Studied by 10 people
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
Denial: don't feel terminally ill
carols 3 stages of denial
Anger: goes up and down
Bargaining: deals/reaching out to higher being
Depression
reactive repression
preparatory depression
Acceptance: no longer struggling
carols 3 types of denial
absolute denial: no way they're terminally ill
fluctuating denial: tells different people different stories on how they feel
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
sudden death
terminal illness
organ failure (COPD, CHF)
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
hospital: (75%)
In-home care
Hospice care
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
everyone who suffers severe loss will be distraught and probably depressed
people who do not show such distress will have psychological problems
Every grieving person has to work through loss by focusing and trying to get better
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:
cognitive component- life satisfaction is a cognitive appraisal
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
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