unit 7 - lesson 3 - Death, Dying and Bereavement...

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Unformatted text preview: Death, Dying and Bereavement Bereavement Death, dying and bereavement Death, Now we are going to move onto our final lesson of the semester. Here we are dealing with a topic that many people do not like to think about or talk about, death. We will also be discussing the process of dying and the process of grieving, also known as bereavement. Specifically we will focus on: Treatment issues Psychological responses to death: Kubler-Ross The concept of death and experience of grief Hospice care Euthanasia Cultural influences Legal and medical definitions Lifespan differences The grieving process Normal grief reactions The 4-component model The dual process model Treatment issues: Hospice care Treatment care First we are going to examine several treatment issues related to terminal illness, hospice care and euthanasia. Although individuals used to have to live out their final days in a hospital or a nursing home, there is now another option, hospice care. Hospice care is different from traditional hospital care because the focus is different. The focus is on palliative care (care focused on comfort) rather than on curative care (care focused on trying to make the person well again). Please listen to the following story on hospice care: In the traditional medical model, the focus has been on curing the person and getting the person better. Death was always viewed as the enemy. However in hospice care, death is not seen as something to be overcome or something to be avoided. It is seen as a natural part of the process. http://www.npr.org/templates/story/story.php?storyId=3613700 (18 minutes) This is a nice introduction to hospice care through a personal story. Discussion board question 1: (a) What was the primary advantage for Kitty of getting help from hospice early? Then describe another advantage of hospice care. (b) When someone decides to turn to hospice care, explain what this means for the how they view their disease and treatment. Explain what goes into a decision to turn to hospice care. (c) Explain how the job of a hospice nurse is different from the job of a nurse at a hospital. Take a look at the next slide for some of the points of focus for hospice care. Treatment issues: Hospice care Treatment Achieving a “good death” In hospice the focus is on helping the person to feel comfortable. Death is dealt with in a more positive manner. The emphasis is placed on having death with dignity. Palliative care Physical and psychological In hospice physical and psychological comfort are stressed. Pain management is usually at the top of the list of priorities. Being kept free of pain is the goal. In hospice the quality of life is selected over the quantity of life. Treatment team The goal of delaying death is abandoned and a goal of comfort is selected instead. The patient receives treatment from a team of professionals who provide medical management of their symptoms as well as psychological counseling and help with end of life issues. Family as a unit In hospice the patient and his family are treated as a unit. A good deal of support is given to the patient’s family in addition to the patient. Treatment issues: Hospice care Treatment Hospice is selected as an option only after patients and doctors agree to stop active treatment of a disease. Please listen to the following news story on hospice care volunteers: http://www.npr.org/templates/story/story.php?storyId=6651108 (9 minutes) Take a listen to the following news story on caring for kids at the end of life: Usually this occurs when the physician feels that further treatment will not help the patient to survive significantly longer or that additional treatment will not significantly improve the life of the patient. At this point the patient is given a choice and may decide that the pain of further treatment is not worth the small chance that it will help or is not the worth the few months of additional life that it may or may not bring. Or in some cases there are no real treatments available, n which case there is less of a choice involved. http://www.npr.org/templates/story/story.php?storyId=5630255&ps=rs Discussion board question 2: (a) Explain how hospice care impacts the needs of more than just the patient. (b) Explain what kinds of concerns caregivers for a terminally ill patient must deal with. (c) Please explain what you thought about the second news story and hospice care for children. (d) Describe two concerns of giving hospice care to children as opposed to adults. Be sure to address why this is usually a more difficult choice with children than it is with adults. Treatment issues: Hospice care Treatment There are different forms of hospice Hospice in a hospital Hospice in a separate facility Some hospitals have entire floors or sections of the hospital devoted to hospice care. Again the difference with these floors as opposed to other parts of the hospital is the focus of care. Although family members are welcome to be present, this type of hospice care provides hospice workers who will provide all treatment for the individual. Another alternative is a hospice facility. This is a freestanding facility that just provides hospice care. As in the hospital setting, although family members are welcome to be present, this type of hospice care will provide hospice workers who will provide all treatment for the individual. Hospice at home Finally individuals may choose to have hospice workers come to their home to help them to manage their pain and other symptoms and to help the families deal with issues related to care and death. In this type of hospice, family members usually help to provide care for the individual in addition to the hospice workers that come into the home. If family members do not or can not help to provide care then they may hire a 24 hour nurse to help to provide care. Treatment issues: Hospice care Treatment Researchers have documented several differences between people who stay at the hospital at the end of their life and those who have hospice care. 1. Less anxiety and depression 2. More time with spouses Hospice staff members are seen as more accessible than regular hospital staff. 