NYU: We Didn’t Know That Donated Bodies Were Winding Up In Mass Graves

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NYU

 
New York University has apologized for allowing bodies donated for use as cadavers by medical students to wind up in mass graves for paupers.

The New York Times found (http://nyti.ms/1Ua2cO5 ) that the remains of donors who had signed forms that promised cremation and the disposal of their ashes “in an appropriate and dignified manner” were instead sent to Hart Island, a potter’s field where unclaimed bodies are buried at public expense.

“As an institution, we weren’t aware that this was happening,” Lisa Greiner, a spokeswoman for NYU Langone Medical Center, told the Times.

Mel Rosenfeld, the senior associate dean for medical education at NYU, said the practice ended in 2013 when the medical school instituted “major changes to our disposition practices for donor remains.” Now, all donated cadavers are cremated, with the ashes returned to families or scattered in a crematory’s memorial garden.

The bodies buried on Hart Island included those of well-off and prominent New Yorkers such as the reproductive rights advocate Ruth Proskauer Smith, who died in 2010 at the Dakota, one of New York City’s most fabled apartment buildings.

Her son, Anthony R. Smith, said in a letter to the Times that his mother would have been outraged by the way her remains were handled “not because she would have cared where she was ‘disposed of’ but because this hugely wealthy institution used this device to cheat the city by having taxpayers pay for burial.”

Marie Muscarnera was buried in a mass grave in 2008 even though she had left $691,700 to the NYU medical school in her will.

The Times says that Muscarnera grew up in Brooklyn in dire poverty but amassed a nest egg of more than $1.3 million through her dressmaking talent and shrewd investments.

Muscarnera left all her money to charity and donated her body to the medical school for use as a cadaver, signing the form saying she wished her remains to be cremated.

Instead, the medical school used her body as a cadaver for three years and then paid a funeral home $225 to transport it to a city morgue in the Bronx. Muscarnera’s body was boxed in pine and ferried to Hart Island, where the city pays inmates 50 cents an hour to do the burying.

Complete Article HERE!

To Be Happier, Start Thinking More About Your Death

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WANT a better 2016? Try thinking more about your impending demise.

Years ago on a visit to Thailand, I was surprised to learn that Buddhist monks often contemplate the photos of corpses in various stages of decay. The Buddha himself recommended corpse meditation. “This body, too,” students were taught to say about their own bodies, “such is its nature, such is its future, such its unavoidable fate.”

Paradoxically, this meditation on death is intended as a key to better living. It makes disciples aware of the transitory nature of their own physical lives and stimulates a realignment between momentary desires and existential goals. In other words, it makes one ask, “Am I making the right use of my scarce and precious life?”

In fact, most people suffer grave misalignment. In a 2004 article in the journal Science, a team of scholars, including the Nobel Prize winner Daniel Kahneman, surveyed a group of women to compare how much satisfaction they derived from their daily activities. Among voluntary activities, we might expect that choices would roughly align with satisfaction. Not so. The women reported deriving more satisfaction from prayer, worship and meditation than from watching television. Yet the average respondent spent more than five times as long watching TV as engaging in spiritual activities.

If anything, this study understates the misalignment problem. The American Time Use Survey from the Bureau of Labor Statistics shows that, in 2014, the average American adult spent four times longer watching television than “socializing and communicating,” and 20 times longer on TV than on “religious and spiritual activities.” The survey did not ask about hours surfing the web, but we can imagine a similar disparity.

This misalignment leads to ennui and regret. I’m reminded of a friend who was hopelessly addicted to British crossword puzzles (the ones with clues that seem inscrutable to Americans, such as, “The portly gentleman ate his cat, backwards”). A harmless pastime, right? My friend didn’t think so — he was so racked with guilt after wasting hours that he consulted a psychotherapist about how to quit. (The advice: Schedule a reasonable amount of time for crosswords and stop feeling guilty.)

