AGING, DEATH, AND DYING

AGING

Ways to measure a person’s age

1. Chronological Age1. # of years a person has lived

2. Biological Age1. How well a person’s body systems are

functioning

3. Social Age1. Measure of the activity level engaged on a

daily basis

STAGES OF DEATH Elizabeth Kubler-Ross

I believe they should be called stages of lossA person may experience these for any type of

loss, such as: divorce, a pet, moving, going away to college, a relationship ending….

People tend to go through a series of stages, they may go back and forth, skip about or have periods where the stages seem to overlap, this is all according to their needs.

Stage One: DENIAL

Usually the first reaction: NOT MEPeople are in shock Unable to admit to themselves that the

patient might die and/or they will suffer the loss death represents

The best thing to do is just listen to what they are saying, you don’t need to come up with the correct response to fix the situation

Stage Two: ANGER

“WHY ME”

May be angry at the situation, not at you

The pain of loss is projected onto others

Try not to take it personally

Stage Three: BARGAINING

Last attempt to correct situation and avoid the inevitable

Pray to God, promise to reform their life

STAGE FOUR: DEPRESSIONThey are losing everything and may feel

hopeless and helplessUnfinished businessWhen the full impact of imminent death

strikes themFeel bad for the people they will leave behindThe best thing to do is just listen and be there

for them

STAGE FIVE: ACCEPTANCE

Learning to say goodbyeAccept the reality of deathMay get personal affairs in order, by way of

will and/or living willTry to live the rest of their life to the fullestListen to their wishes and be there for them

TERMSGrief

Intense emotional suffering caused by a loss, disaster, or misfortune

Empathy Ability to share in another person’s emotions or

feelings

Coping Dealing successfully with difficult changes in your life

Mourning the act of showing sorrow or grief

Ways to help a Grieving Person

Express your sympathy as a sign of respect

Feelings of guilt, despair, and similar feelings are normal

Listen to, hold (hug), and touch a grieving person. Allow the person to share their feelings with you.

Randy Pausch (2008)

• http://video.stumbleupon.com/#p=ithct48cqw

Diseases of the Elderly:Alzheimer’s Disease- more than 5 million

Is a fatal brain disorder that causes physical and chemical changes in the brain.

An incurable illness characterized by a gradual and permanent loss of memory.

Dementia deterioration of intellectual faculties

(memory/content)

Arthritis inflammation of the joints/ breakdown of

cartilage

Diseases of the Elderly:

ALS (Amyotrophic Lateral Sclerosis) Lou Gehrig Disease Progressive disorder of the nervous system

Cataracts lens become cloudy, impaired vision, causes

blindness

Glaucoma fluid inside the eye builds up, may cause

blindness

Diseases of the Elderly:

Osteoporosis- more common in women Brittle bones, which may lead to a broken bone. Due to the lack of calcium in developmental

years

Geriatrician a physician who specializes in caring for the

elderly

Death & Dying Terms:

Funeral The observances held for a dead person usually before burial or

cremation Embalming

Removing Blood and other fluids from a body that prevents deterioration of the body (formaldehyde, methanol, ethanol )

Cremation Complete reduction of a body to ashes by intense heat

EpitaphAn inscription on a tomb or at a grave in memory of the dead person

EulogyA prepared speech or writing extolling the virtues & services of a person

ObituaryA notice of the death of a person, usually published in a newspaper and includes a short biography

Death & Dying Terms:

Probate Establishing a will to settle your estate

Power of Attorney A legal instrument allowing one person to act

as the agent of another person (living will)Living Will (see handout)

A document enabling individuals to provide instructions about the kind of medical care they wish to receive or refuse if they can no longer make decisions

Defining DeathHarvard Medical School Criteria: brain death

Unreceptiveness/Unresponsiveness• Patient does not respond to painful stimuli

Absence of muscular movement and breathing• No breathing for over an hour

Lack of Reflexes• Knee Reflex is absent. Pupils will not respond to

light Absence of brain activity (EEG-Electroencephalograph)

• For 20 min, the brain does not generate electrical impulses

Death & Dying Terms: Palliative Care

Measures taken to reduce the intensity of a disease Hospice

An agency that assists people with a terminal illness May be in the house or in an area of a hospital Gives them more control over their death and how they want to die Medications are freely administered for pain Family members receive counseling to work through grief (better

prepared to interact w/ the dying person) Life Support Systems

Medical technologies used to keep patients alive that would otherwise die

Karen Ann Quinlan – Nancy Cruzan – Terri Schiavo

Death & Dying Terms:• Passive Euthanasia

– The practice of withholding or withdrawing life-prolonging treatment,allow for the terminally person to die naturally

