DEV2004 Chapter 10 Death and Dying

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Questions and Answers

At what point in the life cycle can death occur?

Only in childhood accidents

At any point in the life cycle (correct)

Only in cases of chronic illness

Only during old age

How do most people typically envision their death?

As quick and peaceful (correct)

As slow and painful

As something to be feared

As a drawn-out experience

What is often the common perception of death among children and young adults?

It is viewed similarly to adults

It is associated only with old age

It is perceived as a normal part of life

It is often seen as a distant concept (correct)

What has contributed to an increased life expectancy around the world?

Better living conditions and modern medicine Signup and view all the answers

What common factor is associated with most deaths, as opposed to a handful of illnesses?

A lengthy period of chronic illness or frailty Signup and view all the answers

What factor contributes to friends and family members withdrawing from those with serious illnesses?

They have no solutions to relieve suffering. Signup and view all the answers

In high-income countries, what percentage of deaths occurs among individuals aged 70 and older?

70% Signup and view all the answers

What is a primary reason for dehumanization of incapacitated individuals by healthier people?

A need to maintain protective distance from the possibility of illness. Signup and view all the answers

What percentage of deaths among children under 15 occurs in low-income countries?

40% Signup and view all the answers

What is one of the leading causes of death among newborns in low-income countries?

Birth trauma Signup and view all the answers

Which of the following diseases accounted for the highest number of deaths in high-income countries?

Chronic diseases Signup and view all the answers

What was the third most common cause of death in the United States in 2020?

COVID-19 Signup and view all the answers

Which factor is a significant hidden cause of chronic diseases leading to death in high-income countries?

Tobacco use Signup and view all the answers

What experience may cause paid caregivers to distance themselves from terminally ill patients?

Repeated experiences of grief, leading to burnout. Signup and view all the answers

What contributes to social death among individuals in nursing homes?

Lack of social interaction and communication. Signup and view all the answers

What is the clinical definition of death according to the Uniform Determination of Death Act (UDDA)?

Irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all brain functions Signup and view all the answers

Which of the following is NOT typically observed in the weeks leading up to death?

Increased appetite Signup and view all the answers

What is identified as a characteristic of social death?

Exclusion and dehumanization by others Signup and view all the answers

What significant bodily change is expected days before death?

Decreased blood pressure Signup and view all the answers

Which condition is described as a form of social death impacting certain groups?

HIV/AIDS Signup and view all the answers

How is the 'death rattle' described in the context of the dying process?

Noisy breathing due to relaxed throat muscles Signup and view all the answers

Which of the following best describes the physical signs indicating imminent death?

Cool extremities and purplish discoloration Signup and view all the answers

What is the primary consideration in determining a person's physical death?

Medical standards for cessation of vital functions Signup and view all the answers

What happens to an individual's level of consciousness days before death?

It decreases significantly Signup and view all the answers

Which of the following is a characteristic of 'dehumanization' in the context of social death?

Forcing unwanted medical procedures Signup and view all the answers

What is the leading cause of death during childhood and middle adulthood?

Accidents or unintentional injury Signup and view all the answers

Which age group has suicide ranked as the 2nd leading cause of death?

10-34 years Signup and view all the answers

What was the percentage increase in the suicide rate for males from 1999 to 2017?

26% Signup and view all the answers

What factor has been linked to increased suicide rates in America?

Death of despair Signup and view all the answers

In which demographic have female suicide rates increased significantly since 2006?

Aged 45-64 Signup and view all the answers

Which country has NOT experienced a decrease in suicide rates during the same period as the increase in the U.S.?

United States Signup and view all the answers

What has been identified as a common risk factor for both males and females in relation to suicide?

Lack of mental health treatment Signup and view all the answers

What psychological phenomenon makes adolescents feel immune to death?

Personal fable Signup and view all the answers

Why do individuals in early adulthood typically experience lower rates of death anxiety?

They believe they will live long lives. Signup and view all the answers

Which prevention strategy is known to help decrease suicide rates globally?

Limiting access to lethal means Signup and view all the answers

Which mental health issue is particularly common among females at risk of suicide in middle age?