While few people share my friend’s interest, many share his anxiety. Millions have resolved to waste less time in 2016 and have already failed. I imagine some readers of this article are filled with self-loathing because they just wasted 10 minutes on a listicle titled “Celebrities With Terrible Skin.”

Some might say that this reveals our true preferences for TV and clickbait over loved ones and God. But I believe it is an error in decision making. Our days tend to be an exercise in distraction. We think about the past and future more than the present; we are mentally in one place and physically in another. Without consciousness, we mindlessly blow the present moment on low-value activities.

The secret is not simply a resolution to stop wasting time, however. It is to find a systematic way to raise the scarcity of time to our consciousness.

Even if contemplating a corpse is a bit too much, you can still practice some of the Buddha’s wisdom resolving to live as if 2016 were your last year. Then remorselessly root out activities, small and large, that don’t pass the “last-year test.”

There are many creative ways to practice this test. For example, if you plan a summer vacation, consider what would you do for a week or two if this were your last opportunity. With whom would you reconnect and spend some time? Would you settle your soul on a silent retreat, or instead spend the time drunk in Cancún, Mexico?

If this year were your last, would you spend the next hour mindlessly checking your social media, or would you read something that uplifts you instead? Would you compose a snarky comment on this article, or use the time to call a friend to see how she is doing? Hey, I’m not judging here.

Some might think that the last-year test is impractical. As an acquaintance of mine joked, “If I had one year to live, I’d run up my credit cards.” In truth, he probably wouldn’t. In a new paper in the science journal PLOS One, two psychologists looked at the present value of money when people contemplated death. One might assume that when reminded of death, people would greatly value current spending over future spending. But that’s not how it turned out. Considering death actually made respondentsless likely to want to blow money now than other scenarios did.

Will cultivating awareness of the scarcity of your time make you grim and serious? Not at all. In fact, there is some evidence that contemplating death makes you funnier. Two scholars in 2013 published an academic paperdetailing research in which they subliminally primed people to think about either death or pain, and then asked them to caption cartoons. Outside raters found the death-primed participants’ captions to be funnier.

There’s still time to rethink your resolutions. Forget losing weight and saving money. Those are New Year’s resolutions for amateurs. This year, improve your alignment, and maybe get funnier in the process: Be fully alive now by meditating on your demise. Happy 2016!

Complete Article HERE!

Pets Get Send-Off Wit A Very Human Touch

By Yves Herman and Meredith McGrath

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Pets are getting a high-class send-off at Animatrans, a funeral home that claims to be the first in Belgium to cater exclusively for pets.

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Chantal Detimmerman weeps at the funeral parlour as she spends a last few moments with her beloved Chico who has been prepared for cremation and laid out in a dog basket.

That is no disrespect for Chico.

Curled up as if asleep, with a garland of flowers around one paw, the Chihuahua is getting a high-class send-off at Animatrans.

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“I loved him so much that I decided to keep his ashes, to always have Chico next to me,” Detimmerman said.

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Other customers choose to turn their dead pets into an even more tangible reminder.

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“Arthur was a special duck,” said Myrian Waeles, who nuzzles her nose against the mallard’s green head as she poses for photographs at her home in nearby Lennik, a town west of Brussels.

Arthur stares ahead with the same expression he has had for the last eight years, since he died and Waeles took him to Animatrans to be stuffed. The company also makes death masks, casting an impression of an animal’s face in long-lasting resin.

“Having Arthur, stuffed next to me, comforts me.”

“He was always waiting for me at the door when I came home, walking next to me in the living room,” Waeles said of her duck.

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Patrick Pendville set up the funeral service after seeing first-hand what animal disposal often looks, and smells, like.

Dropping a dead dog off at an animal rendering plant, a guard instructed him to unpack the carcass, remove its collar, and throw the body into a two-metre-high (7-foot) container swarming with flies, among other animal remains.

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Pendville says his company – which charges between 35 and 350 euros for a cremation – provides a humane way for people to say goodbye to animals they feel were part of the family. But by law it is classified as a processor of hazardous waste.

