AGNG 313 Final Exam

Good Grief:

the world death rate is holding steady

at a hundred percent the onion is a

satirical journal so it's their job to

make fun of us as we try to hide from

mortality what would happen if we turn

toward loss instead of running from it

what if grief has something to teach us

in 2008 my husband and best friend died

Vic was my harbour and safety net so

what did I learn from that loss to

answer that question I have to go way

back to my first childhood memory I was

small I stood near my mother who was

lying face down on a wooden bench

her eyes were hidden in her hands but I

could tell she was crying because her

back was heaving up and down her sobs

scared me but I didn't call out to her

instead I was captivated by rays of

coloured light coming from above dancing

off the walls and filling the space soft

color covered my mother's back my little

arms everything I didn't understand the

experience then and I don't understand

it conceptually now but I felt protected

by that light and even as a child I knew

my mother couldn't feel the protection

because her face was turned away from it

I learned as an adult that I'd been

under three when that happened my father

was in a Catholic hospital and he was

expected to die my mother had taken me

with her to the hospital chapel so the

light came from stained-glass windows

and the wooden bench was a

pyew knowing the facts about the

experience didn't change its power I

trusted that support was available

during grief if I looked for it

my father didn't die at the time he

lived eleven more years always ill after

his death when I was 14 my mother felt

completely unsupported and was afraid

she would drown in grief so she

retreated she went to work came home and

went into her bedroom although she loved

my father she didn't weep for him and

she didn't speak about him and didn't

want me to speak about him either while

he was lost to death she was lost to

life when I returned to school no one

mentioned what had happened to me and

after we buried my dad the family never

returned to the cemetery of course I

felt distant from my mother and isolated

from everyone

my father's empty chair at the dining

room table left a huge hole in my heart

eight years ago after months of a

lingering flu an oncologist told my

husband Vic you likely have lymphoma I

don't know what kind Vic and I sat in

the in our car in the parking lot

stunned by this news let's not tell

anyone Vic said maybe it'll be nothing

we don't want to worry people over

nothing I took that in and I turned to

him and I said Vic I don't want to do

this alone the way my mother did I need

our sons and our friends

I need all the support I can get I think

you do too

we agreed but I saw how tempting it is

to hide our grief wounds and try to go

it alone Vic died after two tough years

a friend took this photo just a few

hours before his death after that last

exhalation

there was no inhalation the end I was

numb and exhausted but this time I faced

grief rather than running from it I knew

it could be my teacher and I turned

where humans have always turned in times

of challenging transition

I turned to ritual it's human to create

meaningful ritual anthropologists know

they've discovered civilization when

they find signs of ritual at ancient

burial sites we ritualize weddings and

baby showers baptisms and funerals we

create rites of passage to connect our

worldly and our sacred life to move us

from where we are to where we must go I

needed to move from the safety of my

marriage through a vast ocean of grief

to find the woman I am on my own

personal ritual helped me make that

journey I knew I needed to accept that

Vic soul have left his body now I'd been

there for his last breath but there's

something surreal about death for those

of us who art around it much modern

people keep a distance from death and

hand it over to hospitals and morticians

we don't wash bodies and lay them out at

home the way people did just a hundred

years ago

Vick died soon after midnight friends

and I sat with him until morning light

then I washed his body with warm water

and my tears and I helped shroud him

wrapping and tucking as though he were a

baby I helped put his body in a body bag

and I watched as a young man wheeled and

down the hallway toward the hospital

morgue I needed to let him go

I knew that wouldn't be a fast process

it would take a long time but I could at

least set the intention so the day after

his death I went with a good friend and

my oldest son to the crematorium where

Vic's body was being held and to the

funeral home until his body was being

held for cremation we lined the

cremation box with white soft blanket

and we put photographs of his students

his teachers his friends and his family

in the box we surrounded him with

flowers and written prayers because it's

important to stay awake in the after

death experience in many traditions we

put coffee beans in his cremation box

had he made us laugh and weep and we

also put bittersweet chocolate in there

and a box of his favorite shape of pasta

I didn't think he'd be hungry it was

symbolic the way ritual is I didn't even

know if it mattered to him but it

mattered to me

picture this my son put two Hawk

feathers behind his dad's ears and we

covered it with another soft blanket

close the lid of the cremation box and

wrote a prayer on top we had created a

traveling cocoon I knew it would help if

I had a sacred place to soothe my grief

they could ask to have his ashes put

near his favorite red oak tree in our

forest so I thought we'd just scatter

them there but my sons had a much better

idea they dragged large shale and

granite stones out of our creek bed to

the site and they dug a shallow hole I

walked out to the woods carrying a small

cardboard box I'd received from the

crematorium I opened it for the first

