Chapter 13FRHD1010.doc

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University of Guelph
Family Relations and Human Development
FRHD 1010
Susan Chuang

Chapter 13- Death and Afterlife Belief Section 1- Physical Aspects of Death The Demography of Death Death has not always been in adulthood, many died young due to infections. Developed countries death- accidents (young age), heart disease/cancer (late adulthood) • Historical Variations in Death o Infancy was life stage with highest mortality rate o Young women frequently died in childbirth, young men at war o With age, more susceptible to infectious diseases o Until early 20 century infectious diseases were highest cause of death (more than half of deaths in 19 century, only 5% in early 21 st century) o With medical advances and better sanitation, life expectancy increased, people began dying from causes that had been rare before (heart disease, cancer) • Major Causes of Death o Now, common causes of death vary with age and country o Infectious disease primary factor in developing countries o Developed countries primary causes of death:  Infancy/toddler year=accidents  Young adulthood= accidents, homicide, suicide  Late adulthood = cancer, cardiovascular disease o Cardiovascular disease:  Number one cause of death in adults in developed countries.  Plaque builds up in arteries that carry blood to heart threatening health and life.  Diets high in fat increase risk, exercise reduces risk.  Increased build-up can lead to angina, additional increase can result in a heart attack.  Death from heart disease rises after age 45, those 65+ 10 times as likely to die from heart disease  Men have higher rates of death from heart disease  African Americans/Eastern Europeans higher rates due to high fat diets, Southern Europeans, Asian Americans and Japanese, lower rates due to low fat/sugar diets and high consumption of fish  Smoking increases risk o Cancer:  Most common in late adulthood  In late adulthood, cell replacement becomes less efficient/accurate especially in stability genes (repair mistakes in DNA replication), oncogenes (produce abnormal cell duplication), and tumor suppressor genes (suppresses activity of oncogenes)  Cancer cells in affected part of body multiply at extreme rate and form tumors which deplete resources of healthy cells, and impairs functions of affected body part  Common symptoms: weight loss, fatigue, weakness  70% of cancer deaths occur in people 65+  Cancer is more common in men than women  Cancer rates are highest in developed countries where smoking is highest (i.e. Japan and Russia)  Risk factors: smoking, poor diet, excessive alcohol use, chronic exposure to sunlight Beyond Death? Attempts to Extend the Human Life Span • The Sources of Aging: Cellular Locks and Free Radicals o Important factor in aging: cellular lock limits number of times that cells can replicate themselves. Hayflick limit limit of 50 times that cells can replicate themselves o Telomere portion of cell DNA at the end of chromosome which become slightly shorter with each cell replication, eventually becoming so short that replication can no longer occur o Shorter telomeres can lead to various disease (i.e. cancer) centenarians (people who live to be at least 100) who did not have heart disease, cancer, stroke or diabetes were found to have longer telomeres than other centenarians who had 2+ of these diseases o Research being done on the re-growth of telomeres o Another contributing factor to primary aging: free radicals unstable oxygen molecules causing damage to DNA/other structures necessary for cell functions o Antioxidants substance found to absorb extra electron in free radicals (preventing damage to the cell) found in fruits and veggies o Studies indicate supplements of antioxidants may be damaging to health • Can Aging Be Reversed? Hormone Replacement and Calorie Restriction o Two approaches beyond fighting free radicals and evading cellular clock have been studied for slowing/reversing aging process: hormone replacement and calorie restriction o Growth hormone crucial hormone to physical growth in the early decades of life; steady decline after the mid-twenties contributes to primary aging o Experiments with growth hormone supplements yielded great results that were not permanent and regular use of these supplements resulted in excess hair, liver damage, abnormal growth of hands, feet and facial bones o DHEA hormone involved in muscle growth, bone density, and the functioning of the cardiovascular system. Production increases until age 30, then declines, at 80 the body only has 5% of what it had at age 30. No clear benefits have been discovered in regards to DHEA supplements in humans o In studies with animals, reducing calorie intake by 30-50% resulted in an increase in life span of up to 50%. o Research done on 18 midlife adults who had calorie restricted diets for 6 years reported various health benefits Section 2- Socio-cultural and Emotional Responses to Death The Socio-cultural Contexts of Death Most people in developing countries die at home among family or through accidents/wars. Death in developed countries is usually a very technological event (i.e. using medical technologies to try to keep the dying person alive). • Where We Die: Homes and Hospitals o In developing countries most people die at home due to lack of access to medical care. o In developed countries 80-90% of people would prefer to die at home would prefer to die at home (due to the comfort and security) though 60% die at the hospital, 20% in nursing homes, 20% at home o Difficult to die at home due to the fact that most deaths are not caused by infectious diseases, more so gradual diseases that medical technologies can assist with, which result in the person being in the hospital o Too much stress and strain put on caregiver when person is being cared for at home o Complaints of family and dying people about the hospital care being dehumanizing and impersonal • Options and Decisions Regarding the End of Life o Now that people are living much longer, ways of addressing issues that arise when older adults are near the end of their lives have had to be made. (I.e. hospice