Chapter 19:

Death, Dying, and Bereavement

Death anxiety?

“According to most studies, people's number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy.” Jerry Seinfeld

The Experience of Death

Characteristics What

How is death defined?

Where How

The Experience of Death

Characteristics What Where

Where do most people die?

How

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 Medical care is palliative rather than curative

HospiceHospital-based and Home-based Care

Comparison

Hospital-Based Care Home-Based Care

Patient Pain Same Same

Length of Survival Same Same

Patient Satisfaction with Care

Same Same

Family Satisfaction with Care

Higher Lower

Family Sense of Burden Higher Lower

Hospice

The Experience of Death

Characteristics What Where How

Developmental understanding of death Process of dying

Preschoolers: reversible

School-agers: permanent and universal

Adolescents: inevitable; sometimes unrealistic

Early adulthood: unique invulnerability; challenged by early death

Middle and late adulthood: finality, inevitability, universality Who has greatest death anxiety?

Developmental Understanding of Death

What would you do about your impending death? (see Table 19.2)

1. Make a marked change in lifestyle (travel, new experiences)

2. Center on inner life (read, pray)

3. Be with others.

4. Attempt to complete projects.

5. No change in lifestyle.

Figure 19.1 Age, Ethnicity and Fear of Death

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?

Questions To PonderQuestions To PonderQuestions To PonderQuestions To Ponder

The Process of DyingPreparation for Death

Kinds of preparations Practical preparations Deeper preparations Older adults more likely to have made

these arrangements

Theoretical Perspectives on Dying Elisabeth Kubler-Ross’s Stages of Dying

Responses to Impending Death

Greer: Female cancer patients

Five groups Denial (positive avoidance) Fighting spirit Stoic acceptance Helplessness/hopelessness Anxious preoccupation

“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 Grieving Attachment Theory

Bowlby: Four stages of grief

Figure 19.2 Jacobs’s Model of Grieving

Theoretical Perspectives on Grieving Wortman and Silver

Normal Chronic Delayed- 1-5% Absent- 26%

So distress is neither inevitable nor necessary for normal grieving

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

Factors Associated with Grief

Age of the Bereaved Teens often show prolonged grief responses

Modes of Death Death with intrinsic meaning reduces

grief. Sudden and violent or suicide

Gender Incidence of depression among widows

and widowers rises substantially Death of a spouse more negative for men

Theoretical Perspectives on Grieving Pathological Grief

Depression-like symptoms lasting longer than 2 months can lead to long-term depression and

physical ailments may continue for up to 2 years after death

of loved one BUT cultural practices may mimic

pathological grief

Funeral Rites

“Have the courage to live. Anyone can die.” Robert Cody

“I want to die in my sleep like my grandfather... Not screaming and yelling like the passengers in his car.” Will Shriner

“Some die too young, some die too old; the precept sounds strange, but die at the right age” Friedrich Nietzsche

“Death is caused by swallowing small amounts of saliva over a long period of time.” George Carlin

No one can confidently say that he will still be living tomorrow. ~Euripides

From my rotting body, flowers shall grow and I am in them and that is eternity. ~Edvard Munch