Lifespan Development: Death and Dying

Leading Causes of Death

• In 1900, infectious diseases were the leading causes of death, while in 2016, chronic diseases were the leading causes of death in the United States.
• The top 10 deadliest diseases worldwide in 2015 include: heart disease, stroke, lower respiratory infections, COPD, trachea, bronchus, and lung cancers, diabetes, Alzheimer's or other dementia, dehydration, tuberculosis, and cirrhosis.
• Many of the top causes of death are linked to lifestyle choices and are preventable or avoidable if proper actions are taken.
• Unintentional injuries are a leading cause of death for the widest variety of ages.

The Process of Dying

• Physiological death occurs when vital organs no longer function, and may take 72 hours or less.
• Physiological death involves digestive and respiratory systems shutting down, circulation slowing, and mottling occurring.
• Agonal breathing, or gasping, labored breaths caused by an abnormal pattern of brainstem reflex, may occur.
• Brain death occurs when there is no longer brain activity, referred to as clinically dead.
• A vegetative state occurs when the cerebral cortex no longer registers electrical activity, but the brain stem continues to be active.

Social and Psychological Death

• Social death begins earlier than physiological death and occurs when others begin to withdraw from someone who is terminally ill or has a terminal illness diagnosis.
• Doctors, family members, and friends may spend less time with patients after their prognosis becomes poor.
• People in nursing homes may live as socially dead for years with no one visiting or calling.
• Psychological death occurs when the dying person begins to accept death and withdraw from others, and may bring physiological death closer.
• Interventions based on self-empowerment for terminally ill individuals have been associated with better mental health.

Emotions Related to Death

• Bereavement is the outward expression of grief and mourning, and funeral rites are expressions of loss reflecting personal and cultural beliefs.
• Culture does not provide set rules for how death is viewed and experienced, but ceremonies provide survivors a sense of closure after a loss.
• Grief is the psychological, physical, and emotional experience and reaction to loss.
• Grief reactions vary depending on whether a loss was anticipated or unexpected and whether it occurred suddenly or after a long illness.
• Bereavement describes the state of being following the death of someone.

Stages of Loss

• Kübler-Ross described five stages of loss experienced by someone facing the news of their impending death: denial, anger, bargaining, depression, and acceptance.
• Worden's model of grief explains it through four different tasks: accepting the loss, working through and experiencing the pain, adjusting to the changes, and moving past the loss on an emotional level.
• Parkes broke down grief into four stages: shock, yearning, despair, and recovery.
• Strobe and Shut suggested individuals cope with grief through an ongoing process of loss-oriented and restoration-oriented coping.

Care and Practices Related to Death

• Palliative care is an interdisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses.
• The goal of palliative care is to improve the quality of life for both the person and family through relief of symptoms, pain, physical stress, and mental stress.
• Hospice care involves palliation without curative intent and is typically used by people without further options or who have decided not to pursue further options.
• Dame Cicely Saunders emphasized focusing on the patient rather than the disease and introduced the notion of "total pain".
• Euthanasia refers to helping a person fulfill their wish to die and can happen through voluntary euthanasia or physician-assisted suicide.
• Physician-assisted suicide occurs when a physician prescribes the means by which a person can end their own life.