time and pulled out a plastic bag of

about a quart and a half of rough ash

the color of yellow teeth

is that all that's left my youngest son

yelled what a ripoff

and we all started laughing Vic wouldn't

love that joke we put his ashes in the

earth and we built a cairn on top and

then we sang songs and said prayers and

recited favorite poems and we told many

stories about Vic that made us weep and

even more stories that made us laugh

there had been a private memorial

service I'm sorry there'd been a

community memorial service just a few

days after his death but this small

private family ritual a few months later

gave me a sacred place surrounded by

natural beauty I still eight years sorry

six years later I still walked

the Karen under the red oak tree with

the intention of leaving a little sorrow

behind I want to leave you with three

things I've learned from loss I am NOT

in charge of course I never was but when

I stood at the threshold of death I felt

something vast and unknowable so far

beyond my ordinary sense of self opening

to that mystery was humbling it made me

a little wiser and a little more

realistic about our precarious human

situation love and grief are a package

deal think of a movie or a song or a

book that really sticks with you chances

are it's about love and also about

sorrow love ends in loss for the ones

left behind and grief is a natural

response to losing what we've cherished

when I pause to remember someone I've

lost grief is right there but so is love

ritual soothes and heals more than I

ever could have imagined when I couldn't

stand my heartache one more minute I

took my grief for a walk in nature and

visited the cairn under the red oak tree

I often left flowers there I usually

left tears

I always felt better you likely already

create personal ritual in your life even

if you don't call it that

at a recent bereavement group a woman

told me I have a photo of my husband in

my bedroom and I put flowers there and

recently I put his cell phone there and

I'm embarrassed to say it made me feel

better

you created a

personal ritual I told her cell phones

contain our net our personal history and

it turns out many people in the

bereavement group were attached to their

spouses cell phones cell phones have

voices photographs calendars contacts

there are perfect modern momento a

funeral ritual marks the beginning of

the grieving process but grief doesn't

last just a few days we can keep

creating personal rituals for ourselves

as long as we want to as long as they

help us three grieving mothers in

Atlanta created the Atlanta walk to

remember to honor their three infants

who had died ten years later hundreds of

people walk with them to remember lost

children so a small personal ritual

became a healing community ritual I

committed to writing every day after

Vick was diagnosed with cancer because I

wanted to remember what was happening to

us after his death I continued writing

because my daily practice had become a

healing personal ritual years later my

journals led to articles blogs and

eventually a book so my small personal

ritual led me to a whole new life as a

writer

humans create ritual spontaneously and

naturally our rituals can be as small as

a 30-second pause to remember someone

we've lost or as elaborate as a

Hollywood funeral in shared ritual we

dare to show our grief wounds to each

other even if it's our habit to hide

them grief opens our hearts binds us

together

and makes us grateful for each other

through ritual our grief becomes

entwined in love grief is a wound but

it's also an opportunity as the

thirteenth century poet Rilke says the

wound is the place where the light

enters you

you

Dimensions of Wellness website:

While the definition of wellness continues to expand and evolve, ICAA defines it as follows:

Wellness is derived from our ability to understand, accept and act upon our capacity to lead a purpose-filled and engaged life. In doing so, we can embrace our potential (physical, emotional, spiritual, intellectual, social, environmental, vocational) to pursue and optimize life’s possibilities.

The wellness dimensions overlap and coordinate to provide rich environments for living. Wellness becomes a framework that is valuable for serving the wants and needs of a person engaged in life.

Emotional

Feelings are the lens through which people view the world, and the ability to be aware of and direct one’s feelings helps to create balance in life. Coping with challenges and behaving in trustworthy and respectful ways signal emotional wellness, attributes that can be encouraged through peer counseling, stress management, humor/laughter and personal histories.

Intellectual, cognitive

Engaging in creative pursuits and intellectually stimulating activities is a proven approach to keeping minds alert and interested. There are many ways to stay intellectually active, including taking college courses, journaling, painting or joining a theater company, and challenging oneself with games and puzzles.

Physical

The goal of living independently is one shared by many people, and physical wellness is necessary to achieve this. Lifestyle choices that can maintain or improve health and functional ability include engaging in physical activity, choosing healthy foods with adequate nutrition, getting adequate sleep, managing stress, limiting alcohol intake, not smoking, making appointments for check-ups and following medical recommendations.

Professional, vocational

Work that utilizes a person’s skills while providing personal satisfaction is valuable for society as well as the individual. Participating in the paid and unpaid workforce means maintaining or improving skills, and helping others. Older adults contribute to society as experienced professionals, caregiver, mentors, teachers and volunteers. Leisure-time vocations in the arts and through hobbies maintain vocational skills.