“I totally refuse (that) name,” he said. “I eagerly wait for when a pet is considered to be sentient and not an expired common commodity when it dies.”

Complete Article HERE!

Pets on pot: is medical marijuana giving sick animals a necessary dose of relief?

As owners tout benefits and usage in compassionate care, the battle for legalization mirrors humans’ own medical marijuana fight in 1990s California

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Bernie

The Georgiadis’s dog, Bernie, who hasn’t had a seizure in four months.

Bernie, a 130-pound Swiss mountain dog, began having grand mal seizures when he was six months old. About once a week he would violently convulse, foam at the mouth, and urinate on himself for several minutes before recovering an or so hour later. The medication he was given seriously disoriented him, was harmful to his liver and for the most part didn’t work.

At the end of their rope, Bernie’s parents decided to put him on a pet supplement derived from cannabis. Gradually, his seizures became less severe and less frequent, before disappearing altogether.

Despite a large amount of promising anecdotal evidence like Bernie’s story, and a growing industry of cannabis-based pet products, many people have a hard time taking medical marijuana for pets seriously.

“It sounds ridiculous, until you experience it yourself,” said Bernie’s owner, Anthony Georgiadis, who says his dog hasn’t had a seizure in four months.

Living in Florida, where medical marijuana is illegal, Georgiadis orders Bernie’s supplement online from a California company called Treatibles. He is allowed to do this because Treatibles products are derived from legal hemp and contain little to no THC (the intoxicating ingredient in marijuana).

Many pet products are not made from hemp, though, but rather straight marijuana containing trace amounts of THC. So anyone wanting these products for their animal’s chronic pain, anxiety, inflammation, appetite stimulation, or epilepsy have to live in a state where medical marijuana is legal – and even then, they need to have a prescription for themselves just to enter a dispensary.

Last year, Tick Segerblom, a Nevada state senator, introduced a bill to create a medical marijuana registry for pets.

“They thought it was a joke,” Segerblom said of his senate colleagues. “It was the talk of the country for a while.”

“Look at this moron!” Dennis Miller screamed on the O’Reilly Factor, deriding the senator’s bill, calling it “the end of culture as we know it”.

“I have fish at home that want medical marijuana,” O’Reilly joked. “I’m not exactly sure how to deliver that to them, because if you put the cigarette in there it all gets wet.”

Despite the public ridicule, Segerblom said, he had been looking forward to the issue being debated in a hearing, but that hearing never happened. In the end, he said, “it went to a committee headed by a person who hates marijuana, and he made sure that it died”.

Amanda Reiman, manager of marijuana law at the Drug Policy Alliance, said that today’s battle over animal medical marijuana mirrors the clash over human medical marijuana in 1990s California.

“When we first started talking about the idea of using marijuana as a medicine, people laughed about it,” she said. “But they’ve come around, because when you know someone who was helped by cannabis it’s not funny anymore.”

n 2013, Reiman’s cat, Monkey, was diagnosed with terminal intestinal cancer. The chemotherapy and medication caused Monkey to lose her appetite, not sleep and become lethargic. The situation reminded Reiman of the countless scenarios she’d encountered with humans after a decade of working in medical marijuana, so she decided to mix a very small amount of cannabis oil in Monkey’s food.

Monkey

In 2013, Reiman’s cat, Monkey, was diagnosed with cancer.

“It brought her energy back, she was eating and playing – she was actually acting healthier than she had been before she was diagnosed with cancer,” Reiman said. “I knew it wasn’t a cure for her, and in the end she passed away several months later. But I really do feel it gave her a quality of life at the end; instead of just fading away, she stayed strong right up until the end.”

Veterinarians caution against pet owners taking matters into their own hands, because finding the correct dose can be tricky. While many pet medicines are just human drugs in different doses, the weight ratios between humans and animals can make it easy to accidentally give your pet an overdose. And pets overdosing on cannabis is already a serious problem in states where marijuana is legal.

001As with children, it’s common for pets to stumble upon a high potency marijuana edible, eat it, and become incredibly ill and intoxicated.

