Chapter 16

How do feelings about death change over adulthood?

- Cognitive developmental level is important for understanding how young adults view death and the lessening of feelings of immortality. • Middle-aged adults usually experience the death of their parents and begin to confront their own mortality, undergoing a change in their sense of time lived and time until death. • Older adults are les anxious about and more accepting of death.

What feelings do grieving people have?

- Dealing with grief, called grief work, usually takes more time than society wants to allot. Grief is equally intense for both expected and unexpected death. Normal grief reactions include sorrow, sadness, denial, disbelief, guilt, and anniversary reactions. • How people demonstrate grief varies across cultures.

How do people cope with grief?

- Three general approaches help explain how people cope with grief. • The four-component model is based on the processes of: the context of the loss; continuation of subjective meaning of the loss; changing representations of the lost relationship over time; and the role of coping and emotion regulation processes. However, the grief work as rumination hypothesis rejects the need for grief as a basis for recovering form loss. • The dual process model integrates existing ideas about stress into the context of loss and restoration. These stressors operate in a dynamic relation.

What is a DNR?

A do not resuscitate order

________ is an approach to assisting dying people that emphasizes pain management, or palliative care, and death with dignity.

Hospice

________ are most likely to face the death of their parents.

Middle-aged adults

___________ involves describing a deceased spouse in idealized terms.

Sanctification

Compared with other age groups, ________ are especially reluctant to talk about their grief experiences.

adolescents

Feeling sad on the date when your grandmother died the previous year is an example of a(n):

anniversary reaction

The most devastating type of loss for an adult is the loss of a(n):

child

What term defines a lack of heartbeat or respiration?

clinical death

The ________ acknowledges individual differences and rejects broad generalizations.

contextual theory of dying

In general, older adults are less anxious about ________ than other adults.

death

Which event is more likely to result in long-lasting grief that may interfere with the ability to function?

death of a child

What are the stages Kübler-Ross identified that explain people's reactions to death?

denial, anger, bargaining, depression, acceptance

An important issue in bioethics that often affects the very ill is:

euthanasia

Making choices known about what people do and do not want their lives to end constitutes a(n):

final scenario

What condition consists of feelings such as sorrow, anger, and confusion arising after suffering the loss of a loved one?

grief

In general, adults should be ________ when discussing death with children.

honest

In a(n) ________ a person states his or her wishes about life support and other treatments.

living will

Which group has a higher mortality rate following bereavement?

males

Compared with other age groups, ______ show the most negative effects following bereavement.

middle-aged adults

Which age group tends to suffer the most health consequences after bereavement?

middle-aged adults

As opposed to hospital patients, hospice patients are likely to be more:

mobile

Peggy wears a black dress to attend a funeral. Peggy is engaging in:

mourning

Seventy-five-year-old Janet, who lost her husband after 55 years of marriage, has been grieving her loss for almost 2 years. This is:

not abnormal for this age group

What common occurrence during middle adulthood causes one to start thinking about his or her own mortality?

parents' death

Disconnecting a life-support system to a terminally ill person is called:

passive euthanasia

Withholding an antibiotic from a person who dies as a result is an example of:

passive euthanasia

It is possible for a person's cortical functioning to cease while brainstem activity continues; this is a:

persistent vegetative state

Flying a flag at half-staff is an example of a(n) ________ definition of death.

sociocultural

The primary framework for studying death anxiety is:

terror management theory

The primary theory for understanding death anxiety is:

terror management theory

The difference between brain death and a persistent vegetative state is:

the brainstem still functions in a persistent vegetative state

What did Corr's holistic approach to dying emphasize?

the importance of coping efforts of everyone around the dying person

Separation distress and ________ are two characteristics of complicated or prolonged grief disorder.

traumatic distress

Bereavement during childhood:

typically does not have long-lasting effects

The most widely accepted definition of death is _______ death.

whole brain

End-of-life expenses are typically less for those:

with advance directives

How do adolescents deal with death?

• Adolescents may have difficulty making sense of death and are often severely affected by bereavement. Adolescents may be reluctant to discuss their feelings of loss, and peers often provide little support.

What are the types of ambiguous loss?

• Ambiguous loss refers to situations of loss in which there is no resolution or closure. There are two types of ambiguous loss. The first type refers to a missing person who is physically absent but still very present psychologically to family and friends. The second type refers to situations in which the loved one is psychologically absent but still physically present.

What is the difference between normal and complicated grief?

• Complicated grief involves symptoms of separation distress and traumatic distress. Separation distress is preoccupation with the deceased to the extent that it interferes with every- day functioning. Excessive guilt and self-blame are common manifestations of traumatic grief.

