What is Death and Dying?
Death is a natural part of life, but it’s often a topic that people, including caregivers and healthcare providers, find difficult to discuss. Caregivers often feel overwhelmed by tasks related to end-of-life care, such as dealing with medical tasks, talking with healthcare providers, making decisions, and grappling with the sorrow linked to an upcoming loss. Likewise, many healthcare providers do not feel equipped to offer end-of-life care or navigate conversations about death and dying, largely because these topics aren’t extensively covered during their training.
However, it’s vital that patients and their families get the care and support they need when they’re facing the final stages of life. Every patient’s situation is unique, and their needs and those of their family will vary. So, it’s crucial that healthcare providers deliver care and support in a way that honours the patient’s dignity and respects their personal preferences.
What Causes Death and Dying?
The Centers for Disease Control and Prevention (CDC) released 2016 data stating the leading causes of death in the United States and their respective numbers. The top cause was heart disease, with 635,260 deaths. This was closely followed by cancer, which led to 598,038 deaths.
Accidental injuries or mishaps took 161,374 lives, while diseases related to chronic lower respiratory problems caused 154,596 deaths. Stroke, also known as cerebrovascular diseases, resulted in 142,142 fatalities.
Alzheimer’s disease led to 116,103 deaths. Diabetes resulted in 80,058 lives lost. Flu and Pneumonia together resulted in 51,537 deaths. Diseases related to kidneys, like nephritis, nephrotic syndrome, and nephrosis, led to 50,046 deaths.
Unfortunately, there were also 44,965 cases of intentional self-harm, commonly known as suicide.
Risk Factors and Frequency for Death and Dying
The CDC releases yearly reports on deaths in the United States. They analyze this information to notice trends and address potential health problems. This data can then be used to improve healthcare practices and develop community programs.
- Number of deaths reported: 2,744,248
- Death rate stood at: 849.3 deaths per 100,000 population
- Average life expectancy was: 78.6 years
- Infant mortality rate was: 5.87 deaths per 1,000 live births
It’s worth noting the leading causes of death for each age group in 2016:
- Younger than 1 year (23,161 deaths): Mostly due to birth defects and chromosomal abnormalities
- 1 to 4 years (4045 deaths): Mainly caused by unintentional injuries
- 5 to 14 years (5503 deaths): Unintentional injuries topped the list
- 15 to 24 years (32,575 deaths): Again, unintentional injuries were the leading cause
- 25 to 44 years (135,408 deaths): Unintentional injuries claimed the most lives
- 45 to 64 years (539,961 deaths): Leading cause was malignant tumors
- Over 65 years (2,003,458 deaths): Heart diseases were the primary cause
The death rates by gender for all ages per 100,000 population in 2016 were:
- Male: 861.0
- Female: 617.5
Signs and Symptoms of Death and Dying
Death is the final stage of every disease, but each disease progresses at its own pace. As healthcare providers, we need to pay attention not only to the patient’s disease symptoms but also to their needs as they approach the end of life.
Respecting patient autonomy is crucial in this sensitive phase. If patients are capable of making their own decisions, healthcare providers must uphold their wishes. It’s not for healthcare providers to impose their own beliefs onto patients. Family members may be grappling with anticipatory grief, which can make it difficult for them to accept the patient’s wishes. But, as medical professionals, it’s important to keep the patient’s wants front and center during any discussions around these tough topics.
There can be many reasons for these discussions, including:
- Patient is clinically assessed as entering the dying stage
- Patient decides to refuse life-saving treatments, also known as implementing a Do Not Resuscitate (DNR) order
- Patient has been diagnosed with a disease progression that will eventually result in death, such as heart disease, kidney disease, or cancer
- Patient with a pre-existing progressive disease experiences a worsening in health status
- Patient decides to stop curative treatments
- Patient personally invites a discussion on these matters
When gathering information from a patient and during these discussions, it’s important to create a calm and safe space for the patient and their family. Allow them the time to answer questions at their own pace. Make sure the aims of all parties – the patient, the family, and the medical team – are discussed and understood.