“We’ve seen some serious poisonings of animals [from marijuana] and even a couple of deaths,” says the medical director at the ASPCA Animal Poison Control Center, Dr Tina Wismer.

When it comes to pet meds, Wismer says it’s not uncommon for a human medication to be applied to animals purely on the basis of anecdotal evidence. She believes more studies need to be done on the therapeutic use of cannabis on animals to find the right dose.

Dr Sarah Brandon, a veterinarian and cofounder of Canna Companion, a hemp-based pet supplement company, says that over the last 18 years, she has administered cannabis to more than 4,000 animals, and is currently analyzing data before offering it to the medical community.

“Right now, veterinarians have no guidance on this,” she says. “There’s a lot of fear out there, and they are scared to come out and recommend [cannabis]. A veterinarian can recommend a hemp-based product as a supplement, but they cannot encourage them to use marijuana.”

Dan Goldfarb, owner of Seattle-based Canna-Pet, describes the differences between hemp and marijuana: “It’s like dog breeds: you can have a chihuahua or a great dane, both of which are dogs but are bred to exude very different characteristics.”

Canna-Pet, Treatibles and Canna Companion are all strictly hemp-based, so they are allowed to sell their products outside of marijuana dispensaries – even online to states where marijuana is illegal – without the need of a prescription. This also affords them deniability when people like Dennis Miller say they just want to get their pet stoned. But there are a handful of companies who use straight marijuana in their pet products, who say that hemp is too limited.

“We’ve seen better results with a little THC,” says Alison Ettel, founder of Treat Well, who has been using cannabis on a variety of animals for ten years and was recently invited to treat seals at the Marine Animal Center in Sausalito, California. She says that hemp works for some ailments like anxiety, but doesn’t contain a number of medicinal properties that marijuana does, like appetite stimulation, and that hemp can be harmful to an animal with a compromised immune system. “We believe hemp can have more negative effects than positive.”

Ettel adds that while her products contain psychoactive properties, if used in the right dosage in proportion to the animal’s size, there is no reason they should ever become intoxicated by it.

Brian Walker’s California company, Making You Better Brands, offers a marijuana based doggie shampoo for pain relief (along with similar products for horses). Walker says that the marijuana is never activated with heat, a process necessary for making the plant psychoactive.

But his company is still regulated like any other in the cannabis industry, meaning pet owners can only buy it in a dispensary with a (human) prescription, and can’t take it out of state. Walker said the lack of information available about the differences between hemp, active cannabis and inactive cannabis has prevented acceptance among veterinarians of medical marijuana.

“They picture a dog eating a brownie and being high for two days,” he said. “But with non-active cannabis they’re not going to get high – they’re going to get well.”

 Complete Article HERE!

Spiritual care at the end of life can add purpose and help maintain identity

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Spiritual care

In Australian nursing homes, older people are increasingly frail and being admitted to care later than they used to be. More than half of residents suffer from depression, yet psychiatrists and psychologists aren’t easily accessible, and pastoral or spiritual care is only available in a subset of homes.

Depression at the end of life is often associated with loss of meaning. Research shows people who suffer from such loss die earlier than those who maintain purpose. This can be helped by nurturing the “spirit” – a term that in this setting means more than an ethereal concept of the soul. Rather, spiritual care is an umbrella term for structures and processes that give someone meaning and purpose.

Caring for the spirit has strength in evidence. Spiritual care helps people cope in grief, crisis and ill health, and increases their ability to recover and keep living. It also has positive impacts on behaviour and emotional well-being, including for those with dementia.

Feeling hopeless

Many people have feelings of hopelessness when their physical, mental and social functions are diminished. A 95-year-old man may wonder if it’s worth going on living when his wife is dead, his children don’t visit anymore and he’s unable to do many things without help.

The suffering experienced in such situations can be understood in terms of threatening one’s “intactness” and mourning what has been lost, including self-identity.

Nursing home residents are increasingly frail and more than half experience depression.

