Death & Dying

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Questions and Answers

What is one characteristic of sudden death?

Prolonged illness before passing

Gradual decline in functional ability

Unexpected and immediate occurrence (correct)

Loss of appetite and thirst

Which trajectory of death is associated with the rapid decline in individuals who maintain high function before illness?

Organ failure

Sudden death

Frailty

Terminal illness (correct)

Which of the following is NOT a common occurrence near death?

Improved appetite (correct)

Labored breathing

Weakness and confusion

Cold limbs

How does death anxiety typically change as people age?

Decreases with increased understanding Signup and view all the answers

Which stage in Kübler-Ross's model of grief directly follows denial?

Anger Signup and view all the answers

Which trajectory of death is characterized by a slow decline in functional ability, often seen in conditions like Alzheimer's disease?

Frailty Signup and view all the answers

What common physiological occurrence is associated with the near-death stage, often described as a 'death rattle'?

Gurgling sound during breathing Signup and view all the answers

Which statement best summarizes the findings regarding religious beliefs and death anxiety?

Highly religious individuals fear death less than nonreligious individuals Signup and view all the answers

What is the primary focus of palliative care?

Reducing symptom burden and enhancing well-being Signup and view all the answers

Which factor contributes to the underutilization of palliative care?

Widespread acceptance of suffering as a part of death Signup and view all the answers

Which of the following statements about health care teams in palliative care is true?

They require expertise from multiple disciplines to meet patient and family needs. Signup and view all the answers

What misconception about palliative care can hinder its acceptance by families and healthcare providers?

Referral to palliative care means cessation of curative treatment. Signup and view all the answers

Which of the following issues is commonly associated with dying individuals that palliative care aims to address?

Unnecessary invasive procedures and prolonged hospitalizations Signup and view all the answers

What does anticipatory mourning refer to?

Emotional reactions during a terminal illness Signup and view all the answers

Gerotranscendence is characterized by what type of process?

Withdrawal to find non-material meaning Signup and view all the answers

What is described as a broad term for communicating end-of-life choices?

Advanced care planning Signup and view all the answers

Which of the following is included in a living will?

Documentation of life-sustaining treatment preferences Signup and view all the answers

The Patient Self-Determination Act of 1990 ensures what right for patients?

Right to facilitate their health care decisions Signup and view all the answers

What percentage of adults aged 18 and older had an advance directive according to Rao et al. (2014)?

26.3% Signup and view all the answers

What is a common factor affecting whether individuals create an advance directive?

Waiting until a medical crisis Signup and view all the answers

Which of the following is a requirement for health care institutions under the Patient Self-Determination Act?

To inquire about advance directives Signup and view all the answers

What is the primary purpose of a durable power of attorney (DPOA)?

To appoint a healthcare proxy for making medical decisions Signup and view all the answers

Which of the following best describes the actions expected of patients under the Patient Self-Determination Act?

To communicate their medical preferences Signup and view all the answers

What primarily defines death according to the content provided?

The function of the entire brain ceasing Signup and view all the answers

Which chronic condition accounted for the largest percentage of deaths in the United States in 2012?

Heart disease Signup and view all the answers

How did the location of death change from before 1900 to between 1999 and 2013 in the U.S.?

More deaths occurred at home prior to 1900 than in medical facilities Signup and view all the answers

What percentage of U.S. deaths occurred in a nursing home or long-term care facility between 1999 and 2013?

22% Signup and view all the answers

Which statement describes the change in common causes of death over time in the United States?

Chronic conditions have become the leading causes of death. Signup and view all the answers

What role did multigenerational families play in death prior to 1900?

They assumed responsibility for all activities surrounding death. Signup and view all the answers

Which of the following best describes attitudes towards death in modern society compared to the past?

Death is less often discussed openly today than in past generations. Signup and view all the answers

What is a common way that acute conditions, such as infections, have changed in their contribution to death?

They are now ranked as eighth among common causes of death. Signup and view all the answers

In the historical perspective on dying, what trend is noted about the place of death?

Increasingly, deaths are occurring outside the home environment. Signup and view all the answers

Which of the following reflects a significant cultural change regarding death over time?

Death is now primarily dealt with by broader societal institutions rather than families. Signup and view all the answers

Which of the following describes palliative care?

Concentrates on improving the quality of life for patients with life-limiting conditions. Signup and view all the answers

What is hospice care primarily focused on?

Offering comprehensive care during the last 6 months of life. Signup and view all the answers

Which group is reported to be less likely to engage in advance care planning?

African Americans. Signup and view all the answers

What is a common reason individuals may choose not to create advance directives?

A belief that death is a natural process that should not be interfered with. Signup and view all the answers

Which option best describes a misunderstanding regarding advance directives?

They involve communicating wishes through family rather than documentation. Signup and view all the answers

Which factor may contribute to lower completion rates of advance directives in certain populations?

