Chapter 10: Death and Dying

LIFESPAN DEVELOPMENT • Coverage: • Death and Dying • Death Defined • Most Common Causes of Death • Suicide • Fatal Drug Overdoses • Where do People Die? • Developmental Perceptions of Death and Death Anxiety • Curative, Palliative, and Hospice Care • Family Caregivers • Advanced Directives • Cultural Differences in End-ofLife Decisions • Euthanasia • Religious Practices after Death • Green Burial • Grief, Bereavement, and Mourning • Models of Grief • Grief: Loss of Children and Parents • Mourning Death and Dying Death Across the Lifespan: • While death is more common in later stages of life, it can occur at any age. • Death is a deeply personal experience, with reactions and perceptions varying greatly across individuals. Perceptions of Death: • People often imagine death as quick and peaceful. • However, for many, death follows a prolonged period of chronic illness or frailty, except in cases of accidents or certain illnesses that lead to quicker death (IOM, 2015). Impact of Modern Medicine: • Advances in medicine and better living conditions have increased life expectancy. • Despite this, death remains the inevitable end of life. Death Defined Clinical Definition of Death (Uniform Determination of Death Act, UDDA): Death is defined as: o Irreversible cessation of circulatory and respiratory functions, or o Irreversible cessation of all brain functions, including the brain stem. • The UDDA, approved in 1980, provides a medically accepted basis for determining death and is adopted by most U.S. states. Physical Changes Leading to Death (Bell, 2010): • Weeks Before Death: o Loss of appetite, preferring easily digestible foods o Increased sleep, weakness, incontinence, and restlessness o Increased need for assistance with care • Days Before Death: o Decreased consciousness, pauses in breathing, lower blood pressure o Darkened urine, murmuring to unseen people, disorientation o Increased care needs • Days to Hours Before Death: o Comatose-like state, inability to swallow, pauses in breathing o Weak or absent pulse, cool or discolored extremities (e.g., purple hands/feet) o "Death rattle" due to relaxed throat muscles, pale, waxen skin Social Death: • Begins before physical death and occurs when others withdraw or dehumanize the terminally ill. • Dehumanization includes ignoring the person, making decisions without their input, and forcing unwanted procedures. • Social death can affect those with terminal conditions (e.g., AIDS, cancer) as family, friends, and even healthcare providers may avoid them. • Reasons for Withdrawal: o Friends and family may feel uncomfortable, inadequate, or unable to help. o Health professionals may feel unequipped to deal with decline and death. • Impact of Social Death: o Lack of social support can lead to isolation and loss of meaningful interactions. o Social death can occur in nursing homes with no visits or contact. Dehumanization of the Incapacitated, Older, or Ill: • Reasons for Dehumanization: 1|Hikamac chi LIFESPAN DEVELOPMENT o o Healthier individuals create distance to avoid facing their own mortality. Caregivers may dehumanize as a coping mechanism to protect against grief and burnout. Most Common Causes of Death Global Causes of Death (2016, WHO): • Non-communicable diseases (not passed person-to-person) are the leading cause of death worldwide: o Top 3 Causes: ▪ Heart disease ▪ Stroke ▪ Chronic Obstructive Pulmonary Disease (COPD) • Tobacco use is a major contributor to many of these diseases. • High vs. Low-Income Countries: o High-Income Countries (per capita income > $12,476): ▪ 70% of deaths are in people aged 70 or older. ▪ Main causes: chronic diseases (heart disease, cancer, diabetes, dementia). ▪ Infectious diseases are rare, with lower respiratory infections being the only significant infectious cause of death. o Low-Income Countries (per capita income < $1,025): ▪ 40% of deaths are in children under 15. ▪ Main causes: infectious diseases (HIV/AIDS, malaria, diarrheal diseases, tuberculosis). ▪ Childbirth complications (e.g., premature birth, birth asphyxia) are major causes of infant death. The United States (2016): • Historical Shift: In 1900, infectious diseases were the main cause of death; today, chronic diseases dominate. • Top 3 Causes of Death: o Heart disease o Cancer o Accidents (unintentional injuries) Causes of Death by Age Group: • Infants (under 1 year): o Main causes: SIDS (Sudden Infant Death Syndrome), congenital problems, and birth complications. • Children and Young Adults (ages 1-24): o Main cause: Accidents (unintentional injuries). • Adults (middle to late adulthood): o Main causes: Heart disease, cancer, and other chronic medical conditions. Other Concerns: • Suicides and