted to talk
- wrote book of death and dying
- created stages of being diagnosed with terminal illness

Elizabeth's stages of being diagnosed with a terminal illness

1. Denial: don't feel terminally ill
- carols 3 stages of denial
2. Anger: goes up and down
3. Bargaining: deals/reaching out to higher being
4. Depression
- reactive repression
- preparatory depression
5. Acceptance: no longer struggling

carols 3 types of denial

1. absolute denial: no way they're terminally ill
2. fluctuating denial: tells different people different stories on how they feel
3. modified denial: know something is wrong but not worried because they'll get better

preparatory depression

depressed about an event that has not occurred yet, and that you don't know when will happen
- lingering feeling

reactive depression

depressed in reaction to something that has occurred

criticism of stages of terminal illness diagnoses

people don't like stages, made it seem like they were universal for all - sequence may vary and some people don't experience any stages or experience 2 stages at once

E. Mansell Pattison life phases

- Birth: on potential death trajectory
- Crisis: knowledge of death/terminal illness
- Acute crisis: learning about the illness
- Chronic living/dying: trying to live out days - deal with looniness and thoughts of afterlife
- terminal: withdrawal from life events in final days and let go

what life phase has peak anxiety

crisis phase

4 death trajectories

1. sudden death
2. terminal illness
3. organ failure (COPD, CHF)
4. frailty (Alzheimer's)

the experience of dying

- sensation/perception diminishes
- peripheral circulation fails
- often conscious till very end
- spiritual needs arise

how does sensation and perception diminish

- extremities go first, sense of touch diminishes, hand and feet may turn blue
- can still feel pressure (hand squeeze)
- orient to light source

how does peripheral circulation fail

- body covered in sweat when cooling off
- sweat even when body is cold & don't feel as cold as there body is
- lips will turn blue and they won't feel the cold

what do w mean by spiritual needs arise

- in the evening especially dying people want to speak tot there spiritual leader of their spiritual orientation before they die

why is hard to define death

definition varies depending on jurisdiction

types of death

- Function/biological death
- Cellular death
- Brain death
- psychological death
- social death

function/biological death

body ceases to function
can be resurrected
still have brain function for 10-15 mins after

cellular death

muscles contract (rigor mortis)

brain death

- Flat EEG across all 4
- sometimes lower part of the brain is still there (in control of heart) , but top of brain is gone
- cannot be brought back

psychological death

your feelings about dying and how it will affect those around you

social death

attitudes towards death and dying, caring of the dying , mourning

death definition from the law reform commission of Canada

death is the irreversible cessation of brain function that can be determined by the prolonged absence of spontaneous cardiac and respiratory functions

death definition - NS legislature 2019

irreversible loss of the brains ability to control an coordinate the organisms critical functions

most common places death

1. hospital: (75%)
2. In-home care
3. Hospice care
4. palliative care

process of being in hospital to receive life-prolonging care

- diagnosis
- treatment
- decompensation
- dying

bereavement

adjusting to the loss of a loved one

grief

emotions felt in reaction to death
- high emotion in early stages of bereavement

mourning

culturally approved behaviours surrounding death

common themes in grief

shock and disbelief
pre occupation with thoughts of loved one
resolution
lightning bold approach

shock and disbelief

feeling can come and go - worse at 3 months
often think if death is expected it hurts less, which is not the case

pre-occupation with thoughts of loved one

experiencing loss, crying, insomnia, fatigue, go places that remind them of loved one

resolution

about a year after, start to feel a little better because they have lived every day for a year without person and survived so they can do it again (not same for everyone)

lightning bolt approach

feel better, then feel crappy due to events like anniversaries, birthdays
ups and downs, gets better as it goes on

common myths in grief

1. everyone who suffers severe loss will be distraught and probably depressed
2. people who do not show such distress will have psychological problems
3. Every grieving person has to work through loss by focusing and trying to get better
4. everyone will eventually accept the loss intellectually and emotionally

living will

not a legal term in Canada
varies by province
Nb: power of attorney for personal care