Social

Social interactions with family, friends, neighbors and chosen peer groups can be valuable for maintaining health. Personal contact by joining clubs, traveling, visiting friends and family, engaging in intergenerational experiences like making quilts with a elementary school children is beneficial for everyone who it touched.

Spiritual

Living with meaning and purpose in life, guided by personal values, is key to feelings of well-being and connection to the larger world. Group and individual faith-based activities, personal meditation, mindful exercise (yoga, tai chi) and experiencing nature can create the opportunity for spiritual growth.

Environmental

Surrounded by natural and man-made environments, good stewardship means respecting resources by choosing “green” processes that re-use and recycle goods. It also means looking at ways to bring people into the natural environment and encourage active living through urban and property designs emphasizing walking paths, meditation and vegetable gardens and similar options.

CHAPTER 7:

Chapter Seven,

Part One

Work,

Retirement, and

Leisure

DIVERSITY AND AGING

313

KAREN FAZIO, MSG

Gender and

Ethnic  Over the next two decades, the number of older workers will grow

Differences in and make-up a significant proportion of the workforce.

the Older  In 2000, 18.7 million people over age 55 were in the labor force.

Workforce  In 2010, the number increased to 30 million.

 It is estimated in 2020 that the number is 41.4 million workers

over age 55.

 Both, men and women are remaining in the workforce longer.

 In 1940, the typical retirement age was 70.

 Due to wealth, social security, and defined benefit retirement

plans, that age decreased to 62 in 1985.

 This trend switched in the later 1980s.

 Historically, public policy encouraged people over the age

Social of 65 not to work, which made room for younger workers.

Security  There were incentives for early retirement.

Benefits  Incentives have now been removed,

 Incentives now are to hold off collecting SS benefits.

 Older workers are encouraged to delay retirement.

 Full retirement age is now 67, not 65.

 In addition, mandatory retirement for most occupations is

now eliminated due the Age Discrimination in Employment

Act.

 Most people have health insurance coverage through their

Health place of employment.

Insurance  If a person retires before they are eligible for Medicare,

they must buy health insurance on their own.

 This is expensive and often not as comprehensive as a plan

through an employer.

 Many people wait to retire in order to keep their health

insurance plan.

 Traditional defined benefit plans are also not as common.

Concerns  Only 21% of Americans are very confident they will have

about enough money to retire comfortably.

Available  Investing also become riskier as one gets older.

 Many older women have paid in less to social security and

Resources other retirement plans due to breaks in their careers for

childcare, caring for parents and in-laws, leaving their job

for husband’s job relocation.

 Paying in less means less to collect in retirement and as a

result, single women and minorities remain in the

workforce longer.

Attitudes  Baby Boomers report that they plan to work past

traditional retirement.

Toward  There is a cultural shift in the way that people retire.

Work and  Work provides opportunities for social interaction and

emotional support.

Leisure  It allows them to pass on knowledge to younger workers

(generativity).

 Among Hispanics, especially women, are more likely than

non-Hispanic men to report they enjoy their work.

 Working past retirement age is not always for financial

reasons, but for engagement, passion, interest, and

satisfaction.

Health of the

Older

Population  There are a number of indicators that show today’s older

adults are healthier.

 There are declining disability rates.

 More men and women are working in their sixties.

 Those who work in physically demanding jobs are normally

the first to retire.

Educational

 Between 2000 and 2010 the percentage of men and

Background women who by age 60-64 had attained their bachelor’s or

graduate degree increased from26% to 37% for men and

18% to 30% for women.

 This leads to more “white collar jobs” and longer working

years.

 College degrees varied by race.

Gender

Differences

 Women, on average, earn less than men which reduces

social security and retirement benefits.

 In 2013, women earned 78% of what a man earned. 78

cents for every dollar.

 Each generation of women has done better than the last.

Ethnicity and  Women age 55+ in the workforce, regardless of

race/ethnicity, is increasing.

Labor Force

 Older men in every group is also increasing.

Participation

 As men and women age , their numbers in the labor force

decline.

 In comparison with other groups, Asian women participate

in the workforce less than Asian men.

 In the 65-69 age group, each ethnic group, participation in

the workforce has been increasing, but is less than the 60-

64 age group.

Chapter

Seven, Part

Two

Work,

Retirement,

and Leisure

DIVERSITY AND AGING

313

KAREN FAZIO, MSG

 Table 7.3 Educational Attainment

Educational  Level of education and English

proficiency influences the type of work a

Attainment person does.

The most common occupations for these

and the 

groups include physical labor: farm

Workforce workers, janitors, cleaners, gardeners,

construction work, etc.

