The document discusses the evolution of death and dying in the U.S., highlighting changes in leading causes of death from infectious diseases to chronic illnesses. It covers various aspects of death, including biological, social, and psychological dimensions, as well as the key stages of dying according to Kubler-Ross. Additionally, it explains the concepts of hospice and palliative care, which emphasize comfort, dignity, and support for both patients and their families during the dying process.

1. Death and Dying
A Look At Aspects of Death,
Palliative Care and Grief

2. Changes in Leading Causes of
Death in the U. S.
 Life expectancy has been increased by
25 years
 In 1900, infectious diseases killed most
 In 2000, chronic diseases (heart
disease, cancer, stroke) are major
killers

3. Most Common Causes of
Death in U. S.
 Heart disease
 Malignant neoplasms
 Cerebrovascular disease
 Chronic lower respiratory disease
 Accidents
 Diabetes Mellitus
 Alzheimer’s Disease
 Influenza and Pneumonia

4. Deadliest Diseases Worldwide
 Low-income countries
 Middle-income countries
 High-income countries
(WHO, 2004)

5. Biological Aspects of Death
 Physiological death-when vital organs
cease to function
 Body shuts down
 Increase sleep
 Eat less
 Blood pools
 Breathing sporadic
 Clinical death-when brain ceases to
function

6. Aspects of Death
 Social
 When people stop calling or visiting
 Even health care professionals do this
(‘circling the drain’)
 What to do for those who are dying?

7. Aspects of Death
 Psychological
 When person accepts his or her death and
begins to withdraw
 Can occur much sooner than biological
death

8. Kubler-Ross: Five Stages of
Dying
 Denial
 Anger
 Bargaining
 Depression
 Acceptance

9. What is hospice?
Hospitality, place for travelers,
home for the sick

10. Origins of modern hospice
 London
 Dame Cicely
Saunders
 Autonomy of choice
 To live always
 Die peacefully

11. Saunders’ 7 Pains
 Physical
 Spiritual
 Intellectual
 Emotional
 Interpersonal
 Financial
 Bureaucratic

12. Palliative Care
 Care for the dying
 Focus on comfort and pain relief
 Nausea, shortness of breath
 Bed sores, pain
 Double-effect of pain medication
administration
 Focus on dying with dignity

13. Hospice Team
 RN-total care
 MSW family/legal
 Chaplain
 CNA-bathing, grooming
 Physician
 Volunteers
 (see audio clips at the end of your lesson)

14. Grief and Loss
 Grief
 Anticipatory grief
 Grief and mixed emotions
 What to do for those in grief
 Disenfranchised grief