Anxiety and depression Signup and view all the answers

What are the primary responsibilities that contribute to middle-aged adults' fear of death?

Taking care of aging parents and children Signup and view all the answers

What trend has been observed regarding suicide rates in rural versus urban areas?

Higher in rural areas Signup and view all the answers

What is the main concern for individuals in late adulthood regarding death?

Leaving family members behind Signup and view all the answers

What distinguishes curative care from palliative care?

Curative care seeks to cure illness, while palliative care focuses on comfort. Signup and view all the answers

Palliative care is offered to patients suffering from which type of conditions?

Chronic illnesses and end-of-life care Signup and view all the answers

What triggers hospice care eligibility for a patient?

A diagnosis of terminal illness with an anticipated death within 6 months Signup and view all the answers

What is the primary goal of hospice care?

To allow patients to die in peace, minimizing pain Signup and view all the answers

Why might late adulthood individuals have less anxiety about death compared to younger adults?

They have faced the loss of loved ones previously. Signup and view all the answers

Which statement best describes the misconceptions about palliative care?

It was historically only for the dying. Signup and view all the answers

What percentage of Americans prefer to die at home?

80% Signup and view all the answers

Which group experienced a significant increase in drug overdose deaths from 2016 to 2017?

Synthetic opioids other than methadone Signup and view all the answers

What developmental stage do infants not comprehend the concept of death?

Infancy Signup and view all the answers

What is the percentage of deaths that occur in acute care hospitals in the United States?

60% Signup and view all the answers

In which country was the lowest percentage of deaths in hospitals reported?

China Signup and view all the answers

What belief may young children hold about death due to magical thinking?

They can bring the deceased back to life Signup and view all the answers

What significant factor has led to the increased rate of drug overdose deaths since 1999?

Synthetic opioids Signup and view all the answers

At what age do children usually start to understand the finality of death?

Late Childhood Signup and view all the answers

What percentage of caregivers for the elderly are also employed?

72% Signup and view all the answers

Which of the following statements is true regarding advanced care planning?

Durable power of attorney for health care names a decision-maker. Signup and view all the answers

What temporary condition might an infant show after losing a caregiver?

Sluggishness and quietness Signup and view all the answers

What percentage of deaths in older adults occurs in residential care settings, such as nursing homes?

18% Signup and view all the answers

Which cultural approach to communicating bad news contrasts with Western medicine?

Family members are often kept in the dark. Signup and view all the answers

What is the key difference between advance directives and medical orders?

Advance directives are crafted by patients, medical orders by professionals. Signup and view all the answers

What percentage of adults aged 75 and older have given little or no thought to their end-of-life wishes?

More than 25% Signup and view all the answers

In which country are doctors legally required to inform the patient of their health conditions?

Germany Signup and view all the answers

How do cultural factors influence end-of-life decisions in many non-Western societies?

Families often make decisions on behalf of the patient. Signup and view all the answers

What is a common characteristic of medical orders like POLST?

They must be followed by medical personnel. Signup and view all the answers

What common challenge do family caregivers face as the baby boomer generation ages?

Declining number of potential family caregivers. Signup and view all the answers

What percentage of caregivers have been caregiving for 3 or more years?

55% Signup and view all the answers

What type of hospice care is most commonly chosen by patients?

Routine hospice care Signup and view all the answers

Which type of hospice care primarily focuses on pain management and acute symptom crises?

Continuous home care Signup and view all the answers

What percentage of American adults are estimated to be caregivers for someone who is dying or chronically ill?

29% Signup and view all the answers

What major issue is associated with the care provided by hospices according to recent reports?

Inconsistent quality of care Signup and view all the answers

What is a key element of hospice care according to the basic elements outlined?

Social work and counseling services Signup and view all the answers

What common misconception might African-American families have regarding hospice care?

Medical treatment should continue as long as possible Signup and view all the answers

In which situation is inpatient respite care typically utilized?

Providing temporary relief for caregivers Signup and view all the answers

How long can bereavement counseling be provided to families after a patient's death?

