Class 7: Dying (Chapter 12)

Class 7: Dying (Chapter 12)

						Reading: Chapter 12

						Review Questions on Chapter 11, lecture, and videos

						Multiple answers are possible for some questions

						1. Which are axes on the DSM-IV?

						2. Point prevalence refers to

						3. Vascular dementia can be distinguished from Alzheimer’s Disease by

						4. With the exception of dementia and suicide, the general trend in psychopathology in older adulthood...

						5. As depicted in the video, The Mind-Aging, one promising way to fight Alzheimer’s Disease is

						6. One explanation for the association between education and Alzheimer’s Disease in monks and nuns discussed in lecture was

						Quick Note on Presentation Criteria

						Website Review (10 points, 2 points for each). Note: have the urls ready to view quickly.

						Does the reviewer concisely indicate the specific problem he is using these websites to address?

						Does the reviewer clearly and concisely tour one or two functions/pages of the website?

						Does the reviewer clearly indicate how he evaluated the authority of these websites?

						Does the reviewer clearly indicate how he evaluated the ease of use of these websites from the perspective of an older user?

						Does the reviewer clearly indicate HOW he would recommend and use these websites as part of adult education, counseling, social work?

						Movie Review (10 points total, 2 points for each). Note: Cue the tape to the particular part you wish to show. 5 minute limit.

						Does the reviewer concisely indicate the specific aspect about aging he is focusing upon with this movie?

						Does the reviewer clearly and concisely describe and/or show one segment of the movie that demonstrates a key point?

						Does the reviewer clearly evaluate the realism of the movie?

						Does the reviewer clearly evaluate this film from the perspective of an older person?

						Does the reviewer clearly indicate HOW he would recommend and use this film as part of adult education, counseling, social work directed towards older people?

						In the news

						New gene for age onset of Alzheimer’s and Parkinson

						The case in Florida

						Dinner (30 minutes)

						The biological process of death

						Dying has become increasing longer: more people die of chronic disease

						Defining death

						Heart death: but the heart can stop briefly and people can still live

						Brain death: Absence of EEG activity

						Problem: can we detect the smallest electrical activity?

						Problem: what is the EEG point of no-return?

						Comatose: eyes close and reflex reactions

						Vegetative state: eyes open and close as if in sleep cycle but without any awareness

						Recent studies indicate brain activity in response to love one according to MRI scans

						Perhaps “minimal consciousness”?

						Footnote: The problem with so-called near-death experiences

						Anesthesia produces similar experiences

						Near-death experiences seem to differ based on the kind of illness (e.g. heart attack v. other causes)

						Suicide

						Increases with age BUT mainly due to increase suicide in white men

						Why?

						Why do people fear death? Note: fear of death varies greatly across cultures

						Physical suffering

						Isolation and loneliness

						Non-being

						But we don’t fear sleep do we?

						Cowardice & Humiliation

						Wit

						Failing to Achieve Goals

						Negative impact on others

						Note: AIDS orphans

						Punishment or the Uncertainty

						Is there an atheist advantage here?

						Is there a fire & brimstone disadvantage here?

						Increased religious commitment tends to decrease fear of death

						Can we measure fear of death?

						Little correlation between age-->death but its moderated by health

						Unidimensional measures are problematic

						Private v. public feelings

						Fear of death is almost certainly multidimensional

						Death and the health care professions

						Avoid discussing death, tend to the body, immediate situation

						Is this also true for social workers and counselors and families? A professional habit or a cultural one?

						Trying to “improve” death

						Will: Many many people die without a will. Very problematic (especially for non-US citizens)

						Living Will and Health Care Directive: A statement, not a contract, of your preferences

						Respirator?

						DNR

						Feeding tube

						Durable Power of Attorney: Assign someone to make decisions when you can’t

						Organ Donation

						Response to Death

						Kübler-Ross’s Stages “DAB-DA”

						Current results

						No systematic pattern in anger, increased sadness, no particular order, mainly negative emotions

						BREAK (15 minutes)

						Bereavement

						Men might fare worse than women at death of spouse but skewed sample

						NEW! Recent survey of widows indicate that 3 years after loss majority no longer show symptoms of grief. Sample 50-75 years old.

						Contributers: poverty, poor mental health, poor physical health (note: sudden death does not seem make it worse)

						Consequences: Suicide, addictions, illness

						Phases

						confusion, shock, denial

						crying and weeping (alert for suicide attempts)

						Should-have’s (hallucinations are not necessarily abnormal)

						Recovery (slowly learning to adapt)

						“Pathological” grief (note: culture-bound)

						Accute grief for more than several months

						Calm before the storm followed by increase anger and irritability

						Traumatic grief: intrusive preoccupation with the dead, detachment, lost of sense of security

						Textbook argues therapist should help bereaved express grief... Does stoicism have no role?

						Note that there have many cases of therapist exploitation at this point or accusations of misconduct

						Paraprofessionals can help

						Experiment: random assignment to support groups and control groups

						Result: support group members higher self esteem, optimism on health, greater ability

						Yes but are there better outcomes to look at?

						Lecture Extension: Three kinds of deaths

						Know

						How do people’s reactions to preparations to dying and death and medical interventions vary by ethnicity? IMPORTANT

						Cuban Americans / Latino

						African Americans

						Whites

						List several ways in which hospice care differs from hospital care

						Describe how Bill handled the degree of medical care during his dying period

						The dying doctor, Bill, seems to have taken control of his death but were there any surprises? Do you think this is a common occurence for most people?

						What did Bill mean when he says “death gives life that sugar”

						BREAK (15 minutes)

						Euthanasia

						Oregon’s Death with Dignity and Netherlands Physician-assisted suicide policy

						Still handful of cases

						Has NOT become a “suicide paradise”

						Withholding water rated by nurses as being least painful

						ACTIVITY

						Should therapists and counselors be involved in this process or should this process be left to doctors and families? Provide 3 pro’s and 3 con’s, please, for the case for psychosocial workers in this process.