Drug Overdoses: These are increasing causes of death throughout the lifespan. Suicide Suicide Rate Increase (1999-2017): • Suicide rate increased by 33% in the U.S. • 10th leading cause of death overall in the U.S. • 2nd leading cause for ages 10-34 and 4th leading cause for ages 35-54 (CDC, 2018). General Statistics (2016): • Around 45,000 people died by suicide in 2016 (CDC, 2018). • Suicide rates increased for all racial and ethnic groups. • Rural counties (20.0 per 100,000) have a higher suicide rate than urban counties (11.1 per 100,000). Suicide and Gender: • Male Suicide Rate: Increased 26% from 1999 (17.8 per 100,000) to 2017 (22.4 per 100,000). • Female Suicide Rate: Increased 53% from 1999 (4.0 per 100,000) to 2017 (6.1 per 100,000). • Gender Differences: o Males generally have higher suicide rates due to higher substance abuse, reluctance to seek mental health treatment, and use of more lethal methods. o Females: The suicide gap is closing as females are now engaging in selfharm, substance abuse, and risktaking behaviors. o High Risk Groups for Females: Pain, depression, and anxiety, especially in middle age. o High Risk Groups for Males: Older males (75+), although their rate has decreased from 1999. Deaths of Despair: • The U.S. suicide rate is increasing, while it is decreasing in other countries like Canada, Japan, and most of Western Europe. • Economic Decline: Loss of farming and manufacturing jobs, particularly in rural areas, has contributed to "deaths of despair." • Contributing Factors to Suicide: o Relationship issues o Substance use disorders 2|Hikamac chi LIFESPAN DEVELOPMENT o o o Financial/legal problems Health concerns Limited access to mental health treatment in rural communities. Prevention: • Limiting Access to Lethal Means: o Reducing access to toxic gases, pesticides, and firearms has led to decreased suicide rates. o Installing bridge barriers and restricting access to lethal substances. • Mental Health Treatment: o Improving access to mental health services, particularly in the workplace, is vital. o Specific programs are being designed for high-risk occupations. • Warning Signs and Support: o Recognizing warning signs of suicide and encouraging treatment can help prevent suicides. Fatal Drug Overdoses Drug Overdose Deaths (2017): • 70,237 deaths from drug overdoses in the U.S. (Hedegaard et al., 2018). • The drug overdose death rate in 2017 was 21.7 per 100,000. • The rate in 2017 was 9.6% higher than the rate in 2016 (19.8/100,000). • Overdose death rates have been increasing steadily since 1999. Urban vs. Rural Areas: • Unlike suicides, drug overdose deaths occur equally in both urban and rural areas. Synthetic Opioids: • The death rate from overdoses involving synthetic opioids (such as fentanyl, fentanyl analogs, and tramadol) increased by 45% from 2016 to 2017. • The rate for synthetic opioid overdoses went from 6.2 per 100,000 in 2016 to 9.0 per 100,000 in 2017. Fentanyl: • Fentanyl is a highly potent opioid, making it easy to cause a fatal overdose. • It is synthetic, meaning it is cheap to produce and easier to conceal than heroin, contributing to its rise in overdose deaths. Where do People Die? Americans' Preferences vs. Reality: • 80% of Americans would prefer to die at home. • However, in reality: o 60% of Americans die in acute care hospitals. o o 20% die in nursing homes. 20% die at home. Cultural Differences: • In some cultures, dying at home is not preferred, and some patients may wish to die in a hospital instead. • Despite preferences, fewer people are dying at home than would like to. International Statistics: • 54% of deaths in over 45 countries occurred in hospitals. • The country with the highest hospital death rate was Japan (78%). • The country with the lowest hospital death rate was China (20%). Death in Residential Care: • For older adults, 18% of deaths occurred in residential care settings like nursing homes. • The likelihood of dying in residential care increases by 10% for each decade after age 65. • Women are more likely to die in residential care than men. Developmental Perceptions of Death and Death Anxiety Infancy: • Infants do not understand death but react to the separation caused by it. • They may become sluggish, quiet, lose appetite, and experience weight loss when separated from caregivers. Early Childhood: • Young children lack an understanding of death and may think: o Death is temporary or reversible. o People are just sleeping. o They can wish someone back to life. • They may feel responsible for the death due to their actions (misbehavior or words). Middle Childhood: • Children begin to understand death is final. • They may still engage in magical thinking (thinking they can bring someone back