4. Quality of life Spouses visit patients more when they are in hospice and participate more in their care than spouses of those staying in hospitals. 3. Hospice staff seem more accessible Those in hospice care are significantly less anxious and depressed. In addition they are more mobile than their hospital counterparts. Finally quality of life improves under hospice care for most individuals. Please read pages 540-544 Treatment issues: Euthanasia Treatment Now we’re going to move on to another possible treatment issue when dealing with terminal illness, that of euthanasia. Euthanasia is defined as the practice of ending life for merciful reasons. Thus euthanasia advocates believe that if a person is suffering and there is no treatment or end to the suffering then the patient should be allowed to die in order to end their suffering. In euthanasia, many feel that it is important to make the distinction between actively ending someone’s life and letting the person die. This is the difference between active and passive euthanasia. In addition both of these differ somewhat from assisted suicide. We will be examining all three of these over the upcoming slides. Treatment issues: Active Euthanasia and Physician assisted suicide Physician Active euthanasia is the deliberate ending of an individual’s life. This could be based on the person’s own wishes or it may be based on the wishes of someone who has the legal authority to make this decision. Usually this occurs when an individual is in a persistent vegetative state or when the person is at the end of a terminal disease. Examples would include giving someone a drug overdose, disconnecting them from life support, or ending a person’s life through “mercy-killing” Physician-assisted suicide occurs when a physician helps the patient to end his or her own life but it is still ultimately the patient who is taking the final step ending life. Treatment issues: Active Euthanasia and Physician assisted suicide and Different forms of active euthanasia and physician-assisted suicide are legal in different places in the United States and across the world. For example, the Netherlands were the first country in 2001 to legalize the official use of physicianassisted suicide through legislation. Physician-assisted suicide can occur under the following circumstances: Another example would include Oregon and Washington who have both passed “Death with Dignity” laws These laws allow people to request and obtain prescriptions for lethal doses of medicine This medicine must be self-administered (making it assisted suicide) The patient needs to be terminally ill and must be informed of alternatives (such as hospice care) The patient must also make a written and an oral request within 15 days of one another Within 10 years that this law was in effect in Oregon a total of 341 patients died under it Please read the following article on the Oregon’s death with dignity act The condition of the patient is intolerable and there is no hope that there will be any improvement Relief is not available The patient is competent enough to make rational decisions The patient requests this options on multiple occasions Two physicians have reviewed the case and are in agreement with the patient http://latimesblogs.latimes.com/booster_shots/2008/10/study-criticize.html Discussion board question 3: (a) According to the article, what are some of the potential concerns of an assisted suicide law? (b) How does more knowledge about hospice and more hospice potentially available influence the need for euthanasia? (c) Explain how the potential ethics and considerations of euthanasia change for someone in a persistent vegetative state and who is stable and in no imminent danger of death versus someone who is conscious, aware but dying a difficult and painful death from a progressively terminal illness. Treatment issues: Passive Euthanasia Treatment Passive euthanasia involves allowing a patient to die because of withholding treatment. Examples include: Withholding chemotherapy from a cancer patient Not performing a surgical procedure Withholding food or water Some individuals believe that it is ethically responsible to discuss the possibility of passive euthanasia in instances of patients who already have severe dementia due to a disease such as Alzheimer's disease. For example, in these cases, caregivers may decide to withhold cancer treatment from such a patient because the treatment would only prolong a very difficult and traumatizing death. Treatment issues: Passive Euthanasia Treatment Some individuals argue that any form of passive euthanasia can not really be considered passive because engaging in the act leads to the person’s death and thus all euthanasia involves actively doing something. To that end some