Flashcards in Exam 1 Deck (53):
1. What is life expectancy?
a. Average amount of time that a member of a particular cohort can expect to live
life expectancy in 1900 vs now?
1900 = 47
Now = 78-79
4. How have the causes of death from the 1900 to today impacted trajectories of dying?
a. Early 1900s more people died from acute conditions = acute trajectory
b. Now = lingering trajectory
What is longevity?
a. The maximum amount of time that a member of a given species can live (122 years)
6. What has contributed to longevity?
c. Improved nutrition and sanitation
d. Life extending technologies
7. What is geographic mobility and how has it impacted familiarity with death?
a. Movement of people from one location to another over time
i. Less likely to be present for death
ii. Loss of shared rituals
iii. Less intergenerational contact
8. How have life-extending technologies impacted familiarity with death?
a. Changes our understanding of the dying process
b. Less familiar with “natural” dying process
9. How has location of death changed from the late 1800s and 1900s to now? (Where did people die then and where do majority of people die now?)
a. 1800s, early 1900s – death was at home
i. Family members surrounded by multiple generations and would take more part in taking care of the body for burial (front parlor).
b. Now – death more often in hospitals or nursing homes
10. How does Freud’s early psychoanalytic theory explain death anxiety?
a. Humans are not really anxious about death.
b. unconscious does not respond to passage of time, so death (end of personal time) does not register.
c. cannot comprehend our own annihilation, so the anxiety we have just seems like it’s about death.
d. Castration anxiety – fear of losing value, love and security by being less than a whole person
e. We can’t really fear death because we can’t comprehend death experientially before it happens.
11. How does Terror Management theory explain death anxiety?
a. Awareness of mortality is the basic source of anxiety
i. Unsettling unknown process.
ii. biological instinct to survive which brings up anxiety about death.
iii. In order to not be overwhelmed by death anxiety, we try to control it in 2 ways:
1. Keeping up self-esteem
2. Becoming part of an entity greater than our self
a. Reason why we have religion beliefs about death and what happens after instills meaning, purpose, order, and predictability.
iv. Advantage of death anxiety
1. Edge theory (emphasizes adaptation and survival) – distinguishing between everyday low-level anxiety and heightened states of arousal.
12. How does Edge theory explain death anxiety?
a. Edge theory (emphasizes adaptation and survival) – distinguishing between everyday low-level anxiety and heightened states of arousal.
13. What are the issues with measuring death anxiety?
a. Scores are difficult to interpret.
b. Questions can be confusing
c. Self-report bias
d. Studies don’t sample diverse populations
e. Doesn’t give understanding of how scores might change over time
14. How does death anxiety differ among gender
i. Women score higher than man on death anxiety scales
ii. Doesn’t mean they are more anxious but in general women report more and are in touch with senses better
How does death anxiety differ among age
i. Adolescence and early adulthood
1. High anxiety
2. Report a sense of being cheated by death
ii. Early middle-age
1. Anxiety decreases – life is more settled and predictable
2. Later middle-age, 50s
a. Anxiety increases
b. Undergo change in sense of time
c. Become more aware of own mortality
d. For women end of reproductive cycle
3. Older adults, 60+
a. Anxiety decreases
b. Life is more settled and predictable
14. How does death anxiety differ among religiosity?
i. In later adulthood, people with firm beliefs or disbeliefs in religion and after life report less death anxiety than those with doubts or moderate beliefs
15. What is situational death anxiety?
a. Transitional situation (moving, graduating)
b. Encounter with life-threatening illness, accident (get cough - think its cancer again)
c. Death of loved one
16. What are three ways to deal with death anxiety?
i. Live a meaningful life
ii. Increase death awareness
1. Activities: writing own obituary, planning funeral
2. Death education
3. View movies/documentaries about death, dying, and grief
a. Clinical death?
cessation of heartbeat and breathing
b. Harvard Criteria for Brain death
i. Unreceptive and unresponsive
ii. No movements and no spontaneous respiration or spontaneous muscular movement
iii. No reflexes
iv. Flat EEG
v. No circulation to or within brain
What did Kastenbaum et al., (1971 and 1996/7) find in his 2 studies on “How we personify death?”
• 1971 study
o Respondents were most likely to see death as “a gentle, well-meaning sort of person.” The “grim, terrifying” image was the least frequently selected
o Death was usually personified as a relatively old person
o Masculine representations are more common than feminine representations
• 1996/7 study
o Death is still represented as predominantly male
o Women continue to favor the image of death as the gentle comforter
o Men often describe death as “cold and remote”
o Men were also more likely to see death as “grim and terrifying”
o Still viewed as a relatively old person
How do personifications of death help individuals and societies cope with death?
