The anxieties of growing old when you’re LGBTQ

Who would you call to bring you chicken soup? For many LGBTQ seniors who are alone, that’s no easy question.

A person holds an umbrella in the rainbow flag colors in the annual Gay Pride Parade, part of the Durban Pride Festival, on June 29, 2019, in Durban, South Africa.

By Steven Petrow

Who would bring you chicken soup if you were sick? For most people of a certain age, that’s easy — a spouse or an adult child would step up.

For many LGBTQ people, however, it’s not a simple question at all.

“Many [would] have to think really hard about this,” said Imani Woody, an academic and community advocate who retired from AARP to start an organization serving LGBTQ seniors. She said chicken soup is a stand-in for having a social support system, which many of us need.

“Build your village right now,” Woody said.

A few years ago, I would have said that my then-husband would be my primary caregiver if I became ill or disabled. I’d have done the same for him. Now I’m 65 and divorced, and this issue — who can I call on? — is top of mind for me.

It’s also a serious concern for many LGBTQ people I know, whether single or partnered. Take one friend of mine, for example, who is 60 and a single gay man. He took care of his dying father last year (as I’d done four years earlier with my parents). During his dad’s lengthy illness, we talked about two questions that terrify us (and I don’t use that word lightly): “Who will take care of us when we need help?” “Where will we go when we can no longer take care of ourselves?”

Of course, aging is an equal opportunity challenge for straight and queer people alike. But in interviews with more than four dozen LGBTQ people, singled and partnered, I heard repeatedly about the anxieties faced by queer elders.

SAGE/Advocacy & Services for LGBT Elders, the National Resource Center on LGBTQ+ Aging, and document the health challenges LGBTQ people face. We’re twice as likely as our straight counterparts to be single and live alone, which means more likely to be isolated and lonely. We’re four times less likely to have children. We’re more likely to face poverty and homelessness, and to have poor physical and mental health. Many of us report delaying or avoiding necessary medical care because we face discrimination or mistreatment by health-care providers. If you’re queer and trans or a person of color, these disparities are heightened further. (There are about 3 million LGBTQ people 50 and older.)

“It’s a very serious challenge for many LGBTQ older people,” said Michael Adams, chief executive of SAGE. “The harsh reality is that there just aren’t as many opportunities for older LGBTQ folks when it comes to creating, building and maintaining social connections. … We’re lacking the personal connections that often come with traditional family structures.”

In part, that’s because LGBTQ people have often found themselves rejected by family, friends and community in their younger years because of their sexual orientation or gender identity. To boot, we could not legally marry until 2015, when the Supreme Court ruled in favor of marriage equality. But even married queer folks can end up alone after a divorce or death, which often brings different challenges than those faced by straight people facing the same life-changing events.

An 80-year-old lesbian put it to me this way: For straight people, “If you were to go into a nursing home, you would not have to worry that people taking care of you did not approve of your orientation, or that the facility would not take you because they were a ‘religious’ community. These are real issues for the queer community.”

Another friend tells me he has no plans for the future except a guest room and a second bathroom. And another said he hopes by the time he needs care, there will be an LGBTQ senior community in his city. “Otherwise, I have nothing,” he said.

A former colleague of mine, a lesbian, told me she worries about the cost of senior living: “I dread it all. I won’t have any dough then, so it’s really up to fate.”

Senior living communities, which provide support for the aging, can be less than welcoming to those who are LGBTQ. Staff, some of whom have traditional views on sexuality, gender identity and marriage, also pose challenges to LGBTQ elders since many facilities lack the training and policies to discourage discrimination, which can lead to harassment, Adams said.

Patrick Mizelle, who lived in Georgia with his husband, told Kaiser Health News several years ago that he worried about how “churchy” or faith-based their local options seemed, and feared they would not be accepted as a couple. “Have I come this far only to go back in the closet and pretend we are brothers?” he asked.

Rather than take that risk, they moved across the country to a queer-friendly senior living complex in Portland, Ore. They are among the lucky ones in that they could afford both the move and the cost of this domestic situation.

How do you find a welcoming LGBTQ senior living arrangement? SAGE publishes a comprehensive list of long-term care facilities (organized by state and city, along with level of care) that it has found to be welcoming.

“We also have resources about the kinds of questions that a consumer can ask to figure out if a provider is paying attention to the steps that need to be taken to become more welcoming to LGBTQ older adults,” Adams said.

SAGE also offers training to staff members at facilities that provide elder care, and has partnered with the Human Rights Campaign, the national LGBTQ lobbying and advocacy organization, in launching the Long-Term Care Equality Index, which sets out best practices to help make these facilities welcoming to the LGBTQ community. More than 75 facilities have made pledges to abide by these best practices. AARP also provides a list of affordable LGBTQ-welcoming senior housing.