to life). • Feelings of guilt may arise, as they may think they could have prevented the death. Late Childhood: • Children understand that everyone will die, including themselves. • They may think death happens due to wrongdoing and may develop fears of their parents dying. • They may continue to feel guilty after a loved one’s death. Adolescence: • Adolescents understand death as well as adults and begin to think abstractly about it. 3|Hikamac chi LIFESPAN DEVELOPMENT • Some adolescents become fascinated with death, imagining their funeral and how others will react. • Despite this, they may feel invincible (due to the personal fable) and engage in risky behaviors (substance use, unsafe sex, reckless driving). Early Adulthood: • In early adulthood, individuals have a lower death anxiety because they expect a long life. • Lower rates of death and the expectation of a long life make them less likely to worry about death. Middle Adulthood: • People in middle adulthood experience more fear of death than in other age groups. • Caretaking responsibilities for children and aging parents increase death anxiety, as they worry about leaving loved ones behind. Late Adulthood: • Contrary to common belief, individuals in late adulthood generally have lower death anxiety. • They have fewer caretaking responsibilities and may have completed many life goals. • Past experiences with loss reduce anxiety about death, and the primary concern becomes control over how they die. Curative, Palliative, and Hospice Care Curative Care: • Designed to cure or overcome illness/disease. • Aims for complete recovery (e.g., chemotherapy). • Criticized for sometimes ignoring other goals of medicine, like preventing illness and relieving suffering. Palliative Care: • Focuses on comfort and relief from physical and emotional pain. • Can be offered alongside treatments for chronic illnesses (e.g., cancer, heart disease). • Not limited to the dying; offered to anyone suffering from chronic illness. • Part of hospice care programs. Hospice Care: • Developed in the mid-20th century in the UK by Cicely Saunders and popularized by Elizabeth Kübler-Ross in the U.S. • Focuses on end-of-life care for terminally ill patients with an expected death within 6 months. • Involves a team of professionals offering medical, psychological, and spiritual support to patients and families. • Care options are provided at home, hospital, nursing home, or hospice facility. Types of Hospice Care: • Routine Hospice Care: Most common; provided at home. • Continuous Home Care: Intense nursing care, including aides, for 8 to 24 hours at home for pain/symptom management. • Inpatient Respite Care: Temporary care in a facility to give family caregivers a break. • General Inpatient Care: Provided when pain/symptoms cannot be managed at home and require hospitalization. Hospice Statistics: • In 2017, around 1.5 million people in the U.S. received hospice care. • Most patients had dementia, heart disease, or cancer. • Many patients enter hospice care only weeks before death, and about one-third are in hospice for less than a week. Basic Elements of Hospice: • Care for both patient and family as a unit. • Pain and symptom management for the patient. • 24/7 care availability. • Coordination of all medical services. • Social work, counseling, and pastoral services. • Bereavement counseling for the family up to one year after the patient’s death. Challenges with Hospice: • Increasing regulations and insurance guidelines limit the services provided. • Hospice providers have less control over services and limited stays. • A report by the U.S. Department of Health and Human Services (2018) revealed concerns over poor quality care at some Medicare-certified hospices. Cultural Views on Hospice: • African-American families: May want to pursue treatment for as long as possible, believing only God can decide when a person dies. • Chinese-American families: May feel uncomfortable discussing death or being near the deceased. • Healthcare providers must be sensitive to cultural differences regarding hospice care and death. Family Caregivers • 66 million Americans (29% of adults) are caregivers for someone who is dying or chronically ill (Institute of Medicine, 2015). • Two-thirds of caregivers are women. Challenges for Caregivers: 4|Hikamac chi LIFESPAN DEVELOPMENT • Physical: Caregivers assist with tasks like lifting, dressing, feeding, bathing, and transportation. • Emotional: Caregivers often worry about performing tasks correctly and safely, with little training or support. • Financial: Family caregivers often face high out-of-pocket expenses. Impact on Daily Life: • Caregiving can interfere with personal wellbeing and other family/work obligations. • Many