 In 2013, fatal and non-fatal work injuries were

highest among Hispanics.

 Language barriers among supervisors and workers

is an issue, especially for training purposes.

Work  Many immigrants who fear deportation do not

report unsafe working conditions.

Injuries  The most frequent type of fatal injuries were

transportation incidents, followed by assaults and

violent acts, contact with equipment or objects,

and falls.

 Among all ethnic groups, the likelihood of having a

fatal work injury increases with age.

 Age prejudice (ageism) is one of the most

socially acceptable forms of prejudice in the

United States.

 Older workers are discriminated against

through false poor performance evaluations,

Age refusing to hire or promote older workers,

encouraging retirement, limiting an older

Discrimination worker's access to job-related education.

 Despite legislation that protects older people

from discrimination, it is the fastest growing

form of dismissal litigation.

 The law requires employers to make

reasonable accommodations for

workers with physical or mental

disabilities, who are otherwise qualified

and do not pose an undue hardship on

Discrimination the operation of the business.

 Accommodations include:

against those  Accessibility

with  Modifying work schedules, reassignment

to a different work position

Disabilities  Acquiring or modifying equipment,

examinations, training material, policies,

or providing qualified readers or

interpreters.

Discrimination  In recent years there have been new

developments in regard to protecting an LGBT

Based on person’s employment rights.

Sexual  In 1998, President Bill Clinton signed an Executive

Order that prohibits discrimination n the federal

Orientation government based on sexual orientation.

 In 2014, President Obama added gender identity.

 Twenty-one states and DC have enacted laws that

prohibit discrimination for sexual orientation.

 18 states and DC for gender identity.

 Many large companies provide equal rights and

benefits to their LGBT workers.

 FRD occurs when an employee is unfairly

penalized at work due to their family

obligations for providing care.

 There are some laws that protect against

this:

Family  An employer may not refuse to hire a

Responsibilities person because they have a disabled

child.

Discrimination  Men and women both make take leave

for caregiving

 An employer may not refuse to promote

a mother.

Diverse

Retirement  Women and other minorities may have an

intermittent work history which impacts their

Patterns ability to retire.

 Sources of retirement are often referred to as

the three-legged-stool: Social Security,

pensions, and savings and investments.

 Many women and minorities only have social

security to live on.

Diverse

Retirement

Patterns  Phased Retirement – Full-time workers moving

to part-time or retire and do something else.

 Bridge Jobs - Changing jobs or restructuring

work to bridge into retirement.

 Some people will start their own business or do

what they have always wanted to do.

Retirement  Planning for retirement is about more than money, it is also

about preparing oneself psychologically.

Planning

 Key objectives to sound retirement planning include:

Programs

 General financial, psychological, and health information.

 To help participants understand the value of retirement

benefits.

 To motivate participants to plan.

 To reduce anxiety.

 To help people identity their desired lifestyle for retirement.

 It is critical for retirement planning programs to be inclusive

of diverse populaitons.

 Retirement is a major life transition and

includes aspects of an individual’s life,

their self-identity, self-worth, relationships,

financial status, and daily activities.

Adjustment to  Planning helps people prepare and

Retirement adjust to the change in lifestyle.

 The reason a person is retiring is an

important consideration, as well: natural,

for health reasons, to take care of a

family member, etc.

Leisure  An older adult’s leisure activities depend

upon SES.

Activities  High income older adults are more active in

leisure pursuits than low-income individuals.

 Health, transportation, and cost of activities

are barriers.

 Older men tend to perform household

maintenance, paid work outside the home.

 Women tend to do housework, childcare,and

volunteer work.

 Senior centers provide congregate

meals, home-delivered meals, exercise,

information and assistance,

socializing,and transportation.

 Some have had limited success due to

poor health, seniors are busy elsewhere,

Senior Centers lack of interest, they may not want to be

with other older people, lack of

participation of men make other men

resistant.

 Senior centers also need to be culturally

competent and adjust to their changing

communities.

 The most popular form leisure involvement is

volunteering.

Volunteering  Reasons for volunteering vary from wanting to

meet people to wanting to remain active.

 The Experience Corps, an evidence-based

program in which older adults, including

minorities and low-income seniors volunteer at

high intensity.

 For example, many provide 15 hours per week

helping school age children in areas of

reading and math.

 Some provide tutoring.

 Studies show that both, children and seniors

benefit.

Religious

Participation  Many elders form of leisure activity involves

religious or spiritual practices.

 This allows people to volunteer, engage with

others, uplift the community, as well as

themselves.

Lifelong  Lifelong learning has been changing.

Some older adults seek formal education to change

Learning



careers in order to move into more fulfilling and

meaningful work.