Up to 1 year Signup and view all the answers

What is one of the physical challenges faced by family caregivers?

Lifting and bathing the patient Signup and view all the answers

What percentage of caregivers providing care for more than 3 years are employed?

60% Signup and view all the answers

In many cultures outside of Western society, what is the general attitude towards advanced directives?

They hold little or no relevance. Signup and view all the answers

What percentage of survey respondents gave significant thought to their end-of-life wishes, according to a Pew Research Center Survey?

37% Signup and view all the answers

What do the majority of Blacks and Hispanics prefer regarding end-of-life treatment?

To have everything done to keep them alive. Signup and view all the answers

Which states and region allow physician-assisted dying?

Nine states and D.C. Signup and view all the answers

What is a requirement for a person seeking physician-assisted dying in the U.S.?

Must be at least 18 years old. Signup and view all the answers

How is lack of eating perceived in many other nations in relation to dying?

As a sign of dying. Signup and view all the answers

What is a common concern expressed by Hispanics regarding choosing a family member for end-of-life decisions?

It could isolate that individual. Signup and view all the answers

What has been suggested as a reason for the low rate of completion of advanced directives among non-whites?

Distrust of the U.S. health care system. Signup and view all the answers

Which of the following countries uniquely permits euthanasia for individuals under the age of 18?

Belgium Signup and view all the answers

What was the percentage of individuals who died from the lethal prescriptions written in Oregon by January 2019?

65.8% Signup and view all the answers

What is the primary goal of green burials?

To reduce the environmental impact of funerals Signup and view all the answers

Which term describes the period following a loss during which individuals experience grief and mourning?

Bereavement Signup and view all the answers

What common reactions might individuals experience during typical grief?

Anger and difficulty concentrating Signup and view all the answers

Which of the following is a symptom of complicated grief?

Feelings of disbelief and yearning for the deceased Signup and view all the answers

What differentiates complicated grief from major depressive disorder?

Focus on the individual's history and cultural norms Signup and view all the answers

What is disenfranchised grief?

Grief that is not socially recognized Signup and view all the answers

How do traditional burials typically compare to green burials in terms of cost?

Green burials typically have fewer required add-ons, making them less expensive Signup and view all the answers

What environmental factors are associated with traditional burials?

Significant use of wood, steel, and embalming fluids Signup and view all the answers

What can suppress the immune system of individuals experiencing grief?

The grieving process itself Signup and view all the answers

Which of the following best describes mourning?

The process of adapting to a loss influenced by culture Signup and view all the answers

What does the Dual-Process Model of Grieving emphasize for bereaved individuals?

Moving back and forth between grieving and preparing for life without the loved one Signup and view all the answers

Why is the loss of a child considered particularly distressing compared to other types of bereavement?

It leads to severe long-lasting grief and higher mortality rates among parents Signup and view all the answers

What effect does the death of a child have on bereaved parents, according to research?

It significantly increases risks to both physical and mental health Signup and view all the answers

What does reaching acceptance in the context of terminal illness signify?

Patients are learning to incorporate their condition into daily life. Signup and view all the answers

In the context mentioned, what must a bereaved person do regarding their focus during grieving?

Constantly oscillate between recognizing loss and envisioning future restoration Signup and view all the answers

What emotional state is associated with individuals who have recently experienced the death of a child?

Increased depression and potential suicidal behavior Signup and view all the answers

What role does hope play according to Kübler-Ross's observations of terminally ill patients?

Hope can provide motivation during the grieving process. Signup and view all the answers

What is the term used for grief that is not recognized or supported by society?

Disenfranchised grief Signup and view all the answers

How is the orientation toward loss characterized in the Dual-Process Model of Grieving?

Reflecting nostalgically on memories of the deceased Signup and view all the answers

What criticism does Friedman and James raise concerning Kübler-Ross's Five Stages of Grief?

The stages are only applicable to terminally ill patients. Signup and view all the answers

What is the primary goal of the restoration orientation in the grieving process?

To help the bereaved adjust to life without the loved one Signup and view all the answers

Which of the following best describes anticipatory grief?