have argued that removing a feeding tube from a terminally ill patient is morally wrong and should not be legally allowed. Courts have agreed with this idea unless the person has made their wishes known through a living will or through having a durable power of attorney. Consider the case of Terri Schiavo. Please listen to the following broadcast that occurred immediately following her death: http://www.npr.org/templates/story/story.php?storyId=4545316 (about 5 minutes) Discussion board question 4: (a) Explain your thoughts about withholding treatment for newly diagnosed cancer from a loved one who already has advanced stage Alzheimer’s disease. Would you give this treatment or withhold it? Explain your reasoning. (b) Explain your opinion about the Terri Schiavo case. Do you agree more with the parents or more with the husband on this issue? Explain which side you believe the law should have settled on. (c) Explain how religion played a role in this story and how religion plays a role in euthanasia as a whole. (d) If you were in a persistent vegetative state with no hope of recovery explain what you would want your family to decide for you. Living Wills and Durable Power of Attorney Living As the case of Terri Schiavo makes clear, it is very important that an individual makes their desires known regarding how they would want to be treated under different medical conditions. If Terri had a living will or advanced directive then there would not have been the fight that ensued between her parents and her husband. In most areas in our country, euthanasia (such as removing a feeding tube) can only occur when the person has made their wishes clear and has a durable power of attorney for health care. A durable power of attorney is someone who acts as your agent in the case of your illness or inability to communicate. This person can legally speak for you if necessary and make medical decisions for you in your are unable to do so. Kubler-Ross’s theory Kubler-Ross’s Now let’s move onto the psychological reactions that individuals have to the news that they are near death. Kubler-Ross was the first physician to focus on this issue. Initially Kubler-Ross became interested in understanding the different reactions to death that patients go through when they are faced with a terminal diagnosis when she was a psychiatry instructor in the 1960s at the University of Chicago. Please take a listen to the following news story on Kubler-Ross Please watch the following clip from Kubler-Ross http://www.youtube.com/watch?v=-ry4iIegZrU Please watch the final clip from Kubler-Ross in this series http://www.npr.org/templates/story/story.php?storyId=3871190 http://www.youtube.com/watch?v=H6yvJ_MWnJE (please just watch until 2 minutes 30 seconds, you do not need to watch the entire thing) Discussion board question 5: (a) Explain how differently doctors handled the issue of death today versus how they handled the issue in the 1960s. (b) Explain how Kubler-Ross changed the idea of death in the United States. (c) Explain how Kubler-Ross’s ideas about death were consistent with the hospice movement. (d) What were Kubler-Ross’s ideas about spirituality in children and what does she conclude about this? (e) What are Kubler-Ross’s suggestions for visiting a terminally ill patient? Kubler-Ross’s theory Kubler-Ross’s Kubler-Ross’s research was initially very controversial since physicians at the time tended to not like to discuss death with their patients and saw death as their ultimate failing or as a failing or the medical system. However Kubler-Ross persisted and ended up spending the rest of her career focusing on the process of death and dying and as the news story discusses spent her later years focusing on the issue of life after death. Initially Kubler-Ross set up her theory as a series of stages. However as she continued on in her research she realized that the stages are not universal. She found that: Not everyone goes through the same stages Not everyone goes through the stages in order Sometimes people repeat a stage several times and move back and forth between stages. Sometimes a person may be in the two different stages at once. These stages are detailed in the next few slides Kubler-Ross’s theory Kubler-Ross’s Denial “Maybe there was a mistake” Often times when people are first told of a terminal diagnosis they respond with shock and disbelief. They may feel that this diagnosis could not possibly be accurate. At this point, people may search around for a second, third, and even fourth opinion, trying to find someone who will offer them a different opinion. Eventually most people get past this feeling. Anger “Why me?” Another common response is anger. People may come to resent the health care workers who are trying to help them or family and friends. They may feel it is unfair that others get to live and that they have to die. It is likely that they feel angry about the diagnosis and then they displace that anger onto those around them. Kubler-Ross’s theory Kubler-Ross’s Bargaining Depression “If I am really good, then maybe a miracle will happen” Another common feeling that people may have is one of bargaining. They may feel that they can bargain good behavior for good health. At this point he person is looking for a way out of the diagnosis. In this case the person may try to make a deal with God and often will try to set a timetable such as, “If you just only let me live to see my daughter get married then I will be the best wife and mother in the world.” “Why bother