The Experience of Death Where Death Occurs
Hospitals in the U.S. (45%) Decedent’s home (25%) Long-term Care (22%) Hospice (14%) Other (6%)
The Experience of DeathHospice Care
Philosophy Death viewed as normal Families and the patient encouraged to
prepare for death Family are involved in patient’s care Control of care is in the hands of the patient
and family Medical care is palliative rather than curative
Hospice CareTypes of Hospice Care
Home-based programs Hospital-based programs Special hospice centers Hospice
HospiceHospital-based and Home-based Care
Comparison
Hospital-Based Care Home-Based Care
Patient Pain Same Same
Length of Survival Same Same
Patient Satisfaction with Care
Same Same
Family Satisfaction with Care
Higher Lower
Family Sense of Burden Higher Lower
Let’s take a minute to review some of these comparisons.
Dying, Death, and BereavementHospice Care
Hospice Care
Pros Reduced cost of death Less burden on central caregiver
Cons Increased family worry about pain
management
The Meaning of Death for Adults Death as Loss: Age
Age differences
Young adults: Loss of opportunity to experience things; loss of family relationships
Older adults: Loss of time to complete inner work
The Meaning of Death for Adults Death as Loss: Ethnic Differences
Ethnic differences
Mexican Americans: Increase time spent with family or loved ones
White and African-Americans: Would not change their lifestyle
See Table 19.2 for responses to hypothetical impending death
Stop and Think!
At what age do you think people are most fearful of
death?
What prompted your answer?
Fear of Death
Middle-aged adults most fearful of death
Sense of unique invulnerability prevents intense fear of death in young adults
Older adults think and talk more about death than anyone else
Fear of Death Religious beliefs
Religious beliefs and fear of death Very religious adults less afraid of death Those totally irreligious may also fear
death less
Fear of DeathPersonal Worth
Fear of death reduced Adults accomplish goals or believe they
have become the person they set out to be Belief that life has purpose or meaning
How is this related to Erikson’s stage of integrity versus despair?
Your loved one is dying of a terminal illness. Would you use a hospice center? Why or why not?
If you were told that you had a terminal disease and only 6 months to live, how would you want to spend your time until you died?
On a scale of 1– 5, with 5 being high, how much do you fear death?
Questions To PonderQuestions To PonderQuestions To PonderQuestions To Ponder
The Process of DyingPreparation for Death
Kinds of preparations Practical preparations Deeper preparations Older adults more likely to have made
these arrangements
The Process of DyingPreparation for Death
Final preparations Unconscious changes just before death Terminal drop for psychological health
Theoretical Perspectives on Dying Criticisms of Kubler-Ross’s Theory
Methodological problems
Cultural specificity
Stage concept unsupported
Theoretical Perspectives on Dying Alternate Views
Two additional views
Shneidman: Dying process has many “themes”
Corr: Coping with death involves taking care of specific tasks
Theoretical Perspectives on Dying Responses to Impending Death
Greer: Attitudes and behavioral choices can influence course of terminal disease
Five groups/stages Denial (positive avoidance) Fighting spirit Stoic acceptance Helplessness/hopelessness Anxious preoccupation
Theoretical Perspectives on Dying Responses to Impending Death
Greer concluded that the message may be:
“Those who struggle the most, fight the hardest, express their anger and hostility openly, and who find some sources of joy in their lives live longer.”
Theoretical Perspectives on DyingPsychoanalytic Theory
Traumatic death often followed by physical or mental problems
Grief therapy with children makes use of defense mechanisms (sublimation, identification)
Theoretical Perspectives on Grieving
Freud: Death of a loved one is an emotional trauma
Ego tries to insulate itself from unpleasant emotions through defense mechanisms such as denial
BUT Defense mechanisms provide only temporary
relief
How do people grieve in healthy ways?
Theoretical Perspectives on Grieving Attachment Theory
Bowlby Intense grief likely to occur at loss of any
attachment figure
Quality of attachment related to grief
Theoretical Perspectives on Grieving Attachment Theory
Sanders five stages of grief comparable to Bowlby: Shock Awareness Conservation/withdrawal Healing Renewal
Theoretical Perspectives on Grieving Attachment Theory
Revisionist Views Avoiding expressions of grief neither
prolongs grief nor inevitably creates mental health problems
Grieving does not occur in fixed stages Many themes present simultaneously but
one or another may dominate at one point in time
Adults develop different patterns of grieving
Theoretical Perspectives on Grieving Patterns of Grieving
Wortman and Silver Normal Chronic Delayed Absent
Theoretical Perspectives on Grieving The Experience of Grieving: Death Rituals
Psychosocial functions of death rituals such as funerals
Help family and friends manage grief by giving a specific set of roles
Bring family members together in unique ways
Establish shared milestones for families
Theoretical Perspectives on Grieving The Process of Grieving
Factors Associated with Grief: Age of the Bereaved
Children express feelings of grief like teens and adults
Teens often show prolonged grief responses
Theoretical Perspectives on Grieving Factors Associated with Grief
Modes of Death and Grief Caregiver widows may show depression. Death with intrinsic meaning reduces grief. Sudden and violent deaths evoke more
intense grief. Suicide produces unique responses in
survivors.
Theoretical Perspectives on Grieving Widowhood and Effects of Grief
Immediate and long term effects on the immune system
Incidence of depression among widows and widowers rises substantially
Theoretical Perspectives on Grieving Pathological Grief
Depression-like symptoms lasting longer than 2 months
Grief lasting longer than 6 months can lead to long-term depression and physical ailments
Problems may continue for up to 2 years after death of loved one
BUT cultural practices may mimic pathological grief
Theoretical Perspectives on Grieving Sex Differences
Spouse death more negative for men than for women.
Risk of death higher in men immediately after a spouse’s death.
Widowers withdraw in multiple ways. Alcohol use may influence depression. Social relationships remain important for
both sexes.
Theoretical Perspectives on Grieving Preventing Long-Term Problems
“Talk-it-out” approach to managing grief can help prevent grief-related depression.
Developing coherent personal narrative of events surrounding spouse’s death helps manage grief.
Participating in support groups helps.
Appropriate amount of time off from work to grieve is important.
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