Health Psychology – Chapter 16: EndOfLife Issues
death in modern society occurs overwhelmingly in hospitals, although this portion
if you are in a longterm care facility when the end comes, you are likely to die
there. If you are living in the community when the end comes, you are likely to be
taken to a hospital and die there.
Hospitalization at the end of life can result in a prolongation of dying, rather than
a good death
Death due to suicide increases near the end of life, but reasons for this are not
Suicide in old age tends to happen among those who have severe health problems;
most have not attempted suicide before; and, unlike suicide among younger
people, it is equally likely for the married and the single.
KublerRoss developed her theory of five stages inherent within the process of
dying: denial, then anger, then bargaining, then depression and finally acceptance.
Varies from person to person.
It is important to recognize that dying involves more than biological changes;
there is meaning in life even when death is impending.
Older people, by virtue of their proximity to death, are assumed to accept death; it
is assumed that they do not find it frightening and need not even discuss death.
It was found by Clarke and Hanson that older individuals in the UK do want to
talk about death, although they are not obsessed by or overly preoccupied with it.
It is a myth that just because one is aged, one is necessarily completely prepared
Because of the prolongation of the dying process due to chronic illness in old age,
there has been increased interested in SPIRITUALITY and the meaning of life
toward the end.
Dying individuals can have CRISES OF MEANING also referred to as soul pain,
where they experience a lack of meaning, coherence, or comfort with their life.
QualityAdjusted Life Years refer to the duration of life in various compromised
health conditions. All score one full year of healthy life at 1.0. the standard
“gamble technique” asks a respondent to make a hypothetical choice between
continued life in their present state or a gamble that would result in either perfect
health or death.
o Time tradeoff refers to asking individuals how much time they would be
willing to give up in order to be in…
Lawton argues that years of desired life is not determined entirely by quality of
life but is mediated by intervening cognitive affective schema referred to as
valuation of life. VOL is defined as the extent to which the person is attached to
his or her present life due to enjoyment and the absence of distress, as well as
hope, futurity, purpose, meaningfulness, persistence and selfefficacy. Lawton and
his associates find that people choose fewer years of life if life is marred by
functional and cognitive impairment or pain.
VOL is an attitude that motivates people for continuing to live longer and that its
incorporation of purpose may be critical as a sustaining force in the desire to live. Fear of death ▯fear of the unknown or to fear of the process of dying.
Canadians identified five domains of quality endoflife care:
o Receiving adequate pain and symptom management
o Avoiding inappropriate prolongation of dying
o Achieving a sense of control
o Relieving burden
o Strengthening relationships with loved ones
TRAJECTORY ▯refers to a particular path and can include a change in the
pattern of health status. In endoflife trajectories, you can think of one trajectory
as sudden death from an unexpected cause, such as an accident or heart attack. All
of these trajectories define living near death in terms of health status.
It appears that depression increases with nearness to death and that suicide rates
are higher among terminally ill adults than among healthy adults
At the end of life, seniors want candid but sensitive communication; they also
want respect and recognition and a multidisciplinary approach that docues on
medical needs as well as on psychological, spiritual and emotional needs.
COMFORT: a state of ease and contentment; relief from discomfort; and
transcendence, or being strengthened and invigorated. Only the individual knows
when they are comfortable.
Leading causes of death are now from chronic progressive organ system failure –
heart disease, cancer, stroke.
Areas that are believed are relavent for quality of care: spirituality and personal
growth while dying; a natural death in familiar surroundings with loved ones;
symptom management; sensitive communication to allow decision making and
planing’ family and patient treated as a unit; absence of financial, emotional and
physical burden for family members
Research on healthcare providers most notably physicians, do not provide care
consistent with the wishes of the patient.
Medical care tends to focus on survival even survival at all costs.
Physicians’ communication with patients is therefore of particular importance
near the end of life. Most adults want realistic estimates of how long they can
expect to live.
There has been a lack of communication, because of the difficulty of definitive
diagnoses and prognoses and because of a desire to maintain the hopes of the
In quebec, the term palliative care was used, rather than hospice, and is a unique
Canadian use of the term. American usage differentiates between the terms
hospice and palliative care, with hospice representing a formal set of practices and
closely linked to federal requirements for medicare funding and PALLIATIVE
care a more general descriptive term. Canadian usage does not distinguish in this
In 2001, the B.C. government announced the establishment of the Palliative Care
Benefits Program to remove financial barriers for terminally ill persons who wish
to receive care at home. The vast majority of those enrolled are cancer patients, to be eligible, individuals
must be in the terminal stages of a lifethreatening disease or illness with a life
expectancy of up to 6 months.
The compassionate care benefit allows Canadians to receive employment
insurance if they temporarily leave their jobs to care for a dying family member
The focus in palliative care is on MAXIMUM COMFORT and not simply
Comfort care is often consistent with limitations on aggressive medical
interventions. It can include transfer to acutvecare hospitals or units of hospitals
and tube feeding if normal eating is not possible.
Effective grieving requires the treatment and prevention of coping problems
related to death; coaching patient and family through grieving; assessing and