• Active Euthanasia– The practice of intentionally hastening the death of

a person who requests it to avoid painful or prolonged living

– Dr. Jack Kevorkian – http://www.nndb.com/people/272/0000232

03/• Lethal Injection

– Injecting a drug that will result in death

Karen Ann Quinlan 1975- 21 yr. old ingested alcohol and sedatives Cardiopulmonary arrest and fell into a persistent

vegetative state Parents wanted to remove respirator Hospital said no Parents’ lost the first case Parents’ won the second case and turned the respirator off Karen continued to breath without life support and lived

for 10 years This case:

led to hospital and hospice ethics committees Led to advance directives (living wills)

Nancy Cruzan

1983 automobile accidentPermanently unconscious, no higher brain

functionKept alive by feeding tubeParents’ lost the first caseLater showed evidence and wonRemoved the feeding tube in December

1990 and later died that month

Terri Schiavo Feb. 1990- 26 yr. old severe brain damage from respiratory

and cardiac arrest and her heart stopped for 5 minutes 1998- husband filed to get the feeding tube removed

(saying wife told him that she didn’t want artificial respirator if she were ever put on one)

Parents fought 2000- Husband could discontinue life support The feeding tube was removed in 2003 and then reinserted

six days later “Terri’s Law” “Terri’s Law”- gave the governor authority to order the reinsertion

of the feeding tube, which had been removed six days earlier in compliance with a court order.

2005- Tube was removed again, after two weeks of no food and water, she died March 2005

Death With Dignity – Oregon, Washington, Netherlands, Belgium,

Switzerland, Thailand, Luxembourg

Allows patient to gain control over their death• Plan their funeral or memorial service• Want to decide who their doctors will be, type of

treatment, and who can visit them.• 18 years old or parent consent if under 18• 2 Doctors must diagnose & 6 months terminal illness• Mentally capable of making the decision on your own• Resident of the state• Patient makes three requests; two oral and one written• Patient drinks a strong Barbiturate potion (9g Pentobarbital)• Time from ingestion to unconsciousness is 1 to 20 minutes (avg. 4 minutes)• Time from ingestion to death 5 minutes to 48 hours (avg. 20 minutes)

http://www.deathwithdignity.org/media/uploads/OregonYear12Table.pdf

SuicideThe act of intentionally taking one’s own

life.Third leading cause of death among people

between the ages of 15-24 years of age lack of family support sense of isolation Guilt, low self-esteem, sense of worthlessness Increased use of drugs and alcohol

People who attempt suicide give warning signs that are a cry for help.

Many suicidal people reach out for help repeatedly before taking their own life.

Cluster Suicide A series of suicides occurring within a short

period of time and involving people within the same community or connected in another way

Possible Warning Signs of SuicideChange in eating and sleeping habitsWithdrawal from friends, family, and

regular activitiesUse of alcohol or other drugsViolent actions (rebellious behavior,

running away, angry, and destructive)Marked personality changesNeglecting personal appearanceDecline in their work (school/work)

Possible Warning Signs of Suicide

Giving away favorite possessionsInability to concentrate or make decisionsNot tolerating praise or rewardsRe-occurring theme of death in writingFrequent complaining about physical

symptomsIncreased Risk taking

Factors that Contribute to Suicide

Rising divorce rate, and break-up of families.Many teens live in troubled families.Pressure to succeed in school and life.Questions about sexual orientation.Increase in use of alcohol and drugs.

Why Someone Would Want to Die?

End the emotional pain they haveUnder extreme stressTrivial matters become overwhelmingBecome tunnel visionSuicide Mindset: the feeling that suicide is

the only solution to the problems of living

What do you do if someone is Suicidal?You might ask the person directly are you

contemplating suicide?

Most people will reach out for help before they try to kill themselves.

Listen to your friend.

Let them know that you are listening and that you understand.

What do you do if someone is Suicidal?

Don’t debate whether suicide is right or wrong.

Allow them to express their feelings.

Get involved. Become available. Show interest.

Don’t lecture on the value of life.

Get help from people or agencies specializing in crisis.

Adults who can help in a crisis

ParentGrandparent, uncle, aunt, other relativesTeacher or CoachFriendsTherapist at a schoolReligious leadersPerson working the suicide hotline