with anything” Many people also experience depression, sadness and grief about their situation and their illness. Psychologists see this as a form of anticipatory grief in which the person is grieving his own death. If a person is able to discuss her feelings this may help her to be able to work through this phase and move on to acceptance. Acceptance “It will all be ok. There is no need to fight anymore” At this point the person accepts that death is coming and they feel at peace with that knowledge and ready for it. They may begin to make preparation for death and may start to detach from the world. They will often report feeling as though they can finally give up the struggle and rest. Kubler-Ross’s theory Kubler-Ross’s Given Kubler-Ross’s acknowledgement that the stages do not need to occur in order and are not universal for all patients, I do feel that your book does not adequately evaluate the theory. At the same time, it is important to note that KublerRoss’s theory could be used improperly by a wellmeaning individual if it was believed that all stages must be gone through in order. After additional research, Kubler-Ross emphasized that the grieving process is different for everyone and that not everyone will experience all of these feelings, nor will they experience them in order. She felt that the goal as to help the individual to achieve an appropriate death and to help her to work out each problem as it arises. After this additional research, she emphasized that her theory should be used as a series of themes to be dealt with as opposed to a series of stages through which everyone must pass. Studies have suggested that attempting to force these stages onto an individual attempting to deal with a terminal diagnosis can be very harmful to their ability to deal with the emotions that arise. Please read pages 551-556 The concept of death and the experience of grief the Now we are going to turn our attention to a new topic, the concept of death and experience of grief. First we are going to focus on cultural influences Then we will examine legal and medical definitions Finally we will explore differences across the lifespan in these ideas Cultural influences on the concept of death Cultural Culture can influence our concept of death. Various cultures have different beliefs about death. Some examples are below: In some South Pacific cultures the life force is thought to leave the body during illness and during sleep and thus death, a leaving of the life force, can occur many times throughout a lifetime before one’s final death. Among some of Papua New Guinea (specifically the Kwanga), most death is believed to result from sorcery. In Ghana, people talk about having a “good death”. A good death occurs when someone has finished all of their business and tied up all of their loose ends. Then the person can be at peace with others and with their impending death. Finally a good death occurs when they are at home surrounding by relatives. In addition culture and religion also have different rituals and customs surrounding the mourning of someone’s death. Orthodox Jews usually recite ritual prayers over a certain period of time. They also cover all of the mirrors in the house and men slash their ties to represent the loss. The Muscogee Creek tribe’s ritual includes digging the grave by hand and then once the person has been placed in the grave, everyone throws a handful of dirt over the person to symbolize one last handshake before the grave is covered. The Toraja of Indonesia encourage grieving relatives to get over their loss quickly but then people still maintain a connection to those who have died through visits in their dreams. Legal and medical definitions of death Legal Although different cultures may have varying definitions of death and meanings of death, there is a need for a common medical definition of death. Clinical death We used to rely on what we now consider to be “clinical death” as the true definition of death. A clinical death occurs when there is a lack of heartbeat and respiration. Whole-brain death However as modern medicine has advanced we need a different definition of death. According to the President’s Commission for the Ethical Study of Problems in Medicine and Biomedical and Behavioral Research (established in 1981) “whole brain death” is said to occur when several criteria are met: “No spontaneous movement in response to any stimuli” “No spontaneous respiration for at least one hour” “Total lack of responsiveness to even the most painful stimuli” “No eye movements, blinking or pupil responses” “no postural activity, swallowing, yawning, or vocalizing” “No motor reflexes” “A flat electroencephalogram (EEG) for at least 10 minutes” “No change in any of these criteria when they are tested again 24 hours later” All of these criteria must be met. In addition, all other alternative explanations such as coma must be ruled out. Finally the lack of EEG activity needs to be present both within the brain stem which is responsible for vital functions within the body and within the cortex which is responsible for thought. Whole brain death usually occurs within 8-10 minutes of clinical death. Legal and medical definitions of death Legal Social death Social death occurs when others begin to treat the person as a deceased person. For example, family members may close the eyes of the deceased person. The body of the deceased person may be moved to a morgue at this point. Persistent vegetative state A persistent vegetative state occurs when