 Participation in education allows older learners to

attend to a deeper search for understanding,

meaning, and purpose stimulated by advancing

years.

 Lifelong learning helps people transition and to face

challenges related to retirement, loss of

spouse/partner, declining health and strength.

 We need to better develop these opportunities to

make them accessible to every member of the

community.

CHAPTER 8:
Chapter Eight, Part One

Religious Affiliation and Spirituality

Diversity and Aging – 313

Karen Fazio, MSG

• Religion is generally defined as a formal system of belief in God

or another being.

Defining • Refers to efforts aimed at relating the human to the divine.

• Religiousness has specific behavioral, social, doctrinal, and

Spirituality denominational characteristics because it involves a system of

worship and doctrine shared within a group.

and Religion • Spirituality pertains to one's inner resources, especially one’s

ultimate concern, basic values around which all other values are

focused and the central philosophy of life—religious,

nonreligious, or antireligious-- that guides daily life.

• May pertain to the supernatural and nonmaterial dimensions of

human nature.

• Refers to the way a person seeks, finds, creates, uses, expands

personal meaning in the context of the universe.

• Spirituality is the human’s drive for meaning and purpose.

Religion, Spirituality, and Aging

• In recent years, research on the topic of aging and religion/spirituality has expanded, due

to the its correlation with health.

• Research shows that older adults who are religious or have some sort of spiritual

framework in their lives enjoy better mental and physical health.

• Quantitative Methods – See Table 8.1 for a multidimensional approach to measure

religion/spirituality.

• Qualitative Methods – “Gives voice,” Ex. Focus groups, interviews – collect narratives about

how rl/sp is practiced or experienced.

Diversity and Religious Practice

• Among African Americans, religion is important and plays a key

role in safeguarding health and wellbeing.

• The oldest old are most likely to describe themselves as

religious.

• A survey of African American congregations found that a

variety of services are offered:

• Basic needs assistance

• Financial services, low-income housing

• Counseling and intervention

• Education and awareness – child-care, life skills, tutoring

• Health related activities – HIV/AIDS, substance abuse, counseling

• Recreation and fellowship

Diversity and Religious Practice

• Among Hispanics, religious and spiritual practice is diverse and

affected by cultural traditions and values.

• Older Hispanics are more likely to attend weekly religious services

than younger counterparts and use religious organizations as a

source of assistance.

• Fe is a concept that incorporates varying degrees of faith,

spirituality, hope, cultural values and beliefs.

• Fe represents a way of being, of living, imagining.

• It is a coping mechanism designed to help people maintain a

positive attitude.

• Native Americans have no word in their

language for religion—it is integrated into

who they are—a way of life—there is no

separation.

• Expression is diverse among tribes.

Diversity and • God is a universal force, often called Great

Spirit or Spirit.

Religious • Walk in a sacred way is encouraged as a

Practice way of life.

• Oral traditions and ceremonies are valued.

• Shamans have special ties to higher powers

for healing.

• Humor is part of the sacred way.

• The journey of life is a spiritual path.

Diversity and Religious Practice

• A common misperception is that LGBT are not religious or

spiritual—this is not true.

• While some religious organizations have rejected LGBT

participation, others are affirming. (Unitarian, Episcopalian,

and Reformed Judaism, for example).

• LGBT people report higher levels of spirituality.

• There is little research on the impact of spirituality and health

among LGBT people.

Diversity and Religious Practice

• Religious practice among rural elders is found

everywhere and plays a central role in day-to-day

life.

• Studies show that prayer, reading the Bible, and

church services are all used to manage health and

ultimately feel God is in control.

• In rural communities, there is variance across ethnic

groups.

Maslow’s Pyramid

Maslow spoke emphatically about the importance of dealing with life’s

vicissitudes from a growth mindset: that is, regarding stressful or

challenging situations as opportunities for growth rather than

retreating into passivity or pessimism. Especially in pivotal times, he

opined, people may face an important choice to make in this regard—

and discover inner wellsprings of strength that they hardly knew

existed.

The key to Maslow's writings is understanding that there

are no quick routes to self-actualization: rather it is

predicated on the individual having their lower

deficiency needs met. Once a person has moved through

feeling and believing that they are deficient, they

naturally seek to grow into who they are.

The Self-Actualizing Elder

• For those who have reached self actualization- the ability to reach

one’s full potential or to actualize, aging is much more positive.

• Those who have satisfied all the lower levels in Maslow’s hierarchy of

needs may focus solely on things like creativity, purpose and

happiness.

• These individuals are characterized by having philosophies and

positive mental health about themselves.

• The self-actualized see the process of aging as normal and therefore

have a more meaningful and positive quality of life.

