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Chapter 19:. Death, Dying, and Bereavement. In This Chapter. The Experience of Death Death Itself. Characteristics Clinical death Brain death Social death. The Experience of Death Where Death Occurs. Hospitals in the U.S. (45%) Decedent’s home (25%) Long-term Care (22%)

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chapter 19

Chapter 19:

Death, Dying, and Bereavement

the experience of death death itself
The Experience of DeathDeath Itself

Characteristics

  • Clinical death
  • Brain death
  • Social death
the experience of death where death occurs
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 death hospice care
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 care types of hospice care
Hospice CareTypes of Hospice Care

Home-based programs

Hospital-based programs

Special hospice centers

Hospice

hospice hospital based and home based care comparison
HospiceHospital-based and Home-based Care Comparison

Let’s take a minute to review some of these comparisons.

dying death and bereavement hospice care
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
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
The Meaning of Death for AdultsDeath 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
Stop and Think!

At what age do you think people are most fearful of death?

What prompted your answer?

fear of death
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
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 death personal worth
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?

slide17

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Questions To Ponder

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?

the process of dying preparation for death
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 dying preparation for death1
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
Theoretical Perspectives on Dying Criticisms of Kubler-Ross’s Theory

Methodological problems

Cultural specificity

Stage concept unsupported

theoretical perspectives on dying alternate views
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
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 death1
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 dying psychoanalytic theory
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
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
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 theory2
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 theory3
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
Theoretical Perspectives on Grieving Patterns of Grieving

Wortman and Silver

  • Normal
  • Chronic
  • Delayed
  • Absent
theoretical perspectives on grieving the experience of grieving death rituals
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
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
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
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
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
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
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.