Cultural taboos surrounding discussions about death. Signup and view all the answers

What is a common misconception related to health literacy and advance care planning?

Lower health literacy leads to less awareness about healthcare options. Signup and view all the answers

Which is NOT a factor influencing preferences for advance directives?

Trust in the healthcare system. Signup and view all the answers

What is a notable trend among the U.S. population regarding advance directives?

Lower awareness and completion rates in minority groups. Signup and view all the answers

Which of the following attitudes towards death can influence advance care planning?

Beliefs that discussing death is taboo and should be avoided. Signup and view all the answers

Study Notes

Death Trajectories

Four common trajectories of death include sudden death, terminal illness, organ failure, and frailty.
Terminal illness is characterized by a rapid decline in function after a period of high functional status.
Examples of terminal illnesses include certain types of cancer.
Organ failure, such as chronic obstructive pulmonary disease or congestive heart failure, involves a gradual decline in functional ability.
Frailty, often associated with conditions like Alzheimer's disease, involves a slow and steady decline in functional ability.

Physical Occurrences Near Death

Common physical occurrences near death include loss of appetite and thirst, excessive sleep, weakness, confusion, disorientation, loss of bowel and bladder control, cold limbs, labored or shallow breathing, and a gurgling sound during breathing (death rattle).

Attitudes Toward Death

Fear of death is widespread across cultures.
Death anxiety typically decreases throughout adulthood.
Research on the relationship between religiosity and death anxiety has produced conflicting results, with some studies suggesting less fear of death among highly religious individuals, while others find the opposite.
Understanding the death process can help reduce death anxiety.
Kübler-Ross's five stages of death and dying include denial, anger, bargaining, depression, and acceptance.
Anticipatory mourning refers to the emotional and coping processes individuals experience during a life-limiting illness, involving anticipating future losses.
Gerotranscendence is a concept that describes a possible shift in perspective among older adults as they may withdraw from material pursuits and focus on finding meaning from a less material perspective.

Advanced Care Planning

This encompasses processes for individuals to communicate their wishes regarding future end-of-life decisions.
Advance care planning can be informal through discussions or documented through advance directives.
Common advance directives include living wills and durable power of attorney (DPOA) appointments.
A living will outlines an individual's preferences for life-sustaining treatments such as mechanical ventilation, artificial nutrition, or antibiotics.
The Patient Self-Determination Act of 1990 guarantees patients' rights to participate in their healthcare decisions, accept or refuse treatments, and complete advance directives.
Healthcare institutions receiving federal funding are mandated to inquire about advance directives and document their presence in patient records.

Advance Directives and Their Completion Rates

Despite the availability of advance directives, many individuals wait until a medical crisis to consider their preferences.
Approximately 26.3% of adults aged 18 and older have completed an advance directive, while this figure rises to 37.2% among older adults.
African Americans, Hispanic Americans, Asian Americans, and Native Americans are less likely to create documented advance care plans or be aware of Advance Directives.

Reasons for Not Making Advance Directives

Reasons for not making advance directives can include a preference for more aggressive end-of-life care, distrust in the healthcare system, a desire for family communication rather than written documents, belief in a higher power's control over death, cultural taboos surrounding death discussions and planning, and lower health literacy among disadvantaged populations.

Palliative and Hospice Care

Palliative care focuses on managing symptoms and improving quality of life for individuals with life-limiting conditions, regardless of disease stage, without inhibiting curative treatments.
Hospice care is a specialized form of comprehensive palliative care provided during the last six months of life when individuals choose to forgo aggressive treatments and prioritize quality-of-life care.
Palliative care teams typically include physicians, nurses, social workers, chaplains, psychologists, pharmacists, dietitians, occupational therapists, physical therapist, and volunteers.
The success of palliative care in addressing client needs can depend on the care system, team type, and team dynamics.

Benefits of Palliative Care

Palliative care can reduce unnecessary and invasive interventions, frequent hospitalizations, financial burdens, and symptoms like pain, fatigue, sleep disturbances, delirium, depression, anxiety, constipation, and breathing difficulties.
Studies show that palliative care is associated with reduced symptom burden, improved well-being, decreased treatment intensity near death, and enhanced family satisfaction with care.

Underutilization of Palliative Care

Factors hindering the use of palliative and hospice care include reluctance among providers and families to discuss end-of-life care, concerns about "giving up" or a lack of hope, patient misunderstandings about palliative care versus hospice care, and the time required for palliative care teams to explain the continued use of curative treatments.

Other Factors Leading to Underutilization of Palliative Care

Lower health literacy, exposure to discriminatory healthcare practices, beliefs that suffering is an inherent part of death, and limited access to medical care can also contribute to the underutilization of palliative care.

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Description

This quiz explores the four common trajectories of death, including terminal illness and organ failure. Additionally, it examines physical occurrences near death and societal attitudes toward mortality. Test your knowledge on this important and sensitive topic.