the person’s EEG functioning in the cortex is absent but the EEG functioning in the brain stem is still functioning. In this case the person can not think but the vital functions of the body continue to work. This individual is not considered to be clinically dead. Some philosophers believe that the whole brain standard does not reflect the importance of the cortex in making us human. They suggest that we need to adopt a new standard that would follow a “higher brain standard” so that when an individual’s cortex stops functioning, they can be declared dead. However other philosophers believe that the whole brain standard still needs to be met to fully define true death. Conception of death and the experience of grief over the lifespan grief Death is understood differently at different points across the lifespan. How you think about death now is probably very different from how you thought about it as a child and is also different than how you will think about it 20 years from now. Usually we do not confront the possibility of our own death until we have experienced the death of a parent. Most people rely on the assumption that their parents will die before they do and so as long as their parents are alive they provide some sort of buffer from their own death. Once people have experienced their parents’ deaths then they realize that they are the oldest generation in the family and are next line to die. As friends and acquaintances begin to die, they realize that the ages of the deceased friends and relatives are similar to their own. At some point during middle age, the individual changes the way he thinks about time. He once thought of time in terms of how much of life he had spent living already and now he adjust to thinking about time in terms of how much time he has left. Older adults tend to be more accepting of death than any other age. This may be related to ego integrity that we discussed in the last lesson. In addition, they have also experienced more loss than any other age group and consequently have had more time and experience in coming to terms with their own mortality. After that general overview of how one views their own death, let’s talk more specifically about the concept of death and also the experience of grief across the lifespan. We’ll start with childhood on the next slide. Conception of death and the experience of grief over the lifespan: Childhood grief During the preschool age children tend to think about death as something that is temporary, a state that one could awaken from. Usually between the ages of 5-7 children begin to realize that death is permanent and that it means that one no longer has any biological functioning. A child between the ages of 9-10 usually realize that death is universal and that it happens to everyone. The socioemotional stage of the child may also influence of they deal with death. For example, a child who loses a person close to them when they are in their initiative versus guilt stage may come to think that they are somehow responsible for the death and may feel guilty over the death. Conception of death and the experience of grief over the lifespan: Childhood grief Children can show their grief in many ways. Somatic effects Psychological effects Emotional distress and depression, separation anxiety, fear that other people around them will also die, learning difficulties, etc. Behavioral effects Sleeping troubles, changes in eating patterns, stomach-aches bed-wetting, headaches, etc. Regressive behaviors, explosive emotions, temper tantrums, extreme shyness or disinterest in play, a need for over-attention, etc. When handling a death with children: When discussing someone’s death with a child, they need to be told about it in a straightforward way. Using euphemisms such as grandma is “sleeping” or she has “gone away” are a bad idea because children can take these literally and then develop additional fears. In addition it is important for adults to make sure that children understand that whatever their reaction is, it is ok and acceptable. Children need to know that it is ok to cry or be sad. Research suggests that going to a funeral is important for children. Even though they may not fully understand what is going on or have fears or discomfort during the funeral itself, their overall recovery from the death seems to be enhanced if they are allowed to attend the funeral. Conception of death and the experience of grief over the lifespan: Childhood grief Please watch the following clip from Katie Couric Take some time to visit and look around the sesame street site on grief http://www.cbsnews.com/8301-500803_162-20002553-500803.html?tag=mncol;lst;7 (30 minutes) http://www.sesamestreet.org/parents/grief Discussion board question 6: (a) Describe three general suggestions from the clip for helping kids to deal with the death of a parent (make one of them specific to the death of a parent who has been chronically ill). (b) Describe one misconception that children can have about death. (c) According to Elmo, explain two things that children can experience when they are grieving. (d) Explain two ways in which parents know that their grieving children need additional help. (e) Explain one suggestion for people who are supporting a grieving family. (f) Please describe your thoughts about the resources present on the sesame street website. (g) Describe two suggestions from this site that are different from what you already discussed above. Conception of death and the experience of grief over the lifespan: Adolescence grief Although many people think that adolescents have limited experience with death, studies show that between 40-70% of adolescents will experience the death of someone close to them during their college years. Most teenagers and young adults associate death with a traumatic event rather than a long drawn out illness. This is how they tend to think about death because of their relative lack of experience with chronic illness. Grieving among teenagers Teenagers may have trouble making sense of death, especially if it is the first time they have experienced it. The effects of bereavement can be especially severe in adolescence and can lead to long-term depression, chronic illness, low self-esteem, lasting guilt, problems in relationships and problems at work and school. When an adolescent loses a sibling or a parent, they may be particularly less likely to want to talk about it with others. This may result in higher incidents of somatic issues. Adolescents need to also learn how to respond to others who do not want to talk about it or to others who tell them that they need to just get on with their lives. When an adolescent loses a friend they may be particularly likely to experience survivor’s guilt. Conception of death and the experience of grief over the lifespan: Young Adulthood grief Young adults also have a difficult time dealing with death, especially when it comes to acknowledging the possibility of their own death. This is probably because young adults are working hard at establishing themselves in the world and believe that they would be cheated out of their futures if they were to lose their lives at that point. Similar to the feelings of invulnerability that adolescents feel, young adults also often feel a unique sense of invulnerability and feel that they are immune from death. Young adults tend to have an increased fear of death than adolescents. This may be because they have experienced the death of someone close to them, which made death more of a reality. Conception of death and the experience of grief over the lifespan: Young Adulthood grief Grieving in young adulthood: Losing a spouse Young adults who lose a spouse have an especially difficult time in dealing with death. This is compounded when that young adult has a child or children. These adults must deal with death at an unexpected time in their lives and so that unexpected nature can contribute to the difficulty in their experience. In addition, these young adults who have children must deal with their own grief as well as with their children’s grief. Also the children can be a constant reminder to the parent of a deceased spouse. Young adults who lose a spouse typically do not report diminished grief for 5 to 10 years after the loss. Making meaning out of the death is particularly important and these young adults will continue to revise that meaning over time. Please watch the following CBS news video on war widows http://www.cbsnews.com/video/watch/?id=4126862n&tag=related;photovideo Discussion board question 7: (a) Describe two issues that these widows discuss as difficulties. (b) Explain why you believe that other people on the base shun these widows. (c) Explain how maintaining a connection to the community enables them to cope better with their loss. Conception of death and the experience of grief over the lifespan: Middle Adulthood grief In middle adulthood death becomes much more realistic. Middle aged adults become aware of the finite nature of life because they have had more experience with death. Fear of death is typically highest during this stage of life. One’s own immortality breaks down and anxiety rises. Losing a child Children are supposed to outlive their parents and thus when parents lose a child this can be particularly traumatic. The natural order of life seems to be violated. Whereas usually a loss of a child is readily acknowledged and accepted by society as producing extreme grief, other examples of losing a child are not so readily acknowledged and this too can cause problems. For example, losing a child during birth or immediately after birth or even during pregnancy (due to miscarriage or even abortion) can create very strong grief reactions in the parents. It is clear that attachment begins before birth. When these deaths are not acknowledged by friends and family, parents can be left to feel even more grief. These parents are expected to recover more quickly and can feel even worse when they do not conform to expectations. It is important to validate one’s personal feelings of grief and acknowledge the death with ritualistic processes that one would take if an older child had died. This can help the parents to process some of their grief. However most parents report that they never fully resolve their feelings of grief over a lost child. Please watch the following video: http://www.youtube.com/watch?v=L1Rky9jGzhM Discussion board question 8: (a) Explain why you think that Jessica’s mom put this video up on youtube. How does this type of project help parents to deal with their grief? (b) Explain why you believe losing a child is the most difficult kind of loss to deal with. (c) Explain why society tends to treat parents who have lost a child during pregnancy or childbirth differently than a parent who has lost an older child. (d) Describe two more suggestions that parents can do help to Conception of death and the experience of grief over the lifespan: Middle Adulthood grief Losing a parent Losing a parent is a rite of passage for middle