Nursing home residents are increasingly frail and more than half experience depression.

Fear is also common among those facing death, but the particular nature of the fear is often unique. Some may be afraid of suffocating; others of ghosts. Some may even fear meeting their dead mother-in-law again.

What plagues people the most though is the thought of dying alone or being abandoned (though a significant minority express a preference to die alone). Anxiety about dying usually increases after losing a loved one.

But such losses can be transcended by encouraging people to pursue their own purpose for as long as they can; in other words, by caring for the spirit.

What is spiritual care?

Spiritual care has religious overtones that make it an uncomfortable concept in a secular health system. But such care can be useful for all – religious and non-religious – and can be provided by carers, psychologists and pastoral specialists alike.

Spirituality can be defined as “the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred”. Perhaps the Japanese term “ikigai” – meaning that which gives life significance or provides a reason to get up in the morning – most closely encompasses spirituality in the context of spiritual care.

Guidelines for spiritual care in government organisations, provided by the National Health Services in Scotland and Wales, note that it starts with encouraging human contact in a compassionate relationship and moves in whatever direction need requires. Spiritual needs are therefore met through tailoring components of care to the person’s background and wishes.

Spiritual care can involve having your dog nearby or being surrounded by your favourite sports team regalia.

Spiritual care can involve having your dog nearby or being surrounded by your favourite sports team regalia.

For instance, one person requested that her favourite football team regalia be placed around her room as she was dying. Another wanted her dog to stay with her in her last hours. Supporting these facets of identity can facilitate meaning and transcend the losses and anxiety associated with dying.

Spiritual care can include a spiritual assessment, for which a number of tools are available that clarify, for instance, a person’s value systems. Such assessments would be reviewed regularly as a person’s condition and spiritual needs can change.

Some people may seek religion as they near the end of their lives, or after a traumatic event, while others who have had lifelong relationships with a church can abandon their faith at this stage.

Other components of spiritual care can include allowing people to access and recount their life story; getting to know them, being present with them, understanding what is sacred to them and helping them to connect with it; and mindfulness and meditation. For those who seek out religious rituals, spiritual care can include reading scripture and praying.

Spiritual care in the health system

Psychologists or pastoral care practitioners may only visit residential homes infrequently because of cost or scarce resources. To receive successful spiritual care, a person living in a residential home needs to develop a trusting relationship with their carer.

For those who seek out religious rituals, spiritual care can include reading scripture and praying.

For those who seek out religious rituals, spiritual care can include reading scripture and praying.

This can best be done through a buddy system so frail residents can get to know an individual staff member rather than being looked after by the usual revolving door of staff.

Our reductionist health care model is not set up to support people in this way. Slowing down to address existential questions does not easily reconcile with frontline staff’s poverty of time. But health care settings around the world, including Scotland and Wales, the United States and the Netherlands, are starting to acknowledge the importance of spiritual care by issuing guidelines in this area.

In Australia, comprehensive spiritual care guidelines for aged care are being piloted in residential and home care organisations in early 2016.

People with chronic mental illness, the elderly, the frail and the disabled have the right to comprehensive health care despite their needs often being complex, time-consuming and expensive.

Finding meaning at all stages of life, including during the process of dying, is a challenging concept. It seems easier to get death over with as quickly as possible. But the development of new spiritual care guidelines brings us one step closer to supporting a meaningful existence right up to death.

Complete Article HERE!

Everything dies and it’s best we learn to live with that

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Everything dies and it’s best we learn to live with that

Fear of dying – or death anxiety – is often considered to be one of the most common fears. Interestingly though, neither of the two widely used diagnostic psychiatric manuals, DSM-5 or ICD-10, has a specific listing for death anxiety.

Death is related in the manuals to a number of anxiety disordersincluding specific phobias, social anxiety, panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder. Although many psychologists will argue that these fears are proxies for the larger fear of death.