How is death defined?

• Death is a difficult concept to define precisely. Different cultures have different meanings and rituals surrounding death.

What is disenfranchised grief?

• Disenfranchised grief, in which a loss is downplayed by others in a bereaved person's social network, is an important consideration in understanding grief.

How does one make one's end-of-life desires and decisions known?

• End-of-life decisions are made known most often through a living will, healthcare power of attorney, and specific medical requests such as a do not resuscitate order. It is important family and healthcare professionals are aware of these decisions. The Patient Self-Determination Act requires health- care facilities to inform patients of these rights but must take the patient's competence to make decisions into account.

What legal and medical criteria are used to determine when death occurs?

• For many centuries, a clinical definition of death was used: the absence of a heartbeat and respiration. Currently, whole-brain death is the most widely used definition. It is based on several highly specific criteria that are assessed by trained healthcare professionals. The condition of persistent vegetative state often creates a complicated situation for determination of death.

How do people experience the grief process?

• Grief is an active process of coping with loss. Four aspects of grieving must be confronted: the reality of the loss, the emotional turmoil, adjusting to the environment, and loosening the ties with the deceased. When death is expected, survivors go through anticipatory grief; unexpected death is usually more difficult for people to handle. - "Recovery" may be a misleading term, as the process of adjusting and readjusting to life following a loss never ends. • The mode of death, personal factors, and extent of social support make a difference in dealing with grief. • Anticipatory grief does not appear to make the grieving process any easier. However, the degree of attachment to the person who died does.

How do people deal with their own death?

• Kübler-Ross's approach includes five stages: denial, anger, bargaining, depression, and acceptance. People may be in more than one stage at a time and do not necessarily go through them in order. • A contextual theory of dying emphasizes the tasks a dying person must face. Four dimensions of these tasks have been identified: bodily needs, psychological security, interper- sonal attachments, and spiritual energy and hope. A contextual theory incorporates differences in reasons people die and the places people die.

How do people deal with end-of-life issues and create a final scenario?

• Managing the final aspects of life, after-death disposition of the body, memorial services, and distribution of assets are important end-of-life issues. Making choices about what people want and do not want done constitute making a final scenario. One of the most difficult parts of a final scenario is separation from family and friends. Jointly creating a final scenario among the dying person, family, and health- care professionals is optimal.

What is death anxiety, and how do people show it?

• Most people exhibit some degree of anxiety about death, even though it is difficult to define and measure. Terror management theory is a common frame for understanding death anxiety. Young adults show greater brain activity when exposed to death-related concepts than do older adults. • The main ways death anxiety is shown are by avoiding death (e.g., refusing to go to funerals) and deliberately chal- lenging it (e.g., engaging in dangerous sports). The many components of death anxiety affect many different aspects of behavior. • Death education has been shown to be extremely effective in helping people deal with death anxiety.

How do older adults face the loss of a child, grandchild, or partner?

• Older adults are usually less anxious about death and deal with it better than any other age group. • The death of a grandchild can be traumatic for older adults, and the feelings of loss may never go away. • The death of one's partner represents a deep personal loss, especially when the couple had a long and close relationship. The history of the relationship influences the grief process.

What do children understand about death? How should adults help them deal with it?

• The cognitive and psychosocial developmental levels of children determine their understanding of and ability to cope with death. This is especially evident in the behaviors children use to display their grief. - Research indicates that there are few long-lasting effects of bereavement in childhood.

What is hospice?

• The goal of a hospice is to maintain the quality of life and manage the pain of terminally ill patients. Hospice clients typically have cancer, AlIDS, or a progressive neurological disorder. Family members tend to stay involved in the care of hospice clients. Pain management can also be achieved in ways other than through hospice.

What are the ethical dilemmas surrounding euthanasia?

• Two types of euthanasia are distinguished. Active euthanasia consists of deliberately ending someone's life, such as turning off a life-support system. Passive euthanasia is ending someone's life by withholding some type of intervention or treatment (e.g.. by stopping nutrition). Physician-assisted suicide is a controversial issue and is being addressed in some states through laws. It is essential people make their wishes known through either a healthcare power of attorney or a living will. - The personal and financial costs of prologing life when the patient would have prefered another option are significant, as are the ethical issues regarding prolonging life without considering quality of life.

How do adults deal with death? What special issues do they face concerning the death of a child or parent?

• Young and middle-aged adults usually have intense feelings about death. Attachment theory provides a useful framework for understanding these feelings. • Midlife is a time when people usually deal with the death of their parents and confront their own mortality. • The death of one's child is especially difficult to cope with. • The death of one's parent deprives an adult of many important things, and the feelings accompanying it are often complex.