Death and Dying

A Look At Aspects of Death, Palliative Care and Grief

Changes in Leading Causes of Death in the U. S.

Life expectancy has been increased by 25 years

In 1900, infectious diseases killed most

In 2000, chronic diseases (heart disease, cancer, stroke) are major killers

Most Common Causes of Death in U. S. Heart disease Malignant neoplasms Cerebrovascular disease Chronic lower respiratory disease Accidents Diabetes Mellitus Alzheimer’s Disease Influenza and Pneumonia

Deadliest Diseases Worldwide Low-income countries Middle-income countries High-income countries

(WHO, 2004)

Biological Aspects of Death

Physiological death-when vital organs cease to function

Body shuts down Increase sleep Eat less Blood pools Breathing sporadic

Clinical death-when brain ceases to function

Aspects of Death

Social When people stop calling or visiting Even health care professionals do this

(‘circling the drain’) What to do for those who are dying?

Aspects of Death

Psychological When person accepts his or her death

and begins to withdraw Can occur much sooner than

biological death

Kubler-Ross: Five Stages of Dying

Denial Anger Bargaining Depression Acceptance

What is hospice?

Hospitality, place for travelers, home for the sick

Origins of modern hospice London Dame Cicely

Saunders Autonomy of

choice To live always Die peacefully

Saunders’ 7 Pains

Physical Spiritual Intellectual Emotional

Interpersonal Financial Bureaucratic

Palliative Care

Care for the dying Focus on comfort and pain relief

Nausea, shortness of breath Bed sores, pain Double-effect of pain medication

administration Focus on dying with dignity

Hospice Team

RN-total care MSW family/legal Chaplain CNA-bathing, grooming Physician Volunteers

(see audio clips at the end of your lesson)

Grief and Loss

Grief Anticipatory grief Grief and mixed emotions What to do for those in grief Disenfranchised grief