The Self-Actualizing Elder

• S.A. individuals are completely satisfied and content with their past.

• They accept themselves for what they are, and those around them as

well. They do not have self-conscious problems and are able to live

their lives free of guilt.

• The self-actualized elder is realistic about their future and are not

controlled by the fear of the unknown.

• These people are not swayed by the opinions of others and are

product of their own personal beliefs and ideas.

• It is because they have such a strong foundation about who they are,

that other minor problems they face in life do not phase them.

The Self-Actualizing Elder

• Those who have aged and have self-actualized are eager to pass

down their knowledge and personal philosophies to the next

generation.

• They have lived a life of significance and full of meaning and

want to share it with their community.

• The self-actualized are proud of their accomplishments and still

want to make a difference in the world today. These are the

people that are actively involved with their community, charities

or any sort of global awareness organization.

Chapter Eight,

Part Two

Religious

Affiliation and

Spirituality

Diversity and Aging – 313

Karen Fazio, MSG

This Photo by Unknown Author is licensed under CC BY-SA

Religious Traditions and Asian Americans

• “Asian Americans” represents an

example of combining diverse groups

under one label.

• This group includes 26 Census-defined

subethnic groups.

• Religious traditions and beliefs focus on

views about birth, life, and death.

• These views influence how older people

contribute to society, how they create

personal meaning, how they are treated

by the young, and how they approach

death.

• Our text covers Muslim, Hindu, and

Buddhist traditions.

Muslims in the U.S.

• The Qur’an regards the loss of capacities in old age as

obvious evidence of universal frailty and dependence that is

an inevitable condition of human beings.

• It is the nature of all human life.

• Everything that lives has its stated term and so has human

life.

• It is assumed that old age brings wisdom and maturity.

• Regardless of condition, older adults are treated with

respect.

• Most are cared for in the home and it is considered a blessing

and an opportunity to grow spiritually.

• In the U.S. Muslims have immigrated from more than 60

nations, so it is important to remember diversity among

traditions and culture.

Stages of Life Model

• Student Stage, Householder

Stage, Retirement Stage,

Renunciation Stage.

• These stages are lived out in a

repetitive cycle of birth, death,

and rebirth.

• The belief that all beings is

determined by modes of action

over successive lifetimes

(reincarnation).

• Aging is a marker of life’s journey

• Aging as growth and maturity

• Aging as decline and loss

• Aging as an accomplice of death

Hindu Tradition (page 469)

• The term Buddha means enlightened

Buddhist Tradition or mentally awakened.

• The distinctive characteristics

include:

• All human beings suffer.

• Life is inherently unsatisfactory

and not worthy of attachment.

• Impermanence is a key principle.

• Value to personal understanding

• Meditation is the number one

reason for growth

• Nonviolence is a key principle

• The way to cease to desire is to

follow the Eightfold Path: right

belief, right intent, right speech,

right conduct/action, right

endeavor or livelihood, right

effort, right mindfulness, and

right meditation.

CHAPTER 9:
Chapter 9 Death, Dying

and Bereavement, Part

One

DIVERSITY AND AGING - 313

KAREN FAZIO, MSG

Changing the

Context of Dying

 In preindustrial societies, death rates were

high in childhood and youth, and parents

could expect as many as half of their children

to die before the age of 10.

 Most deaths now occur from chronic disease

over an extended time period.

 This means that it is increasingly the old who

die, making death a predictable event of age

and the completion of the life cycle.

 That said, in Western society, both aging and

death are often denied.

Beliefs About Life and Death

 Attitudes and practices surrounding dying,

death, and bereavement vary from culture

to culture and from subculture to subculture.

 Issues of loss, mortality, the meaning of life

and death are universal concerns.

 Religion plays a large role in one’s beliefs

about life and death.

 More insulated from death than in the past,

many Americans are uncomfortable

discussing it—especially the prospect of their

own death. This discomfort is shown even in

the euphemisms people use—sleep, pass

away, rest—instead of the word death itself.

 This avoidance of death fits well into the

biomedical model of health.

Stage Model of

Grief

 The stages of dying—one of the most widely known and

classic frameworks for understanding the dying

process—were advanced by Kübler-Ross (1969, 1981).

 Each stage represents a form of coping with the process

of death.

 Shock and denial

 Anger (“why me?”), resentment, and guilt

 Bargaining, such as trying to make a deal with God

 Depression and withdrawal from others

 Adjustment/acceptance.

 David Kessler added a sixth stage: finding

meaning after loss.

Stage Model of

Grief

 Although it is now generally agreed that there is no “typical,” unidirectional way to die through progressive

stages, Kübler-Ross’s controversial work was a pioneering catalyst.