aged adults. It works to redefine oneself and one’s relationships with others. It also redefines the self within the generational order as the oldest generation and thus by implication the next generation in line to die. Losing a parent deprives people of A source of guidance and advice A source of love A model for one’s own parenting style An opportunity to improve or repair a relationship with a parent The loss of an older parent is different from the loss of a younger parent. When a person loses a younger parent, they often report a sense of lost time and opportunity with that parent, especially when they have young children. Middle aged adults in this situation often report that they feel they have missed out on the opportunity to provide a relationship between their parents and their children. When a person loses an older parent there is often a sense of letting go of the person and a sense of relief that the suffering of the older parent is over. However there is also a sense of loss and a sense that one no longer has a “buffer” against their own death. Eventually many middle aged adults report that losing an older parents helps them to better accept the reality one’s own death. Conception of death and the experience of grief over the lifespan: Late Adulthood grief Older adults tend to have less fear of death than middle aged adults. They have had more time to think about it and process it and prepare for it. In addition, they have had even more experience with it than middle aged adults. Individuals in late adulthood tend to have more fear over the period of uncertainty immediately before death than of death itself. They tend to worry about their degree of incapacity before death and who will take care of them. They also will often report not wanting to be a burden on their family in the time immediately before death. Conception of death and the experience of grief over the lifespan: Late Adulthood grief Loss of one’s partner later in life This usually represents a deep personal loss. When a couple has been together for a long time, the death of a partner represents a loss of part of the self. Although death may be more expected during this time frame, even older adults grieve their spouses for long periods of time, at least 30 months is average. Studies have shown that depression following the loss of a spouse in older adulthood is often positively related to the strength and positivity of the relationship. The better the relationship was, the more depression tends to occur following one partner’s death. Some older adults will “sanctify” their spouse after death. This tends to occur among especially women who have lost a husband. When this occurs the widow sees her husband in idealized ways. This provides validation for the widow that she had a good marriage and that she is, by association, a good person as well. Older bereaved adults who can discuss their feelings with someone often find a reduced sense of hopelessness and intrusive thoughts. Discussing the loss can help a person to make sense of the loss and deal with their feelings. Again a key in the grieving process seems to be the ability to find meaning in death. Please read pages 544-551 The grieving process The Grief is an active process. In order to work their way through the process, people must accomplish several tasks. Acknowledge the reality of the loss Work through emotional turmoil People experience a wide range of emotions following the loss of someone. It I important that the bereaved feel free to express these emotions and not try to repress them or avoid them. Adjust to a pattern in which the deceased person is no longer there Initially many people have a difficult time acknowledging that the loss has actually occurred. In the initial days and sometimes weeks, the individual may have a difficult time simply acknowledging that the loss has occurred. The bereaved person must adjust to a life without the deceased person. The bereaved person must develop new patterns and habits that do not include the deceased person. As they are developing those habits they will most likely be continually reminded of their loss. Loosen one’s ties to the deceased person The bereaved person must loosen their connection and bond with the deceased person so that they can reengage with their social network. The bereaved person needs to find an effective way to say goodbye. The grieving process The It is important to remember the following about grief: 1. It is a process. This means that it can take a very long time to complete and that it can change form over time. 2. It is highly individual. Grieving occurs differently in different people. What works out well for one person may not work at all for another person. 3. Do not underestimate the amount of time it takes to get back to normal. A survivor may seem to be back to him or herself after a few weeks but this is rarely the case. It takes much longer to work their way through the grief process and the complex emotions accompanied by it. Researchers find that a person needs a minimum of a year following a loss to work through the grieving process and that two years is not uncommon. In addition, it may take substantially longer than that under different circumstances (e.g., for example in the case of the loss of a child). 