care, euthanasia) Most elderly people in developed countries leave instructions for end of life care so their loved ones do not have to make decisions on their behalf o Hospice Approach to Care of the Dying  Hospice alternative to hospital care at the end of life, emphasizes physical, emotional, social, and spiritual needs of dying persons/ their families (occurs when people are identified with less than 6 months to live) most commonly takes place at home, takes stress off of caregiver having hospice care worker also includes: • Interdisciplinary care team (medical personnel, counselors, volunteers) • Psychological/spiritual counseling for patients/family • For those providing hospice care at home, housekeeping and periodic relief from care • Psychological support for the dying • Bereavement care for family/friends after death  Hospice care has recently expanded in developed countries  Much less expensive than standard hospital care  Tends to be applied at very end of life (20 days)  Not many people using hospice care possibly due to reluctance of “giving up” on patient  More whites receive hospice care, African Americans tend to prefer aggressive medical treatments than palliative care  Palliative care a type of care that focuses on relieving the patient’s pain/suffering allowing the person to die with dignity (terminally ill people) o Euthanasia  Euthanasia practice of ending the life of a person who is suffering from an incurable disease/severe disability two types: • Passive euthanasia ceasing medical interventions that would prolong one’s life. i.e. ending chemotherapy allows death to take place without causing it. • Active euthanasia ceases treatment but also takes steps to hasten death. I.e. medical personnel gives dying person medical means to die without pain (i.e. medication, lethal injection)  In real life, it is sometimes difficult to distinguish the difference between the two types of euthanasia  There is a high support for both types of euthanasia as long as the words “assisted suicide” are not being used  In almost all countries passive euthanasia is legal while active is not, most major medical societies (i.e. American/Canadian Medical Association) support passive but not active while courts generally accept the judgment of physicians providing medications to relieve pain even to the point of active euthanasia (providing drugs to ease pain=legally acceptable but with the intent to cause death is not though it is usually impossible to decipher between the two) The Netherlands however allows assisted suicide (with conditions): • Patient clearly indicates desire to die • Patient’s physical/mental suffering=severe/unlikely to improve • All other options of care have been attempted/refused by patient • Second doctor has been consulted ensuring all conditions have been met  Physicians have admitted that these conditions are frequently ignored, and euthanasia has been provided to elderly people who are not terminally ill just “weary of life”  Oregon allows active euthanasia for people who are terminally ill with less than 6 months to live o Easing the Exit: Advance Directives  Controversial time when patient is unable to make the decision on what they would like to be done, sometimes instructions have been left  Advance directive person’s written/oral instructions concerning end-of-life care  DNR (do not resuscitate) provision in living will indicating medical personnel are not to attempt to prolong life if the heart stops/person stops breathing  Advance directive may also include a health care proxy (designated person to make decisions for patient)  Physicians rarely know about the advance directives and even when they do they are hesitant to follow it for fear of legal vulnerability and because they’ve been trained to do everything possible to save a life Bereavement and Grief Bereavement experience of losing a loved one Grief intense psychological response that often accompanies bereavement • The Emotional Arc of Grief o After bereavement, grief is often followed by shock, numbness and disbelief, as shock fades, many emotions can arise (i.e. sadness, anger, anxiety, loneliness, guilt, etc.) can cause states that resemble symptoms of depression (i.e. lethargy) everyday activities can seem to be too much o These intense emotions subside with time, new activities/relationships/routines may be formed due to loss of loved one o Survivor’s identity may change (i.e. no longer a wife but a widow) o When there was a close attachment to the person who has died, feelings of loss/yearning may never entirely fade o Most severe grief:  Parents depends on age of child, how much support child received from parent, at risk for emotional difficulties (long/short term)  Children severe enduring reacting, high levels of distress even years later, high risk for divorce  Spouse complex effects, vary by gender. Older adults = wide variety of psychological problems 10 times higher among newly bereaved. (i.e. depression, substance use, etc.) Risk of mortality for bereaved person is 7 times higher than married peers in first year following death o Women tend to outlive their spouses (get married younger), less likely to remarry especially as they strengthen relationships with children, build new life for themselves, tend to financially struggle o Men more likely to experience physical/mental health problems, men more likely to remarry o The “how” of death affects course of grief, the more unexpected, the more intense the grief tends to be • Confronting Death o People not only have to face the deaths of those they love but also their own deaths, there are 5 stages that people go through in their response to imminent death. [Kubler-Ross]  Denial those with terminal illness refuse to believe they are dying.  Anger person feels it is not fair they are dying, question; why me? Anger may be directed to family members, medical personnel, God, healthy people in general  Bargaining once anger fades, person usually tries to bargain for more time specifically with God/spiritual entity  Depression despite bargaining, condition worsens, medical procedures usually invasive/pain
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