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HLTC22H3 (102)
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University of Toronto Scarborough
Health Studies
Anna Walsh

Death and Dying in the Chinese culture By Yu Xu RN CTN Death and dying in the Chinese culture Death as bad  Chinese culture death is always regarded as a negative life event except a good death ( BAI XI SHIT or white happy event”  good death is death as a result of natural cause such as again with a content life and no outstanding life regrets  life is lost forever when death occurs  believe in preserving and prolonging life.  talking about death is taboo  giving a clock is taboo since the phonetic sound symbolizes the count down of death Chinese atheist  talking about death and dealing with it is difficult since this is the first time a topic has been discussed and looked at seriously when life is threatened  feelings of anxiety, stress, distress and panicking are not uncommon  believed the talk of death may hasten the pace of death itself. Christians  are exposed to the idea of death early  death of jesus for our sin is a convincing arguments to become Christian  death and afterlife are the most frequent topics of sermons Westerners deal with death better than Chinese for several reasons  they have though about and pondered on death for years, even decades  Christians have faith which help them deal with death in a serene manner  talking about death amounts for making necessary preparations to face or deal with death are encouraged Dead as living  dead should be treated with respect  happiness, wealth and health are life’s most important goals  dead should be given proper treatment consistent with the stature of the dead Food ensure dead were not hungry Paper money was to ensure that the dead would not suffer from poverty Burial artifacts those that dead liked the most For instance at the burial site of the first chinese emperor in Xi an China, thousands of life sized clay terra cotta worriers and horses were discovered in the 1970’s which demonstrate the strength of emperor Death as more important for the living rituals and ceremonies associated with death are more important for the living 1) extent of the ritual reflect the stature and reputation of the dead  that face is a very important psychosocial concept  death and its associated rituals are regarded as an indicator of social status of the dead and his/her family in the community 2) serve as a comfort measure for the soul of the dead but more important for the living 3) serves as an opportunity for bonding, socialization and networking among family members and other associates Death and dying as a family affair  death is a family matter, not only involving the immediate family but also involving extended families and extensive relationship network built over the years  family members as a group make healthcare decisions  western concept uses autonomy Implications for nursing practice Living will Advance directive Power of attorney Common practice in the during healthcare agency admission for a living will This question is not accepted for Chinese ppl Culturally sensitive way of asking is if the document exists End of life care issues  veracity (telling the truth) Chinese telling a white lie is expected by health care professionals Western ppl health care professionals must tell the truth Culture based expectations  Chinese it’s a collective illness of one affects every family member who usually demonstrates love by taking turns to be at the bedside and caring for the sick around the clock in turn Cultural differences regarding heroic measures  health care decisions after the patient becomes incompetent is left to the decision of family because the central role of the family in Chinese culture heroic measures is to sustain and prolong life should be implemented and sustained at all cost because death is almost always perceived as negative life event Fourth  important in both cultures how the dead is being treated, especially in the presence of family. Modifications of existing practice and procedure based on western values and beliefs need to be made with regard to death and end of life care of Chinese patients if culturally competent care is the goal .Armed with an indepth understanding of underlining beliefs regarding death and dying in the Chinese culture. End of life issues; advance planning can help family members make decisions at the end of life KAISER PERMANENTE announced that consumers can obtain information about advance directive on this website, thereby clarifying end of life decision making  highlights advance directives pages of its website which provides visitors with thorough guidance an advance medical directive is crucial for having control over your own medical care even if you become unable to make decisions to communicate wishes Liviing will also called a treatment directive documents personal wishes about end of life medical treatment in case of decision making or communication abilities are lost Outlines treatment measures taken at the hospital if the patient is hospitalized with a serious illness Living will projects the right for a patient to refuse treatment A medical power of attorney is a legal document that lets patients appoint someone make medical treatment decisions for him/her at the end of life and when they are unable to communicate Laws vary from state to state A patients health care agent can use the information in a living will as well as what he or she knows about the patient personally to make decisions about medical treatment Patient can and Predictor of place of death for seniors in Ontario: A population based cohort- Analysis By Sanober et al Read Results  place of death was determined for 58 689 seniors  above age 66 from 2001/2002 The relationship of place of death to medical and socio demographic characteristics was examined using a multinomial model 49.2% of these individuals die in hospital 30.5 percent died in long term facility 9.6 died at home while receiving long term care 10.7% died at home without home care Co-morbidities were the strongest predictors of place of death p< 0.0001. A cancer diagnosis increased the chances of death at home while receiving home care Seniors with dementia were Most likely to die in LTC facilities Acute diseases were most likely to die in hospitals Higher SES associated with greater probability of dieing at home. Solution: appropriate planning and resource allocation may help move place of death from hospitals o nursing homes or community, in accordance with individual preferences Introduction  Canadians like to die at home because they want to avoid the technologically focused end of life. Feel Palliative care allows PRIVACY and FAMILY closeness  however large portion of ppl in industrialized countries spend their last days in hospitals Factors predictive of hospital and long term care facility death include 1) increased age 2) female gender 3) being single as opposed to married or common law relationship 4) lower income 5) less education 6) low SES 7) born outside the country are more likely to die in hospital than those born in Canada 8) decreased physical function and increased severity of illness are associated w/ increased rates of hospital death 9) higher availability of hospital beds and nursing homes in one’s neighborhood is associated with increased chances of death in institutions ( hospitals LTC)  availability of hospice service increases likelihood of death at home as does availability of home care insurance  ppl with younger, female or unemployed caregivers and multiple primary caregivers are more likely to die at home  likely when the primary caregiver is the care recipients partner or offspring Nova Scotia  females and younger cancer patients were more likely to die in hospital Manitoba  seniors dying at home while receiving home care was most likely followed by dying in an LTC facility or hospital.  