Adulthood and Aging Chapter 13 Dying Death and

Death Anxiety • Involves fears of death-related factors: § § § Dying process Moment

Death Anxiety (cont'd) • Declines in middle age and late adulthood • Older adults

End-of-life Decisions Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education,

Advance Directives • Advance Directives: legal documents detailing (wishes of) end-of-life concerns § Allows

Advance Directives (cont'd) • Patient Self-Determination Act, 1960, empowers patients: § § Patients can

Advance Directives (cont'd) • Living will: a self directive with instructions to sustain/prolong life

Palliative Care and Hospice Programs • Palliative care treats symptoms and keeps individual comfortable

Palliative Care and Hospice Programs (cont'd) • Physiological concerns for patients in hospice care:

Palliative Care and Hospice Programs (cont'd) • Psychological concerns: § Depression § Anxiety §

Euthanasia and Physician-Assisted Death • Dilemma: whether severely ill patients to continue futile life-sustaining

Euthanasia and Physician-Assisted Death (cont'd) • Physician-assisted suicide: legal in the state of Oregon,

Close to Death Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson

Psychological Changes (cont'd) • Five-stage model of dying patients proposed: § Stage 1: denial

Psychological Changes (cont'd) • Five-stage model of dying patients proposed: § Stage 3: bargaining

Interacting with those Who are Dying • Dying person may be worried about being

Interacting with those Who are Dying (cont'd) • Be present: § Do not ignore/downplay

Physiological Changes • Bodily changes as death approaches: § § § § Drowsiness and

Physiological Changes (cont'd) • Physically comfort dying person • Stay with body of bereaved,

Transitions Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc.

Marking the End of Life • Marking of event of death influenced by: §

You have the right… Adulthood and Aging Marion G. Mason Copyright © 2011 by

Marking the End of Life (cont'd) • Traditional funeral: § § Preparation of body

Marking the End of Life (cont'd) • Direct cremation • Federal Trade Commission (FTC)

Bereavement • Amount of time individuals spend to recover varies • No correct way

Bereavement (cont'd) • Bereavement: time between experience of loss and full adjustment to routine

Bereavement (cont'd) • Four phases of bereavement: § § Shock and numbness Separation anxiety

Complicated Grief • • Having difficulty adjusting to loss Experiencing long-lasting and intense grief

Complicated Grief (cont'd) • Complicated grief seen in recent widows/widowers • Show signs of:

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Death Anxiety • Involves fears of death-related factors: § § § Dying process Moment of death Situation of our body Spirit after death Unknown beyond this life Fear of obliteration • Fear of death peaks in young adulthood Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Death Anxiety (cont'd) • Declines in middle age and late adulthood • Older adults closer to death do not report anxiety; report anxiety of prolonged dying process Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Advance Directives • Advance Directives: legal documents detailing (wishes of) end-of-life concerns § Allows patients to survive through emergency life-support technology Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Advance Directives (cont'd) • Patient Self-Determination Act, 1960, empowers patients: § § Patients can direct own health care Accept/refuse treatment Prepare advance directive documents Psychiatric advance directives for mental health treatments Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Advance Directives (cont'd) • Living will: a self directive with instructions to sustain/prolong life § After preparing, revisit the document • Health care proxy: appoint designated individual to make important decisions • Document called durable power of attorney of health care • Another procedure: durable power of attorney for finances Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Palliative Care and Hospice Programs • Palliative care treats symptoms and keeps individual comfortable • Can begin anytime after diagnosis • Hospice care: given in last few months of life § For terminally ill patients in last 6 months of life § Care takes place in patient’s home Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Palliative Care and Hospice Programs (cont'd) • Physiological concerns for patients in hospice care: § § § Pain management Shortness of breath Digestive problems Incontinence Skin breakdown Fatigue Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Palliative Care and Hospice Programs (cont'd) • Psychological concerns: § Depression § Anxiety § Confusion Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Euthanasia and Physician-Assisted Death • Dilemma: whether severely ill patients to continue futile life-sustaining procedures • Passive euthanasia: allowing “nature to take its course” • Active euthanasia: direct action of shortening patient’s life; is illegal Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Euthanasia and Physician-Assisted Death (cont'd) • Physician-assisted suicide: legal in the state of Oregon, and other parts of the world § Controversial to consider terminally ill capable of rational thinking § Physician-assisted suicide not unconstitutional § In Oregon Death With Dignity Act passed in 1997 § Such deaths account for 0. 01% Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Psychological Changes (cont'd) • Five-stage model of dying patients proposed: § Stage 1: denial - Patient believes they are mis-diagnosed - They are curable § Stage 2: anger - Patient shows anger at God, loved ones, medical professionals, self Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Psychological Changes (cont'd) • Five-stage model of dying patients proposed: § Stage 3: bargaining - Postpone death; may pray § Stage 4: depression - Death seems reality § Stage 5: acceptance - Acknowledgment of one’s situation - Mental preparation Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Interacting with those Who are Dying • Dying person may be worried about being abandoned • Be present: § Physically, and psychologically § Talk when dying person wishes to; remain close and be respectful § Better to communicate about important matters Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Interacting with those Who are Dying (cont'd) • Be present: § Do not ignore/downplay the fact of dying § Talk about it § Be prepared to ask hard questions, using difficult (painful) words • Create an environment of comfort for the individual: place personal items around Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Physiological Changes • Bodily changes as death approaches: § § § § Drowsiness and confusion Lack of interest in food/water; reduced intake Loss of bladder and bowel control Limbs and skin cool Death rattle: breathe noisily Changes in heart rate Involuntary movements Seizure may occur Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Physiological Changes (cont'd) • Physically comfort dying person • Stay with body of bereaved, pray and grieve together Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Marking the End of Life • Marking of event of death influenced by: § Culture § Religious traditions § Personal and family preferences • Funeral/memorial service facilitates a closure Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Marking the End of Life (cont'd) • Traditional funeral: § § Preparation of body Viewing/visitation Service at funeral home Burial, entombment, cremation • Direct burial: § No preparation or embalming § Simple container § Quick burial Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Marking the End of Life (cont'd) • Direct cremation • Federal Trade Commission (FTC) encourages adults to plan their funeral • Average funeral cost is $10, 000 Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Bereavement • Amount of time individuals spend to recover varies • No correct way to cope with grief • Adjustment influenced by § § § Age Personality The way loved one died Religious/cultural background Social support Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Bereavement (cont'd) • Bereavement: time between experience of loss and full adjustment to routine • Grief: emotional reaction to loss • Mourning: behaviors expected by one’s cultural and/or religious traditions Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Bereavement (cont'd) • Four phases of bereavement: § § Shock and numbness Separation anxiety Disorganization and despair New routines Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Complicated Grief • • Having difficulty adjusting to loss Experiencing long-lasting and intense grief Feelings of emptiness, bitterness Symptoms of grief may reduce after six months • May have difficulty in § Maintaining employment § Social relationships § Normal functioning Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Complicated Grief (cont'd) • Complicated grief seen in recent widows/widowers • Show signs of: § § Major depressive disorder PTSD Panic disorder Generalized anxiety • Helpful to join support group or seek psychotherapy Adulthood and Aging Marion G. Mason Copyright © 2011 by Pearson Education, Inc. All rights reserved.