Transcript Elizabeth Kubler-Ross

AGING, DEATH, AND DYING
AGING
Ways to measure a person’s age
1. Chronological Age
1.
# of years a person has lived
2. Biological Age
1.
How well a person’s body systems are
functioning
3. Social Age
1.
Measure of the activity level engaged on a
daily basis
STAGES OF DEATH
 Elizabeth Kubler-Ross
 I believe they should be called stages of loss
 A 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 ME
 People 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: DEPRESSION
 They are losing everything and may feel
hopeless and helpless
 Unfinished business
 When the full impact of imminent death
strikes them
 Feel bad for the people they will leave
behind
 The best thing to do is just listen and be
there for them
STAGE FIVE: ACCEPTANCE
 Learning to say goodbye
 Accept the reality of death
 May get personal affairs in order, by way of
will and/or living will
 Try to live the rest of their life to the fullest
 Listen to their wishes and be there for them
TERMS
 Grief

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=ithct48c
qw
Diseases of the Elderly:
 Alzheimer’s Disease- more than 5 million

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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

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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
Epitaph
An inscription on a tomb or at a grave in memory of the dead person
Eulogy
A prepared speech or writing extolling the virtues & services of a
person
Obituary
A 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 Death
 Harvard 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 lifeprolonging 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 accident
 Permanently unconscious, no higher brain
function
 Kept alive by feeding tube
 Parents’ lost the first case
 Later showed evidence and won
 Removed 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
Suicide
 The act of intentionally taking one’s own life.
 Third leading cause of death among people
between the ages of 15-24 years of age
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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 Suicide
 Change in eating and sleeping habits
 Withdrawal from friends, family, and
regular activities
 Use of alcohol or other drugs
 Violent actions (rebellious behavior,
running away, angry, and destructive)
 Marked personality changes
 Neglecting personal appearance
 Decline in their work (school/work)
Possible Warning Signs of Suicide
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Giving away favorite possessions
Inability to concentrate or make decisions
Not tolerating praise or rewards
Re-occurring theme of death in writing
Frequent complaining about physical
symptoms
 Increased Risk taking
Factors that Contribute to Suicide
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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?
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End the emotional pain they have
Under extreme stress
Trivial matters become overwhelming
Become tunnel vision
Suicide 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
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Parent
Grandparent, uncle, aunt, other relatives
Teacher or Coach
Friends
Therapist at a school
Religious leaders
Person working the suicide hotline