Objectifying an abstract concept
• Expressing feelings that are difficult to put into words
• Serving as a coin of communication among people who otherwise would hesitate to share their feelings
• Absorbing some of the shock, anger, pain, and fear that is experienced as a result of traumatic events
• Providing symbols that can be repeatedly reshaped to stimulate emotional healing and cognitive integration
20. What are the signs and symptoms of dying? (ones from lecture)
a. Fluid and food decrease
b. Decreased socialization
c. Increased sleep
g. Urine decrease
h. Changes in breathing pattern
i. Congestion: Death Rattle
j. Color changes
k. Temperature changes
l. Permission to go
m. Hearing is the last sense to leave the body
21. Elisabeth Kubler Ross’s stage/DABDA theory,
• Anger (displaced hostility)
• Bargaining (with universe or higher power
o Reactive: reaction to past loss in disease process.
o Preparatory: response to awareness of preparing for death.
• Acceptance (of the reality)
• There is a strand of hope interwoven throughout the stages
• Might not experience all stages
• Some overlay
• There is nothing you can do.
Kubler ross criticisms
o No evidence has been presented that people actually do more from Stage 1 through Stage 5.
o The limitations of the method have not been acknowledged.
o The line is blurred between description and prescription.
o The totality of the person’s life is neglected in favor of the supposed stages of dying.
o The resources, pressures, and characteristics of the immediate environment can also make a tremendous difference.
Corr’s contextual theory of dying/developmental coping model of the dying process.
4 tasks or challenges:
1. Physical – pain, nausea, etc.
2. Psychological – emotions, loss of sense of control, etc.
3. Social – help person keep social connections
4. Spiritual – maintaining sense of connectedness, sense of meaning
ii. Advocates greater empowerment for the dying person and caregivers/family
Glaser and Straus’s Awareness of Dying Model
Context of awareness about dying shapes communication styles.
• Closed awareness: person is not aware of his/her impending death, but others may know.
• Suspected awareness: a person suspects prognosis but it is not verified by those that know.
• Mutual pretense: everyone recognized death is the outcome, but pretends everything is ok.
• Open awareness: death is acknowledged and openly discussed.
24. Doka’s Phase based Task Model of Coping with Illness
a. Pre-diagnostic phase – indicators of illness; What will I do about this
i. Seek medical advice
ii. Seek advice from others
iii. Ignore symptoms
b. Acute phase
i. Understand the disease
ii. Maximize health and lifestyle
iii. Optimize coping strategies
iv. Explore impact of diagnosis on self and others
v. Express feelings and fears
vi. Integrate present reality into sense of past and future
c. Chronic phase
i. Manage side effects and symptoms
ii. Manage stress and examine coping behaviors
iii. Normalize life to extent possible in face of disease
iv. Maximize social support and preserve self concept
v. Express feelings and fears
vi. Find meaning in uncertainty and suffering
d. Recovery phase
i. Dealing with ongoing impact of illness
ii. Dealing with anxieties of it coming back
iii. Redefining relationships with caregivers
e. Terminal phase
i. Manage discomfort
ii. Make treatment decisions
1. Navigating systems: insurance
iii. Manage stress and examine coping behaviors
iv. Prepare for death and say goodbye
v. Sustain self-concept
vi. Finding meaning in life and death
25. What type of care does hospice emphasize?
a. Comfort care and pain management
26. Who is on a hospice team?
a. Volunteers, therapists, nurses, social workers, etc.
27. Who does hospice serve?
a. Medicare, Medicaid, Private Insurers, Donations
28. What are the various locations where a person can receive hospice care?
a. Home, care facility, or hospice facility
29. How does a person qualify for hospice care?
a. 6 month terminal diagnosis and no longer seeking curative treatment
30. What is the history behind the current hospice movement and model that we have in the U.S.?
a. 19th century: France, London – focus on pain control
b. 1967: St. Christopher’s Hospice, Dame Cicely Saunders, London – comfort and pain control needs addressed
US BASED OFF OF THIS - holistic care
c. 1969: Kubler Ross writes On Death and Dying, makes an argument for home-based care.
d. 1972: Kubler-Ross testifies at senate hearing about care for the dying
e. 1974: Florence Wald starts Connecticut Hospice
f. 1986: Permanent hospice benefit
31. What are the barriers to accessing hospice care?
b. Difficulty with stopping life-sustaining treatments
c. Family or personal reluctance
d. Late referrals
e. Difficulties with determining 6 month diagnosis
f. Reluctance of physician to stop treatment
g. Trust in physician
h. Cultural and religious barriers
i. Underserved populations – homeless, prison
j. Lack of education (or myths) about hospice
k. Stigma: AIDS (1980s)
32. What is palliative care and what are the differences between palliative and hospice care?
• Palliative care:
o comfort care and pain relief
o emotional and spiritual support for person receiving care and family
o longer conversations about illness process
o improve quality of life.