4. “Recovery” is not what one should be looking for following the grieving process. It is difficult to say that we ever recover from a severe loss such as losing a spouse, parent or child but rather it is more accurate to say that we “learn to live with” the loss. The impact of the loss can continue throughout the rest of one’s life. The grieving process The There are some risk factors that place people at risk for a particularly difficult or traumatic grieving process. Mode of death Strength of attachment It is commonly believed that if you have time to anticipate someone’s death then it is easier to process than when the death occurs suddenly and unexpectedly. However research on this is mixed. Some research has suggested that the degree of anticipation or expectation does not influence the degree of grief after the person has passed away. Other research has shown that death that is anticipated can sometimes result in less depression. As your book discusses, death occurring from violent or sudden deaths often leads to more stressful grief responses. The stronger the attachment was to the person who died, the stronger the grief reaction tends to be. However with strong and secure attachment also generally comes a decreased risk of long-term depression following the death. This seems to be because someone with a secure attachment has less guilt due to unresolved issues or things not provided etc than someone with a poorer attachment. Church attendance or spirituality Church attendance and a sense of spirituality seems to alleviate grief to some degree. However it is unclear whether this is due to religious beliefs or the strong social support that accompanies service attendance. The grieving process The Relationship to the deceased person Gender The type of relationship that the individual had to the deceased person seems to have a strong effect on the degree of grief. Parents who lose a child report the most grief and this is followed by the loss of a spouse and then the loss of a parent. Men have higher mortality rates following the death of someone close. Some studies suggest that women have higher rates of depression and other studies suggest that men have higher rates of depression. Men also have a more difficult time than women do returning their former levels of emotional functioning than women do. Differences in social relationships may account for some of these differences. In addition, as your textbook discusses, some research has shown that men use alcohol at a higher rate than women do following the death of a spouse and this can also contribute to higher rates of depression among men. Age People who are older experience the fewest health consequences and middle aged adults tend to experience the most health consequences following the death of someone close. Normal grief reactions Normal Although people typically expect sadness and loss as feelings one might experience during the grieving process, the emotions that one experiences tends to be much more complex than simple sadness. Researchers have identified a number of common emotions following the death of someone close. Sometimes these emotions can be confusing or considered unacceptable by the bereaved person or those who are supporting the bereaved person. They include: Disbelief, denial, shock Sadness, anger, hatred Guilt, fear, anxiety Confusion, helplessness, emptiness Loneliness, acceptance relief Happiness, lack of enthusiasm, absence of emotion Discussion board question 9: (a) Explain why you think such a wide variety of emotions occurs during the grieving process. (b) Explain what advice you would have for someone who is grieving and experiencing conflicting emotions. (c) Explain what you can do to support a person who is grieving. Some researchers have tried to identify what occurs during the grieving process. These models are the four component model and the dualprocess model. These will be examined in the upcoming slides. Four component model Four The four component model suggests that four different components influence the grieving process. The context of the loss Continuation of subjective meaning associated with the loss This refers to changes in how the bereaved person views the loss of the relationship. The role of coping and emotion regulatory processes This ranges from the everyday concerns to questions about the meaning of life. Changing representations of the lost relationship over time This includes factors such as whether the loss was expected. This refers to the breadth of coping techniques and emotions that occur during the grieving process. The four component model suggests that grief is a complex process that unfolds over time and is influenced by many factors. Dual process model Dual The dual process model suggests that there are two broad types of stressors that accompany the grieving process. Loss-oriented Loss-oriented stressors focus on the loss itself and includes things such as grief work, intrusion of grief, breaking the bonds with the deceased person, denial or avoidance of restoration changes. Restoration oriented Restoration-oriented stressors focus on adapting to one’s new situation and includes things such as attending to life changes, doing new things, distraction from grief, denial/avoidance of grief, and new roles, identities or relationships. The dual process model suggests that bereaved people cycle back and forth between the two orientations. This model emphasizes a continual changing grief process that changes from dealing with the loss itself and also dealing with moving on. Please read pages 556-569 ...
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unit 7 - lesson 3 - Death, Dying and Bereavement...

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