 It increased public and professional awareness of death and the needs of the dying and their caregivers.

 Her work helped coalesce the growing awareness that both quality of care and quality of life were central to the

experience of dying and that dying individuals should have a voice in their care.

 Her framework can be a helpful guideline, not a fixed sequence that determines a “good death.”

 Another contribution was her emphasis on dying as a time of growth and profound spirituality.

 By accepting death’s inevitability, dying persons can live meaningfully and come to terms with who they really

are. Learning how to die helps us learn how to live.

 Because the dying are “our best teachers,” those who work with them can learn from them and emerge with less

anxiety about their own deaths.

End of Life Care

Numerous characteristics of a “good death” are identified, although few

deaths would meet all these criteria:

 Knowledge that death is coming and an understanding of what to expect

physically and emotionally

 The ability to maintain dignity, to be oneself as long as possible, and to

retain control over care decisions

 Compassionate, respectful and culturally competent care

 Physical comfort: control of pain and other distressing symptoms

 Choice and control in decisions, including about where death occurs

 Access to information, expert and trustworthy health care providers, and

palliative care/hospice in any location

 Supports to minimize spiritual and emotional suffering

 Ability to maintain religious, spiritual, and cultural beliefs and to affirm

significant social relationships Adequate time to say good-bye and

achieve a sense of completion; avoidance of unnecessary prolonging of

the dying process and of being an emotional or financial burden on family

Palliative and Hospice Care

 Hospice care and formalized palliative care can be

differentiated, but pain management is a major component of

both types of end-of-life care.

 Patients have the right to be free from pain.

 Hospice became the word used (1970s) to describe programs

which provide end-of-life care.

 There are key differences between hospice and palliative care

(PC)

 PC is medical care provided to patients of any age with life-

limiting illnesses and is offered in tandem with life-prolonging and

curative therapies.

Palliative and Hospice Care

 PC focuses on relief of pain and suffering by addressing the patient’s emotional,

social, and spiritual needs, not on any lifesaving measures.

 Physicians, nurses, and social workers use both pharmacological and

psychosocial approaches to cope with symptoms and needs, especially pain

management.

 Proponents of palliative care believe that it should be an integral part of

comprehensive care for patients of all ages with life-limiting illnesses.

 Accordingly, palliative care is most effective when integrated into existing care

settings, such as hospitals, skilled nursing facilities, or private homes, and is not

necessarily tied to end-of-life care.

 Individuals may move in and out of palliative care rather than its being viewed as

the final stage of care.

Palliative and Hospice Care

 As the standard for end-of-life care, hospice provides integrated physical,

medical, emotional, and spiritual care not only to the person who is dying but

also to his or her support system.

 It is dedicated to helping individuals who are beyond medicine’s curative power

to remain in familiar surroundings where pain is reduced and personal dignity

and control over the dying process maintained.

 Ensuring the person’s quality of life and the assessment and coordination of the

physical, psychosocial, and spiritual needs of both the individual and family are

fundamental to the hospice approach.

 In contrast to palliative care, active treatment (curative) is not permitted.

Hospice and PC among Ethnic Minorities

 Ethnic minorities typically underuse

hospice and PC

 African Americans, for example,

underuse these services because of

 Past ethical misconduct

 Religious and spiritual beliefs

 Lack of knowledge

 Health policy and reimbursement issues

 Page 503

Advance Care Directives

 A living will is an advance directive that provides guidance to those making decisions about end-of-life

care.

 All 50 states have laws authorizing the use of advance directives to avoid artificially prolonged death.

 These refer to patients’ oral and written instructions about end-of-life care and someone to speak on

their behalf if they become incompetent (e.g., Durable Power of Attorney for Health Care).

 The most common type of advance directive is a living will.

 An individual’s wishes about medical treatment are put into writing in case of irreversible terminal

illness or the prognosis of a permanent vegetative (unconscious) state.

 Under such conditions, living wills can direct physicians to withhold life-sustaining procedures and can

assist family members in making decisions when they are unable to consult a comatose, or medically

incompetent, relative.

 The Patient Self-Determination Act is a federal law requiring Medicare/Medicaid providers to give

patients information about advance directives.

 The PSDA assumes that increased awareness of advance directives will generate discussion between

patients and their health care providers and result in higher rates of completed advance directives.

 Despite this Act, the majority of the general population does not have a written document (e.g., living

will or durable power of attorney) stating their preferences about end-of-life care
Chapter 9 Death,

Dying and

Bereavement, Part

Two

DIVERSITY AND AGING - 313

KAREN FAZIO, MSG

Bereavement and Coping

 The death of a spouse or partner is considered to be one of

the most difficult events for older people.