Testing for Death and Dying
The type of medical evaluation a patient needs will vary depending on their unique situation and the stage they’re at in their treatment. Sometimes, it may be necessary to conduct a variety of lab tests, imaging studies, and other diagnostic tests. However, in some cases, ordering no additional tests might be the best approach if it aligns with the patient’s quality of life goals.
Treatment Options for Death and Dying
The main objective in treating patients is to relieve their suffering. Two frequently mixed-up terms relating to this are hospice care and palliative care. Hospice care is dedicated to patients who are expected to live for about six months or less. Instead of trying to cure the disease, the focus is on enhancing their quality of life, which can entail a wide range of things.
Palliative care, on the other hand, can be introduced at any time to a patient who is suffering and wants to alleviate that suffering without necessarily curing its root cause. This form of care may be used alongside curative treatments. Suffering can come in various forms, and the care required should be multi-faceted.
Some elements that can be addressed include spiritual guidance with the help of religious service providers, giving community resources or a social worker’s intervention to help alleviate caregiver tiredness, managing physical symptoms like pain, nausea, and constipation using different approaches, and even having a palliative care team leader to coordinate everything while keeping everyone informed.
It’s also vital to set a shared treatment goal with the patient and their family and remember that this goal may change over time.
What else can Death and Dying be?
It’s crucial to understand the signs of death, especially for families with a loved one who is nearing the end of their life and has chosen to pass away at home. These signs may include:
- Not breathing
- No heartbeat
- No response to spoken words or touch
- Loss of control over the bowels or bladder
- Eyelids are partially open, eyes don’t move and are focused on one spot, pupils don’t react
- Jaw is relaxed, and mouth is a bit open
What to expect with Death and Dying
Most individuals tend to pass away in hospitals, despite the fact that many Americans express a preference not to, if presented with the option. The amount of time spent at home is considered a significant aspect of patient’s well-being. Studies carried out on older people who live in the community indicate that the days spent at home in the last six months of one’s life remain the same across different ages, genders, and racial or ethnic backgrounds.
However, this time at home is noticeably less for those experiencing organ failure, while those with cancer or experiencing sudden death tend to spend the most time at home in their final months.
Possible Complications When Diagnosed with Death and Dying
Discussing issues related to death and dying is a crucial aspect of patient care. Healthcare providers should be comfortable initiating these conversations not just in the final stage of life, but also when a patient has been given a serious diagnosis or whenever a patient brings it up. It’s important for healthcare professionals to also understand and reflect on their own emotions about death and dying. If strong feelings come up, it’s okay to talk to a colleague, write in a journal, or practice having difficult conversations ahead of time. By dealing with these emotions beforehand, health professionals can be fully present and attentive to their patient’s needs.
In the U.S., the leading cause of death for people aged 1 to 44 is unintentional injuries. This often results in complicated grief for families because of the sudden and unexpected loss. As a healthcare provider, be ready to offer resources and to repeat information, as family members may be in the first stage of grief, denial, and may not remember what you’ve told them. If they’re in the second stage, anger, try not to take any hostility personally. Every family will grieve in their own unique way, so be sure to provide support as needed.
Disagreements can occur if a patient’s wishes don’t align with a family member’s, or if a patient wants to continue treatment that the medical team considers pointless. In these cases, it’s a good idea to have multiple conversations to make sure everyone understands the situation. If a resolution can’t be found, an ethics committee may need to step in.
Preventing Death and Dying
Keeping the lines of communication open is crucial. Conversations should be frequent but not overloaded with information. Ensuring that everyone understands the information shared in each discussion is key. A simple approach to facilitate this is to use the Ask/Tell/Teach/Ask method.
Firstly, Ask the patient or a family member about what they already know about the topic you’ll be discussing. This gives you a starting point to work from. Then proceed to Tell them the new information or Teach them the new skill. To wrap things up, Ask them to put what you’ve just explained or taught into their own words. This helps confirm that they’ve understood the information or mastered the skill you’ve shared.