Grief that occurs before a predicted death Signup and view all the answers

According to the Yale Bereavement Study, which reaction was most commonly reported by participants from the start of their bereavement?

Acceptance Signup and view all the answers

What does the term 'normal grieving' refer to in the context of bereavement?

A process that includes oscillation between grief and life preparation Signup and view all the answers

Which stage of grief is characterized by disbelief and shock?

Denial Signup and view all the answers

What issue is identified with the use of denial in the context of the grieving process?

Denial can hinder communication with healthcare specialists. Signup and view all the answers

How does optimism about prognosis influence the adjustment and longevity of terminally ill patients?

It may enhance adjustment and increase longevity. Signup and view all the answers

What can cause individuals experiencing disenfranchised grief to suffer intensified symptoms?

Absence of formal mourning practices Signup and view all the answers

What is a significant concern among opponents of physician-assisted dying regarding active euthanasia?

It may result in a slippery slope towards non-consensual deaths. Signup and view all the answers

Which stage from Kübler-Ross’s model is argued to be experienced by all those who are dying?

Acceptance Signup and view all the answers

Which of the following models describes a series of stages experienced by someone facing death?

Five Stages of Grief Signup and view all the answers

What was a key finding of Kübler-Ross regarding her interviews with terminally ill patients?

Patients retained a sense of hope about their situation. Signup and view all the answers

In which religion is it customary to wash the deceased and wrap them in a simple white shroud before burial?

Islam Signup and view all the answers

What reaction does anger provide during the grieving process?

It energizes the individual to confront the situation Signup and view all the answers

Which of the following is NOT typically associated with Roman Catholic funeral rites?

Sitting shiva Signup and view all the answers

What feeling is commonly associated with the depression stage of grief?

Loss of interest in the outside world Signup and view all the answers

What has been a concern regarding the assumption of a set pattern in grief among mental health professionals?

It may lead to more harm than good for grieving individuals. Signup and view all the answers

How did Kübler-Ross's personal experiences potentially influence her theory on grief?

They could bias her interpretations of dying patients. Signup and view all the answers

Which of the following statements accurately reflects the nature of grief models?

They serve as general guidelines for grieving experiences Signup and view all the answers

What do Hindu beliefs emphasize regarding funeral rituals?

Reincarnation, leading to prompt cremation after death. Signup and view all the answers

What is a common misconception about the stages of grief as described by Kübler-Ross?

They must be experienced in a specific order Signup and view all the answers

What is a primary function of funeral rites across various cultures?

To provide survivors with a sense of closure. Signup and view all the answers

What percentage of Americans disapproved of physician-assisted dying according to the 2013 survey?

49% Signup and view all the answers

Which behavior might a person exhibit during the bargaining stage of grief?

Trying to negotiate time or favors with a higher power Signup and view all the answers

Which aspect is a common point of contention concerning the Hippocratic Oath related to physician-assisted dying?

The moral obligations of physicians to prolong life. Signup and view all the answers

How are the deceased cared for in Orthodox Judaism after death?

They are washed and wrapped in a simple white shroud. Signup and view all the answers

Which of the following best describes the financial aspect of funerals in 2017?

The median cost for a burial service was over $8,000. Signup and view all the answers

What is a critical view held by some regarding government involvement in end-of-life decisions?

Government involvement may interfere with personal autonomy. Signup and view all the answers

Study Notes

Understanding Death and Dying

Death is a personal experience, varying widely in perception based on age, health, and circumstance.
Most people envision death as quick and peaceful, yet it often follows lengthy chronic illness or health decline.
Life expectancy has increased globally due to improvements in medicine and living conditions, but death remains inevitable.

Definition and Determination of Death

According to the Uniform Determination of Death Act (UDDA), death is the irreversible cessation of circulatory, respiratory, or brain function.
Established in 1980, the UDDA is widely adopted in the U.S. as a standard for determining death.