Existential therapy directly targets death and the meaning of life. It’s practised by psychiatrist Irvin Yalom, a pioneer in understanding fear of death and how to treat it in therapy. He has written a popular book on the subject called Staring at the Sun: Overcoming the Terror of Death. Existential therapy is one way of treating death anxiety but no matter what psychological approach is used, the underlying theme is generally the same: acceptance.

What’s so frightening about death?

All life has death in common, yet it’s striking how little we actually talk about it. In Western cultures at least, the concept can be too much even to consider. But from a clinical psychology perspective, the more we avoid a topic, situation, thought or emotion, the greater the fear of it can become and the more we want to avoid it. A vicious cycle.

Fear of the unknown is one of the specific fears around death.

Fear of the unknown is one of the specific fears around death.

If presented with a client who has death anxiety, we would ask them to tell us exactly what they fear about death. Yalom once asked a client what bothered him most. The client replied, “The next five billion years with my absence.”

Yalom then asked, “Were you bothered by your absence during the last five billion years?”

The specific death fear will be different for everyone, but it can often be categorised into one of four areas: loss of self or someone else; loss of control; fear of the unknown – what will happen after death (nothingness, heaven, hell); and pain and suffering of dying.

Yalom suggests psychologists speak about death directly and early in therapy. The psychologist should find out when the client first became aware of death, who he discussed it with, how the adults in his life responded to his questions and whether his attitudes about death had changed over time.

Once we understand the client’s relationship to death, there are several approaches to help manage the associated anxiety. These include existential therapy, cognitive-behaviour therapy, acceptance and commitment therapy and compassion-focused therapy.

How to treat death anxiety

In one of the first studies to examine death anxiety directly, cognitive-behaviour therapy (CBT), was found to be successful in treating it in those suffering from hypochondria. The strategies used included exposure (going to a funeral), relaxation strategies (breathing) and creating flexible thoughts around death, such as recognising that fearing death is normal.

Some researchers argue that CBT should include strategies that explore the probability of life events – such as calculating the chances of your parents’ meeting and having you. Such techniques can shift our perspective from a negative fear of dying to a positive realisation we are lucky to experience life at all.

We must learn to accept death. It’s not going away.

We must learn to accept death. It’s not going away.

Existential therapy has been shown very useful in treating death anxiety. It focuses on ultimate existential concerns such as isolation. For instance, we have a deep need to belong and having family and friends means, in some way, we live on after death.

Treatment is directed at finding meaning and purpose in life, increasing psychological and social support, building relationships with friends and family and improving coping skills to manage anxiety in daily life.

In compassion focused therapy (CFT), the client is encouraged to descend into the reality of human experience. That means realising we only have about 25,000 to 30,000 days of life. Suffering is normalised and the emphasis is on the fact that the trajectory of life is the same for everyone: we come into this world, grow and flourish and then decay and die.

CFT discusses how the human brain has the fantastic ability to imagine and question our very existence – as far as we know a uniquely human quality. We will then say to clients: “Did you design your brain to have that capacity?” Of course the answer is a resounding no.

So we work on the principle that it is not the client’s fault they have death anxiety but that we must work with our brains so they don’t paralyse our ability to live now.

In CFT we will sometimes use the phrase, “Our brains were designed for survival not happiness”. Strategies arising form this include guided discovery (slowing down and giving clients opportunities to make their own insights) and soothing rhythm breathing.

Although subtly different in approach these therapies have a similar underlying theme. Death is something we must learn to accept. The key for us in the context of death anxiety is how we get out of our minds and into our life.

Some tips that could help

If you struggle with death anxiety, please consider seeing a psychologist. But for now, here are three tips that might be helpful.question existence

  1. Normalise the experience: We have tricky brains that allow us to question our existence. This is not your fault but is how the human brain was designed. It is perfectly normal to have a fear of death; you are not alone in this struggle.
  2. Breathe: When you notice anxiety entering your body and mind, try to engage in some soothing breathing to help slow down your mind and physiological response.
  3. Write your own eulogy as if you’re looking back over a long life: Pretend it is your funeral and you have to give the eulogy. What would you write? What would you have wanted your life to be about? This might provide some meaning and purpose for how to live your life now.