power if attorney for personal care

written instruction for medical care should you be unable to speak for yourself
- NOT the same as "last will ad estimate"

last will and estimate

deals with property - executor will oversee this upon your death

in home care

an alternative to the hospital, people stay in their homes and receive comfort and treatment from their families and visiting medical staff

hospice care

care provided for the dying in institutions devoted to those who are terminally ill and in their final day
- not trying to cure patient, trying to make there last days as plesant, meaningful and pain free as possible

death ethos

our attitudes towards death and dying
prevailing philosophy of death and dying
- can be inferred from funeral rituals, treatment of the dying, belief in afterlife and ghosts, social conventions, representation of death

western attitudes towards dying in the middle ages

tamed death
knew what to expect

western attitudes towards death 18 hundreds

beautiful death
if you died for a cause it was seen as noble

western attitudes towards death in 20th century

invisible death
moved out of home into hospital to die

western attitudes towards dying in 21s century

focus on end of life care and a good death

Medical assistance and dying (MAiD)

Bill C-14, 2016
- eligible for healthcare in Canada
- minimum 18 years old, under 18 go before courts
- grievous or remediable medical conditions
- voluntary request
- informed consent after being counselled on other options
- informed consent again within the 10 days prior to death
- May administer final dose to self or have nurse practitioner

final dose in medical assisted dying

most prefer for nurse practitioner to do it
takes less than 2 minutes after dose

average age of people who use medical assisted dying in Canada and for what reason

age 72
majority due to cancer

how many people requested and got medically assisted dying and how many were self administered

6700
6 self administered

Carter vs Canada

challenged rights in charter
argued not having medical assisted dying went against/denied the right to life

crude death rate

the number of deaths during a given year per 100,000 population as of July 1st of the same year

age specific death rate

the number of deaths in a particular age group during a given year per 100,000 population in the same age group as of July 1 of same year

age standardized death rate

the number of deaths per 100,000 population that would have occurred in a given area in the age structure of the population of that area was the same as that of a specified standard population

successful aging - Row and Kahn model

absence of disease or disability
active engagement with life
high physical and cognitive capacity

what does active engagement with life mean

are able to do all the activities of daily living and instrumental activities of daily living

criticisms of row and Kahns model

overly normative
not inclusive of those who fail to meet all criteria, doesn't take into account sociocultural status, doesn't take into account subjective meanings by older adults

active aging - new model of successful aging

gender: inequality
culture
health and social services
behavioural determinants - quitting smoking to improve health
personal determinants - genetic factors - intelligence
physical environments - safe
social determinants - free from abuse
economic determinants - having proper pensions

social determinants

where did active aging model come from

felt that successful aging was too restrictive, active aging is more inclusive

UCSD-WHI study of successful aging

study of 2000 woman aged 60-89, who were reinterviewed 7 years after first interview
asked the woman how they defined successful aging and if they had aged successfully

woman highest in self rated successful aging had

- scores high on resilience, optimism, self-efficiency - coping well with what life throws at them
- low scores on depression and self reported emotional symptoms
- low on ratings of physical symptoms
- no difference in cognitive symptoms
- high sexual satisfaction - though not necessarily sexually activity

what is different in the UCSD-WHI and other studies of successful aging

no difference in cognitive symptoms
unlike most stereotypes that people have about older adults, most older adults are able to preserve their cognitive ability

subjective well being model

subjective well being:
1. cognitive component- life satisfaction is a cognitive appraisal
2. affective component - positive affect - negative affect

cognative component

what we THINK about something

affective component

how we FEEL about something

3 important successful aging models

social indicator model
paradox of well being
set point perspective

social indicator model

- Older adults have less and so they should be unhappier
- older adults generally have… so they should be unhappy

paradox well being

- older adults are able to overcome objective circumstances
- older adults generally have… and have overcame it so they are happy

set point perspective

- personality determines life satisfaction
- less neuroticism = less life satisfaction
- unhappy tend to die earlier due to risker behaviour

which of the 3 models is the best

paradox of well being