Physical Changes Before Death

Weeks before passing: Decreased appetite, increased sleep, significant weakness, incontinence, and restlessness.
Days before passing: Decreased consciousness, breathing pauses, lowered blood pressure, and morbid murmuring.
Hours before passing: Shallow breathing, weak pulse, cold extremities, and “death rattle” due to relaxed throat muscles.

Occurs when individuals are dehumanized, leading to social isolation before physical death.
Can impact people with terminal illnesses, as friends and family may withdraw, often due to discomfort with the reality of dying.
Social support is crucial for quality of life, and deteriorating social interactions may lead to feelings of social death.

Causes of Death Globally

Non-communicable diseases, such as heart disease, stroke, and COPD, are the leading causes of death, particularly affecting older adults in high-income nations.
In low-income countries, infectious diseases (e.g., HIV/AIDS, malaria) and complications related to childbirth dominate mortality rates.
In the U.S., chronic diseases prevail as causes of death, alongside rising rates of suicide and drug overdoses.

Suicide Trends

Suicide is the 10th leading cause of death in the U.S., but ranks as the 2nd cause for age groups 10-34 and 4th for ages 35-54.
Suicide rates have surged by 33% from 1999 to 2017, affecting both genders and increasing in rural areas.
Various factors contribute to suicides, including relationship problems, financial issues, and substance use disorders.

Deaths of Despair

Refers to deaths linked to the decline in economic and social well-being, notably in rural America due to job loss.
Addressing the issue involves improving mental health resources and prevention programs that focus on access to treatment.

Fatal Drug Overdoses

Drug overdoses claimed 70,237 lives in 2017, with a steady increase since 1999.
Deaths from synthetic opioids like fentanyl have significantly risen and are contributing to the crisis.

Preferred Locations of Death

While 80% of Americans wish to die at home, only 20% actually do; many die in acute care hospitals or nursing homes.
Internationally, about 54% of deaths occur in hospitals, with variations across countries.

Developmental Perspectives on Death

Understanding of death evolves with age, influenced by cognitive development and personal experiences.
Infants and young children struggle with the permanence of death, while adolescents begin to engage more abstractly with the concept.
Middle-aged adults often fear death due to caretaking responsibilities, while older adults may prioritize control over how they die rather than fearing death itself.

Care Approaches

Curative Care: Focuses on curing disease; examples include chemotherapy.
Palliative Care: Aims to relieve pain and provide comfort, now offered for chronic illnesses, not just at life’s end.
Hospice Care: Provides support during end-of-life stages, evolving from the UK to become established in the U.S. through Cicely Saunders' efforts.### Hospice Care Overview
By 2012, approximately 5,500 hospice programs existed in the U.S.
Hospice care aims to relieve pain and provide emotional comfort to dying patients and their families.
A terminal illness diagnosis with a life expectancy of six months or less is required for hospice admission.
Hospice allows patients to avoid invasive treatments during the dying process.
Family education about the dying process is an integral role of hospice workers.

Types of Hospice Care in America

Routine Hospice Care: Most common; typically at home.
Continuous Home Care: Focused nursing care for pain management during acute crises (8 to 24 hours).
Inpatient Respite Care: Temporary relief for family caregivers at a hospital or facility.
General Inpatient Care: Hospital-based care for severe pain and symptom management when other settings are inadequate.

Demographics and Characteristics of Hospice Patients

In 2017, approximately 1.5 million Americans received hospice care.
Common conditions leading to hospice care include dementia, heart disease, and cancer.
Many patients enter hospice care late, often in their final weeks of life, with one-third being on hospice for less than a week.

Essential Elements of Hospice Care

Care of patient and family as a single unit.
Access to pain and symptom management, day and night care.
Coordination of medical services and providing social work, counseling, and bereavement support for up to a year after death.

Challenges and Concerns in Hospice Care

New hospice programs must comply with insurance regulations that limit service provider control over patient care and length of stay.
A report revealed vulnerabilities in care quality, even at certified facilities.

Cultural Perspectives on Hospice Care

Attitudes toward hospice vary among ethnic groups, with some believing in continuing aggressive medical treatments until death.
Cultural discomfort regarding death discussions may affect hospice care acceptance.