• Life threatening illness
• Can still seek curative treatment
• Usually in a facility: hospitals
• Terminal illness with a 6-month diagnosis
• Can no longer seek curative treatments
• Home care facility/home
34. What is a persistent vegetative state?
a. No cortical functioning (higher processes such as thinking), but brainstem activity (heartbeat, respiration).
generally a person does not recover
35. What is the Patient Self-Determination Act and 4 items that the act emphasizes?
• For Medicare and Medicaid healthcare institutions
• Recognizes a mentally competent adult’s right to refuse life support procedures.
• Individuals are entitled to select representatives who will see that their instructions are carried out if the individual if not able to do so.
o Provide summary of healthcare decision – making rights
o Inquire about advance directive completion.
o Educate staff about advance directives.
o Won’t discriminate against patients based on advanced directives status.
36. What does the durable power of attorney for healthcare document do?
For Medicare and Medicaid Healthcare Institutions
i. Provide summary of Healthcare decision-making rights
ii. Inquire about advance directive (AD) completion
iii. Educate staff about advance directives
iv. Won’t discriminate against patients based on AD status
37. What are advance directives?
a. Umbrella term for end of life documents
b. Mainly refers to:
i. Living will: wishes concerning medical treatment
ii. Power of attorney for healthcare: appoints someone to speak on your behalf if you are unable to communicate
38. What is a living will?
a. Wishes concerning medical treatment
39. What are the barriers to completing an advance directive?
a. Discomfort with the topic
b. Belief that doctors should initiate conversation
c. Physician reluctance to initiate conversation
d. Beliefs and practices of AD not being followed
e. Cultural barriers
f. Lack of education about AD
i. No knowledge about the document
iii. Document is unclear
iv. Feels to binding
v. Feels like it only concerns older adults
What is an anatomical gift?
• Donation of all or part of human body.
What are the five factors that restrict the number of successful organ transplantations?
• Willingness of people to donate.
• Condition of the donated organs
• Biological match between donor and recipient to avoid rejection
• Whether the overall condition of the recipient is strong enough to ensure survival with the new organ; even if it is not rejected
• Expense and timely delivery.
42. What are the 4 types of suicide that Durkheim identified? How does the concept of social integration connect to Durkheim’s classifications?
i. Social integration: degree to which individuals are included or integrated into society
ii. Four approaches:
1. Egoistic – not enough involvement with society
2. Altruistic or Institutional – excessive concern for community
a. E.g. suicide bombers
3. Anomic – relationship between an individual and society is suddenly shattered; failure of social institutions
4. Fatalistic – over controlled by society
a. E.g. slavery or lack of women’s rights
43. What are the grief experiences that are unique to a person grieving a suicide?
a. Feelings of abandonment and rejection
c. Shame and stigma (self and others)
d. Hiding mode of death
e. Blaming (self and others)
f. Guilt (is there anything I could have done?/relief)
g. Searching for Meaning-Making sense
h. Overdose: question over categorizing as suicide
i. Increased self-destructive behaviors or suicidality
a. Number of suicides per day in the U.S
b. Most used method of suicide
c. Gender and attempts and completion rates for suicide
i. Death by suicide is more likely to occur among males
1. Women attempt suicide more often than men, but men complete suicide more often than women
2. Connection to mode of suicide
a. Women: poison
b. Men: firearms
suicide trends: race
i. White males at greatest risk, then Native Americans
trend in locations of suicides
West: Wyoming, Alaska, Montana
o Lapsed into a coma after a party April 14, 1975
o Started to breath again but did not return to consciousness.
o Suffered severe and irreversible brain damage as a result of oxygen deprivation.
o Physicians wouldn’t turn off ventilator despite family’s wishes.
o Was in persistent vegetative state for 10 years.
brought right to die issue to the public
o Supreme Court issues its first direct ruling on the subject 15 years after the Quinlan case brought the right to die issue to public attention.
o Critically injured in a car accident.
o Paramedics were able to revive her repiration and cardiac functions, but she was unresponsive.
o 3 weeks later she could grimace, display motor reflexes, and take a little nourishment by mouth but she could not respond to conversation, express thoughts andneeds, or engage in either verbal or nonverbal communication.
o Physicians would not disconnect her feeding tub and hydration.
o Case went to supreme court.
o Treatment would remain because she did not prepare a living will
• Nancy Cruzan