Complete Article HERE!

Here’s what people in their 90s really think about death

By JANE FLEMING

old-age-lead

Across the developed world more people are living longer, which of course means more get to be extremely old by the time they die. Nearly half of all deaths in the United Kingdom are in people aged 85 or older, up from only one in five just 25 years ago.

Dying in older age can mean a different sort of death, such as becoming gradually frailer in both body and mind and developing numerous health problems over many years. Where years after retirement were previously considered just old age, a longer life span means the later years now include variation reflected in labels such as younger old and older old.

Our previous research showed people who are over 90 when they die need more support with daily life in their last year than even those who die in their late 80s. In the United Kingdom, around 85% of those dying aged 90 or older were so disabled as to need assistance in basic self care activities. Only 59% of those between 85 and 89 at death had this level of disability.

This knowledge has implications for planning support for life and death in different care settings. But what do we know about what the older old (95 plus) people actually want when it comes to decisions about their care as they approach the end of their lives?

HOW THE OLDER OLD FEEL ABOUT DYING

The oldest and frailest in our society are becoming less visible as many who need the most support, such as those with dementia, are either in care homes or less able to get out and about. But their voices are crucial to shaping end-of-life care services.

In our latest research, we had conversations about care experiences and preferences with 33 women and men aged at least 95, some over 100, and 39 of their relatives or carers. Of these, 88% were women, 86% were widowed and 42% lived in care homes.

Death was part of life for many of the older people who often said they were taking each day as it comes and not worrying too much about tomorrow. “It is only day-from-day when you get to 97,” said one woman. Most felt ready to die and some even welcomed it: “I just say I’m the lady-in-waiting, waiting to go,” said one.

Others were more desperate in their desire to reach the end. “I wish I could snuff it. I’m only in the way,” was a typical sentiment in those who felt they were a nuisance. Others begged not to be left to live until they were a hundred, saying there was no point to keeping them alive.

Most were concerned about the impact on those left behind: “The only thing I’m worried about is my sister. I hope that she’ll be not sad and be able to come to terms with it.”

The dying process itself was the cause of most worries. A peaceful and painless death, preferably during sleep, was a common ideal. Interviewees mainly preferred to be made comfortable rather than have treatment, wishing to avoid going into hospital.

We found families’ understanding of their relative’s preferences only occasionally incorrect (just twice). For instance, one person said they wanted to have treatment for as long as they could, while their family member believed they would prefer palliative care. This highlights the importance of trying to talk options through with the older person rather than assuming their family knows their views.

We found most discussed end-of-life preferences willingly and many mentioned previous talk about death was uncommon, often only alluded to or couched in humour. A minority weren’t interested in these discussions.

WE NEED TO TALK WITH THE OLDER OLD

It’s rare to hear from people in their tenth or eleventh decade but there are some studies that have explored the views of the younger old. Most often these have concentrated on care home residents and occasionally on those living at home.

A literature review conducted in Sweden in 2013 found a total of 33 studies across the world that explored views of death and dying among older people, although very few of these sought the views of the older old.

A 2002 study found older people in Ghana looked forward to death, seeing it as a welcome visitor that would bring peace and rest after a strenuous life. And a 2013 study in the Netherlands showed many people changed their preferences on how they wanted to die as their care needs changed.

A recent review examined older people’s attitudes towards advance care plans and preferences for when to start such discussions. It identified 24 studies, mainly from the United States and with younger old age ranges. The results showed that while a minority shirked from end-of-life care discussion, most would welcome them but were rarely given the opportunity.

These studies support our findings on older people’s willingness to discuss often taboo topics, their acceptance of impending death, and their concerns around what the dying process would bring: increasing dependence, being a burden and the impact of their own death on those left behind.

To plan services to best support rising numbers of people dying at increasingly older ages in different settings, we need to understand their priorities as they near the end of life.

Complete Article HERE!