caregivers provide care alone with little professional support. Workplace Impact: • In 2013, $25 billion was lost in the U.S. due to work absenteeism related to caregiving. Long-Term Caregiving: • Most caregivers provide care for more than 3 years. • The need for caregivers is rising due to the prevalence of chronic diseases. Decline in Caregivers: • The baby boomer generation entering late adulthood means fewer available potential caregivers for future generations (Redfoot, Feinberg, & Houser, 2013). Advanced Directives Advanced Care Planning: • Refers to documents and orders that guide end-of-life care decisions. Types of Documents: • Advance Directives: o Living Wills: Written or video statements outlining a person’s healthcare preferences under specific conditions. o Durable Power of Attorney for Health Care: Names someone to make healthcare decisions if the patient is incapacitated. • Medical Orders: o Created by a medical professional for a seriously ill patient. o Must be followed by medical personnel. o Include orders like Physician Orders for Life-sustaining Treatment (POLST), Do-Not-Resuscitate (DNR), Do-Not-Incubate, or Do-NotHospitalize. o Some medical orders are limited to the facility in which they were written, but POLST is accepted across healthcare settings in certain states. End-of-Life Planning Statistics: • • Many Americans, including those aged 75 and older, have not thought about or documented their end-of-life wishes. Less than one-quarter of adults have captured their end-of-life preferences in writing or through conversation (IOM, 2015). Cultural Differences in End-of-Life Decisions Cultural Influence on End-of-Life Care: • Cultural factors affect how bad news is communicated, who makes healthcare decisions, and attitudes toward end-of-life care (Ganz, 2019; Searight & Gafford, 2005a). Western vs. Non-Western Practices: • In Western medicine, doctors prioritize telling the truth about health to the patient. • In many non-Western cultures (e.g., India, Japan, many African nations), doctors often withhold information about terminal illness from patients, respecting family wishes and avoiding harm. • Germany: Doctors are required to inform patients about their condition. • India: Doctors follow the family’s decision to withhold information from the patient. Role of Family in Decision Making: • In many cultures, especially in Asian and Hispanic cultures, family plays a central role in healthcare decisions, viewing illness as a "family event." • In contrast, Western medicine views the patient as autonomous, making their own healthcare decisions. Advanced Directives: • The concept of advance directives (e.g., living wills) is not common in many cultures outside the West. • Germany: Advanced directives are a significant part of healthcare planning. • India: Advanced directives are almost nonexistent. End-of-Life Medical Aid: • In Western countries (e.g., U.S., Canada), artificial feeding is commonly used if a patient stops eating. • In many other countries, lack of eating is seen as a natural part of dying, and feeding tubes are not used. End-of-Life Preferences: • A Pew Research Survey (2014) found racial and ethnic differences in preferences for endof-life care: o Whites are more likely to prefer stopping treatment in terminal illness. o Blacks (61%) and Hispanics (55%) tend to prefer efforts to keep them alive. 5|Hikamac chi LIFESPAN DEVELOPMENT • Hispanics may hesitate to choose a single family member for end-of-life decisions, seeing it as a family responsibility (Morrison et al., 1998). Distrust in Healthcare System: • The low completion rate of advanced directives among non-whites could reflect distrust in the U.S. healthcare system due to past health disparities. Euthanasia • Euthanasia is the intentional ending of a person’s life due to a terminal illness or severe disability. • It is categorized into: o Active Euthanasia: Intentionally causing death, often with a lethal dose of medication. o Passive Euthanasia: Withdrawing life-sustaining support (e.g., respirator, feeding tube, heart-lung machine). Physician-Assisted Dying: • A form of active euthanasia where a physician provides the means (e.g., medication) for the person to end their life. • Legal in nine U.S. states and District of Columbia (D.C.) as of 2019. • Requirements for physician-assisted dying: o Must be 18 years or older. o Must have 6 months or less to live. o Must make two oral requests (15 days apart) and one written request to a physician. • Oregon: The first state to pass the law in 1997, where 2,216 lethal prescriptions were written and 1,459 people died from the medication by 2019. Countries Allowing Physician-Assisted Dying: • Canada and several European countries (e.g., Switzerland, Belgium, Luxembourg, Netherlands) also permit it. • Belgium is the only country that allows physician-assisted dying for individuals under 18, with specific conditions (e.g., parental consent, incurable disease, understanding of euthanasia, and imminent death). Controversy and Debate: • Ethical and Legal Issues: o Disagreement over whether individuals have the right to die. o Concerns about a potential slippery slope, where euthanasia could extend to people who are disabled or unable to give consent. o Debate about the Hippocratic Oath, and whether physicians are violating the "do no harm" principle. o Government involvement in end-oflife decisions and religious restrictions against ending life deliberately. Public Opinion: • According to a 2013 Pew Research Survey: o 47% of Americans approve of physician-assisted dying. o 49% disapprove. • Public opinion was similar in 2005, with 46% approval and 45% disapproval. Religious Practices After Death Funeral Rites: • Expressions of loss that reflect personal and cultural beliefs about death and the afterlife. • Provide survivors with closure and allow the expression of love and duty to the deceased. • Offer a marker for the beginning of a new period of life as a survivor. • Lack of closure, especially in cases where a person is presumed dead or when family cannot attend, can make grieving difficult. Hindu: • Belief in reincarnation accelerates the funeral process. • The deceased is cremated as soon as possible. • The body is washed, anointed, dressed, and placed on a stand decorated with flowers before cremation. • Ashes are collected and dispersed in one of India’s holy rivers if possible. Judaism (Orthodox): • The body is washed and wrapped in a simple white shroud, with males also wrapped in their prayer shawl. • The body is placed in a plain wooden coffin. • Burial occurs as soon as possible with prayers and a eulogy. • After the burial, the family gathers to receive visitors in a practice called "sitting shiva." Muslim: • The deceased is washed and wrapped in a plain white shroud (kafan). • Funeral prayers are recited, followed by the burial. • The body is buried directly in the earth (without a casket) and positioned on the right side, facing Mecca. Roman Catholic: • Anointing of the Sick: A priest anoints the ill person with consecrated oil and recites prayers before death. • Final Communion: The person receives consecrated bread and wine. • Funeral Rites: o Wake: Held at a funeral parlor with prayers and eulogies. 6|Hikamac chi LIFESPAN DEVELOPMENT o o Funeral Mass: Includes prayers, bible readings, liturgy, and communion. Burial: At the cemetery with a blessing of the grave, scripture reading, and prayers. Green Burial Cost of Traditional Funerals (2017): • Median cost of adult funeral with viewing and burial: $8,775 • Median cost for viewing and cremation: $6,260 (National Funeral Directors Association, 2019) Nontraditional Funeral Settings: • Nearly half of respondents attended a funeral in nontraditional settings, such as an outdoor location meaningful to the deceased. • Over half expressed interest in exploring green funeral options (NFDA, 2017). Environmental Impact of Traditional Burials: • 64,000 tons of steel, 17,000 tons of copper and bronze, 1.6 million tons of concrete, 20 million feet of wood, and over 4 million gallons of embalming fluid are buried annually in the U.S. (Green Burial Council, 2019). Green Burial Practices: • Focus on reducing environmental impact at every stage of the funeral process. • Includes using biodegradable caskets, cotton shrouds instead of caskets, formaldehyde-free embalming or no embalming, and recycled paper. • Efforts are made to maintain the natural environment around the burial site. Cost of Green Burials: • Many traditional burial items (e.g., concrete vaults, embalming, expensive caskets) are not required in green burials, making them more cost-effective. • Growing consumer demand for green burial options, with many cemeteries offering such choices (NFDA, 2017). Grief, Bereavement, and Mourning Grief: • The normal process of reacting to a loss. • Can be in response to physical loss (death) or social loss (relationships, job). Bereavement: • The period following a loss when grief and mourning occur. • Duration depends on the circumstances of the loss and attachment to the deceased. Mourning: • The process by which people adapt to a loss. Strongly influenced by cultural beliefs, practices, and rituals. Grief Reactions • Typical Grief Reactions: o Mental, physical, social, and emotional responses. o Common feelings: numbness, anger, guilt, anxiety, sadness, and despair. o Difficulty concentrating, sleep and eating problems, loss of interest in activities, physical