 People deal with not only the loss of the person, but also a

change of status from “couple” to single or widowhood.

 In a world designed for couples, this can be a tremendous

identity shift.

 The loss of a spouse/partner can take a toll on a person’s

health –older widows and widowers are more likely than

younger adults to get sick and die within the first six months

following the death.

 Chronic conditions may become worse.

 For heterosexual women, losing a husband is almost a

normative and expected life event.

 Older people are also at risk for losing lifelong friends.

Diverse Culture Approaches to Life and

Death (U.S.)

 For many African Americans, beliefs about life

and death are rooted in religious beliefs.

 Within the context of death, hope, supported by

prayer and belief in God, the focus is that their

loved ones are in a better place.

 African Americans are more likely than other

ethnic groups to turn to friends, the church,

neighbors and other non-related people in times

of need.

 Funerals are a time and place to acknowledge

the worth and importance of the person.

 It is important for all family, friends and

acquaintances to attend the funeral and express

their grief.

Diverse Culture Approaches to Life and

Death (U.S.)

 Hispanic Americans, unlike much of the Anglo-American

population, death is recognized as a natural and

spiritual part of the life cycle.

 All Saint’s Day and All Soul’s Day celebrate the spirits of

the dead and these spirits are expected to visit.

 This includes altars with offerings of favorite foods and

beverages.

 Gravesites are cleaned and decorated.

 After a person has died, taking photos of the deceased

is a way to honor and remember the one who has died.

 Day of the Dead - The roots of the Day of the Dead,

celebrated in contemporary Mexico and among those

of Mexican heritage in the United States and around the

world, go back some 3,000 years, to the rituals honoring

the dead in pre-Columbian Mesoamerica.

Diverse Culture Approaches to Life and

Death (U.S.)

 For Native Americans and Alaska Natives, each

tribe or nation has its own beliefs and beliefs

about life and death.

 Most American Indians believe in life after death;

however, the Navajo do not – they are quick to

bury the dead, believing they may have a

negative impact on the living.

 The Lakota gather around the dying person—this

ritual is important and there may be as many as

20 people present.

 If the family member dies alone, the Lakota suffer

much grief.

 The ceremony takes place at the home

reservation, even if the family of the departed

has lived away for several generations.

Diverse Culture Approaches to Life and

Death (U.S.)

 For Asian Americans, it is important to acknowledge

complex factors about immigration age, ethnic

identity, their tradition and ritual practices.

 In the Hindu tradition, old age is seen as a time of

preparing for death.

 A time for planning, reflecting, reviewing, and

summing up.

 There is a positive appreciation of the role of old age

and death is the final act of the human drama.

 Many Hindus prefer to die at home – some prefer to

go back to India.

 Sacred rituals are practiced for the dying person.

 Cremation is a preference.

Diverse Culture Approaches to Life and

Death (U.S.)

 Buddhists believe in the impermanence of

all forms, feelings, and mental constraints.

 During his lifetime, Buddha instructed

followers to embrace suffering as the true

meaning of existence and to contemplate

death as a means of understanding

impermanence.

 Life is the preparation for death and in the

moment of death, all is achieved.

 To calm a dying person, loved ones chant

sutras (teachings of Buddha).

 It is believed the dying person has the

opportunity for a favorable rebirth and

enlightenment.

Diverse Culture Approaches to Life and

Death (U.S.)

 Islamic tradition – Muslims are taught much

about life after death.

 God is the creator of all things and he has

ultimate authority.

 Death is not perceived as the end but a

passage into an eternal existence.

 Islam has rejected the concept of

reincarnation and the opportunity for an

improved life.

 Thinking about death should bring calmness

to the soul.

 Whether a person goes to heaven or hell

depends upon the life lived and deeds

done.

Diverse Culture Approaches to Life

and Death (U.S.)

 End-of-life issues for LGBT people may be challenging.

 Even though same-sex marriage is Federally recognized, there

is ongoing debate in several states, making it difficult for for

LGBT people to advocate for their loved one.

 Partners may have to pretend they are “just friends” ad not

be acknowledged as a family member.

 Visiting hours may be restricted to “family members,” not

allowing access to same-sex partners.

 Advanced directives and other legal documents can help

but may not override a hospital or nursing home’s practice of

not recognizing a same-sex spouse or partner.

 As with other minority groups, when low-income intersects with

marginalization, there may be great health disparity.

 Many rural LGBT people, for example, do not have legal

documents in place because they are completely closeted

and fear discrimination, even from an attorney.

 Some LGBT people face disenfranchised grief if the

relationship is not acknowledged for what it was.

 They may be left to grieve alone without authentic support.