Family Caregivers

Approximately 66 million Americans (29% of adults) are family caregivers for seriously ill individuals.
A majority of caregivers are women, facing physical, emotional, and financial strains due to caregiver responsibilities.
Caregivers often work their own jobs while providing extensive care for ill family members, resulting in significant productivity losses.

Advanced Directives

Advanced care planning encompasses documents regarding end-of-life preferences, including living wills and durable powers of attorney.
Medical orders, such as POLST forms, guide medical teams but differ from patients-initiated directives.

Cultural Differences in End-of-Life Decision-Making

Cultural attitudes strongly influence expectations for discussing health conditions, decision-making dynamics, and preferences for end-of-life care.
Non-Western cultures may prioritize family decision-making over individual patient autonomy.

Euthanasia and Physician-Assisted Dying

Federal law does not regulate physician-assisted death, leaving states to legislate.
Nine states and D.C. permit physician-assisted dying with specific eligibility criteria.
Controversies surrounding this topic often include legal rights, ethical concerns, and religious beliefs.

Religious Practices Surrounding Death

Different religions have distinct funeral rites that reflect cultural beliefs and provide closure for loved ones.
Typical practices involve hastened burials and specific rituals honoring the deceased.

Green Burials

Rising interest in environmentally friendly burial practices reduces ecological impacts associated with traditional burials.
Green burials can lower costs and have gained popularity with consumers seeking less traditional options.

Grief, Bereavement, and Mourning

Grief: Normal response to loss, can relate to physical or social losses.
Bereavement: The period during which grief occurs. The duration varies based on the attachment to the loss.
Mourning: Cultural processes by which people adapt to their grief.

Complicated Grief

Complicated grief may involve symptoms similar to major depression and can persist for six months or longer.
Clinicians must evaluate if darkened symptoms align with grieving norms and require intervention based on the individual's history.### Disenfranchised Grief
Defined as grief that lacks social recognition, making it difficult for individuals to receive support.
Examples include deaths from AIDS, suicides, perinatal losses, and the death of pets or former partners.
Commonly leads to intensified grief symptoms due to insufficient social support networks.

Anticipatory Grief

Grief experienced before an expected death, providing time for emotional preparation.
Can ease post-loss adjustment; for instance, relieving suffering at the end of a long illness.

Models of Grief

Several theoretical models exist, but none capture all aspects of grief.
Individual grief experiences vary widely; not conforming to a model does not indicate abnormality.

Kübler-Ross’s Five Stages of Grief

Stages: Denial, Anger, Bargaining, Depression, Acceptance.
Denial allows gradual processing of overwhelming news.
Anger channels energy to fight perceived unfairness in life; often directed at various targets.
Bargaining involves making deals for a longer life or less suffering.
Depression allows the individual to fully confront the reality of loss.
Acceptance signifies a move toward incorporating loss into life; does not imply happiness about death but acceptance of reality.

Criticisms of Kübler-Ross’s Model

Skepticism surrounds the existence of distinct stages in grief; experiences differ greatly among individuals.
Critics argue denial and acceptance may hinder communication between patients and healthcare providers.
Research questions the applicability of these stages to all grieving individuals, as Kübler-Ross focused on the dying.
The Yale Bereavement Study contradicted the five stages, finding acceptance and yearning to be more prominent emotional responses.

Dual-Process Model of Grieving

Proposes that individuals oscillate between grieving and preparing for life after loss.
Balances between loss-focused orientation (reflecting on past) and restoration orientation (looking towards the future).
Both orientations are essential for normal grieving and ultimately for recovery.

Loss of Children and Parents

Loss of a child is recognized as one of the most distressing forms of grief.
Bereaved parents face heightened risks for physical and mental health issues.
Research indicates an increase in depression and a higher mortality rate among bereaved parents.
A significant percentage of those recently diagnosed with depression have experienced the loss of a child, with some attempting or completing suicide.

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Explore the complex topics of death and dying as covered in Chapter 10. This chapter delves into personal experiences and emotional responses to death across different age groups. Gain insight into how perceptions of death may differ among children, young adults, and the elderly.