problems, and illness. o Grief can suppress the immune system, making individuals more susceptible to illness. o Typically, symptoms decrease within 610 weeks. Complicated Grief • Symptoms: o Feelings of disbelief, preoccupation with the deceased, distressing memories, inability to move on, and yearning for the deceased. o Symptoms can last 6 months or longer and resemble major depressive disorder. o Often occurs after traumatic losses like sudden, violent, or unexpected deaths. o Clinical judgment is required to distinguish from major depressive disorder, considering the individual’s history and cultural grieving norms. Disenfranchised Grief • Grief that is not socially recognized. • Examples: death from AIDS, suicide, perinatal death, abortion, death of a pet, ex-spouse, or psychological losses (e.g., Alzheimer’s). • Lack of formal mourning practices or recognition by others can intensify grief symptoms due to a lack of social support. Anticipatory Grief • Grief experienced before an expected death, allowing time to prepare. • Can make post-death adjustment easier, particularly after long-term, painful illnesses. • May bring relief as the suffering ends and caregiving responsibilities are completed. • Models of Grief General Notes on Grief Models: • There is no one "correct" way to grieve. Models of grief are guidelines and should not be viewed as rigid or exhaustive. 7|Hikamac chi LIFESPAN DEVELOPMENT Individuals may not fit a model, and that doesn't mean something is wrong with their grieving process. • Grief is experienced in various ways and stages may occur differently for each person. Kübler-Ross's Five Stages of Grief (1969) • Denial: o First reaction to overwhelming news. o Protects individuals by allowing them time to absorb the reality of the situation. o Individuals may question test results or experience disbelief. • Anger: o Provides energy to cope with the situation. o Anger helps feel a sense of control and expresses frustration. o Can be directed at others, health providers, or even higher powers. • Bargaining: o Involves trying to change the situation, often by making promises (e.g., living better or being a better person) to prolong life. o Common example: wanting to live long enough to see a family event. • Depression: o A natural reaction to the reality of the loss. o Feelings of sadness, crying, and loss of interest in life. o May lead to discomfort for others, but it's a crucial part of grieving. • Acceptance: o The individual comes to terms with the reality of death. o Does not mean happiness, but the ability to make arrangements and continue life. o Some terminally ill people may experience more fulfillment during this stage. Criticisms of Kübler-Ross’s Five Stages of Grief: • Stage Validity: o Some researchers argue that not everyone follows these stages, and they might not apply universally (e.g., the stages are primarily based on terminal illness). o Denial and acceptance may not always be helpful in the grieving process, as they can block communication or acceptance of treatment. • Optimism may actually help individuals adjust and increase longevity in some cases. • Relevance to Grieving Loss: o The theory was based on those facing their own death, not those grieving the loss of a loved one. o Grief may not follow the same pattern for everyone, and assuming it does can harm the grieving process. • Yale Bereavement Study (2000-2003): o Did not find support for the five-stage theory. o Acceptance was reported as the most common reaction, and yearning was the most common negative feature. o Other emotions like disbelief, anger, and depression were less frequently reported. • Legacy: o Despite criticism, Kübler-Ross’s work increased awareness about the needs of the terminally ill, focusing on their feelings, wishes, and right to be heard. Dual-Process Model of Grieving (Stroebe & Schut, 2001) • Bereaved individuals move between two types of orientations: o Loss Orientation: Focused on feelings of loss and yearning for the deceased. o Restoration Orientation: Focused on adjusting to life without the loved one by reestablishing roles and activities. • Dynamic Process: o Individuals switch between loss and restoration orientations. o Looking back (loss) and looking forward (restoration) cannot occur simultaneously, so bereaved individuals must shift back and forth between the two. o Both orientations help individuals grieve and work together throughout the grieving process. o Grief: Loss of Children and Parents Loss of a Child • Most Distressing Grief: o Loss of a child is considered the most distressing and long-lasting type of grief (Parkes & Prigerson, 2010). o Bereaved parents have increased risks of physical and mental health issues, including higher mortality rates. 