seniors with Cardio vascular disease were most likely to die at home without home care and less likely to die at hospital regional variations also influenced place of death in Manitoba northern less likely to die in institutional settings than residents of Winnipeg  southern residents more likely to die in institutional settings than residents of Winnipeg (largest urban centre of province) Aims of the study  determined the place of death of all Ontario residents 66 years and older who died in 2001/2002  identified the socio demographic predictors of place of death for these seniors Methods Study was a retrospective statistical analysis of administrative data on cohort of Ontarians who died from 2001/2002 ( april 1 2001- march 31 2002)t  supplementary private insurance for publically insured facilities is prohibited  six administrative databases obtained from Ontario ministry of health and long term care. The registered person database contains demographic information  age  sex  postal code  date of death hospital discharge abstracts provide diagnostic information associated with all in province hospitalizations and indicate whether the patient died while in hospital  hospitals are required to report all same day and in patient procedures to this registry LTC information was obtained from  the Ontario chronic care patient database  contains records of admissions and discharges from chronic care institutions and chronic care beds within acute care hospitals  The Ontario drug benefit database record all outpatient prescription drug claims, contains a field that indicates whether the person was living in a LTC facility at the of prescription  Ontario home care administration data based record all publically funded home care visits. Study populations  included in sample if they were alive and at least 66 years of age at the start of 2001/2002  everyone eligible for prescription drug coverage during the period prior to death 61 237 deaths were identified from RPDB those dropped  individuals with out of province prescriptions  not used provincially insured services in the 1 year period prior to the date recorded for their death were assumed to have moved out of province health care claims that post dated their recorded date of death by more than 30 days final cohort 58 689 deaths predictors of death  age, sex and date of death RPDB  two co morbidities DEMENTIAL AND CANCER were signaled out for specific examination as they have previously been found important diagnosis of cancer used specific international classification of disease 9. Codes for primary metastatic cancer and presence of dementia was determined using a validated algorithm for Ontario administrative data  dummy variables were created to reflect the presence or absence of each of the diseases in Deyo adaptation of the charlson index. Discussion  2001/2002 half the deaths of Ontario citizens occurred in hospital heyland et all reported that in 1997, 73 percent of all deaths and 2/3 of deaths in Ontario occurred in hospital seniors who died of cancer had a higher probability of dying at home while receiving publically funded home care than did seniors without cancer who died similar in manitboaseniors who died of cancer were more likely to die at home  increasing odds of home death for seniors with cancer may be an indication of the success of palliative home care programs in enabling cancer patients to spend their last days at home  seniors with major acute conditions who die are likely to die in hospital which is to be expected since major acute conditions usually need hospitalization and are associated with short term mortality seniors with dementia in their last year of life were most likely to die in nursing homes and other LTC facilities.  cause dementia is a key factor in facility admission  depressed and perceived burden of care among caregivers increase with decline in functional status of care recipients. Care-giving burden of dementia and other psychosocial conditions is greater than the burden of physiologically deteriorative conditions  social deprivation index used to capture the effect of SES was statistically significant but not a strong predictor of place of death  seniors with higher social deprivation were more likely to die in hospital than at home and more likely to die in LTC facilities than at home or in hospital  seniors with lower SES who die at home are more likely to be receiving home care than not  therefore SES is not a deterrent to receiving home care Immigrants  increased home death in immigrant communities  opposition to institutional death  unfamiliarity of and stigma associated with care in nursing homes  lack of LTC that caters to diverse ethnic backgrounds  barriers to accessing health care for immigrant communities seniors who died at home, receipt of home care at time of death differentiated well between seniors with and without co-morbidities of cancer and dementia Socio-economic variables Social deprivation Percentage of recent immigrants • were not sig predictors in pair wise comparisons of death at home with home care and without home care* Limitations  unable to use predictors such as 1) preference for place of death 2) cause of death 3) martial status 4) education 5) caregiver availability and characteristics 6) receipt of hospice care  since data was based on administrative data  immigrant and ethnicity was not determine at individual level and was captured by ecological variables  country of residence was weak predictor because only a short trip was required to use the services  death was limited to 2001/2002 therefore could not look at temporal shifts in place of death and its determinants HOWEVER 1) administrative data allowed for analysis of province wide cohort, examining predictive factors of death of four most common groupings of place of death Conclusion  4/5 ontario seniors die in institutional settings (hospitals or LTC facilities)  common co-morbidities of dementia, cancer and major acute conditions are key predictors of place of death for seniors  lower SES is associated with home deaths but for those dying at home SES is not a barrier for care  end of life care will claim an increasing share of health care resources under the universal health care system Fur
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