8|Hikamac chi LIFESPAN DEVELOPMENT Parents report higher grief scores compared to other types of bereavement. • Impact on Mental Health: o Many individuals recently diagnosed with depression had lost a child within the previous six months. o 8% of women whose child died attempted or committed suicide. • Grief Intensity: o Grief intensity increases with the child’s age, especially until the child reaches 17 years old. o Older children result in deeper grief, as parents have more years of bonding. • Sudden Loss of Adult Children: o Sudden deaths of adult children (e.g., in traffic accidents) cause more intense grief and depression than the deaths of adult children from long-term illness (e.g., cancer). o Parents of unmarried adult children or those with personal struggles (e.g., alcohol, relationships) may experience greater difficulty. Loss of Parents in Adulthood • Common and Less Intense: o The loss of parents in adulthood is more common and typically less distressing. o Studies suggest that the loss of a parent in adulthood is rarely pathological (Moss & Moss, 1995). • Factors Influencing Grief: o Adult men who remain unmarried and live with their mothers may experience greater difficulty coping with parental loss. o Adult children in satisfying marriages tend to have less intense grief and may not need professional help. • Gender Differences: o Loss of a father has more negative psychological effects on sons than daughters. o Loss of a mother tends to have more negative effects on daughters. (Marks, Jun, & Song, 2007) Loss of Parents in Childhood • Negative Long-Term Effects: o Children who lose parents may experience lasting adjustment problems, including: ▪ Increased substance abuse ▪ Greater risk of depression o Higher chance of criminal behavior ▪ School underachievement ▪ Lower employment rates • Need for Professional Help: o While most children and teens don’t require professional help, some may exhibit signs indicating the need for assistance. • Red Flags for Professional Help (Worden, 2002): o Persistent difficulty talking about the deceased o Aggressive or destructive behavior o Persistent anxiety, clinging, or fear o Physical complaints (e.g., stomachaches, headaches) o Sleep and eating disturbances o Social withdrawal or academic problems o Self-blame, guilt, or self-destructive behavior Supporting Children During Grief • Challenges for Parents: o Parents may be preoccupied with funeral arrangements and not have time to address children's concerns. • Explaining Death to Children: o Use clear and direct language (e.g., "died" and "death") instead of euphemisms like "passed away" or "lost." o Children need real explanations, such as “cancer caused death,” to avoid confusion and anxiety about other illnesses. • Providing Support: o Children need someone who will listen and provide accurate, comforting answers to their questions. ▪ Mourning Challenges in Mourning in Modern Society • Lack of Time and Support for Grief: o Society is often described as "deathdenying" and "grief-dismissing" (KüblerRoss & Kessler, 2005). o Grief is often experienced privately and quickly, with people turning to substances or activities to cope. o Employers typically provide only 3 to 5 days of bereavement leave, which is often not enough for individuals to fully process their grief. 9|Hikamac chi LIFESPAN DEVELOPMENT The bereaved are rarely ready to perform well at work after such a short time. Four Tasks of Mourning (Worden, 2008) Worden identified four key tasks that help facilitate the mourning process: • Acceptance of the Loss: o Acknowledging that the loss has truly occurred. • Working Through the Pain: o Actively addressing and experiencing the emotional pain of grief. • Adjusting to Life Without the Deceased: o Making adjustments to daily life and routines without the person who has passed. • Starting a New Life: o Beginning to live a new life while maintaining a connection to the deceased. Support Groups for Grieving Individuals • Benefits of Support Groups: o Provide a space for individuals to share their grief and pain with others. o Help reduce feelings of isolation by connecting people with others who have similar experiences. o Offer an opportunity to learn new coping strategies. • Available Through: o Religious organizations, hospitals, hospices, nursing homes, mental health facilities, and schools for children. Viewing Death as Part of Life • Importance of Recognizing Death: o Viewing death as an integral part of the human lifespan helps those who are ill, bereaved, and the wider community to better cope with loss. o Acknowledging death can benefit caregivers, friends, family members, and society as a whole. o 10 | H i k a m a c c h i