What else can LGBTQ people do to find connection, to find a tribe? Many suggest the importance of developing intergenerational friendships early on in life, even as early as your 30s and 40s. Elders can impart wisdom and experience to younger LGBTQ people, who can provide help in return; as decades pass, the young ones become the elders.

Recently, the Modern Elder Academy, which refers to itself as a “midlife wisdom school,” and the founders of Death Over Dinner, launched a program called “Generations Over Dinner” expressly to connect people of all ages.

The Harvard Study of Adult Development, which began tracking more than 238 men (regardless of sexual orientation) in 1938 and continues to this day, has reported consistently that relationships are the critical ingredient in well-being, particularly as we age.

Put simply, the more connected we are, the more likely we are to be healthy and happy. To paraphrase Imani Woody: Start building those bridges.

Complete Article HERE!

America Is a Rich Death Trap

It’s not just the pandemic. For citizens of a wealthy country, Americans of every age, at every income level, are unusually likely to die, from guns, drugs, cars, our bodies.

By Derek Thompson

Last week, the National Center for Health Statistics alerted Americans to two facts about life and death in the U.S.

The first fact was sadly unsurprising: The coronavirus pandemic killed so many people that U.S. life expectancy fell from roughly 79 in 2019 to 76 in 2021—the largest two-year decline in nearly a century. The drop was sharpest among Native Americans and Alaska Natives, whose life expectancy fell to 65, close to the national average during World War II.

Life expectancy is perhaps the most important statistic on the planet, synthesizing a country’s scientific advances, policy errors, and social sins into a single number. The number is built on a weird hypothetical. The formula for life expectancy says: If Americans lived their entire life in one year—say, 2021—repeating it over and over again like an extended Groundhog Day experiment, how long would the typical person survive? It’s a useful exercise for the purpose of capturing one year’s conditions. But it imagines a life that nobody will ever live. U.S. life expectancy will almost certainly surge in 2022 and beyond, not only because the worst of the pandemic is over, but also because the disaster accelerated technology like mRNA vaccines that could raise life expectancy in future decades.

The second fact was perhaps more alarming: The U.S. fared worse in life expectancy than other high-income countries. While most of the developed world saw conditions improve in the second year of the pandemic, more Americans died of COVID after the introduction of the vaccines than before their invention.

Any explanation of this fact must begin with the American right’s bizarre rejection of the vaccines. During the Omicron wave, Americans were less likely to be vaccinated, less likely to be boosted, and significantly more likely to die of COVID than just about all peer nations. “People don’t think of blood-pressure medication as a political act, but due to the misinformation from some media and elected leaders, Americans saw vaccines as a political statement rather than a health decision,” says Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health.

The American mortality mystery clearly goes much deeper than the pandemic, however. The U.S. suffers from a raft of local epidemics that have turned America into the death trap of the wealthy world.

Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany or the United Kingdom, as I’ve reported. But according to a paper comparing U.S. and European mortality, American babies are more likely to die before they turn 5; American teens are more likely to die before they turn 20; and American adults are more likely to die before they turn 65. “Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” says Hannes Schwandt, a Northwestern University economist and co-author of the paper. Despite our extraordinary wealth, innovation, and panoply of glittering appliances, Americans overall suffer from something like a lifelong death premium.

Some of the most immediate causes of America’s high death rate are guns, drugs, and cars. The U.S. has more guns and gun violence than any other rich country. We have more drug-overdose deaths than any other high-income country—both overall and on a per capita basis. Even before the pandemic, life expectancy in the U.S. declined for consecutive years in 2015 and 2016, largely because of the opioid epidemic and drug overdoses. The U.S. has a higher death rate from road accidents than Canada, Australia, Japan, South Korea, and the European Union. Even on a per-miles-driven basis, the U.S. still has a higher death rate than much of Europe.

So how can we fix the problem? In recent months, I’ve been researching an abundance agenda, and I can see at least two places where more abundance could, in a roundabout way, lead to more longevity: housing and preventative care. (I know, when all you have is a hammer, everything looks like a nail, but sometimes, nails really are everywhere.)

In the past few decades, the lack of housing in and near America’s most productive cities has pushed middle-class families farther away from the best-paying jobs. Among other things, this has increased commute times for people who drive to work. Americans are in their cars more than the citizens of any other OECD country, and the price of driving is paid in more than just vehicle deaths. The frequency of long commutes and the absence of walkable areas might explain why Americans are world leaders in the category of sitting on our butts. One pedometer analysis found that the typical American barely takes 5,000 steps a day. This was significantly fewer than residents of other countries in the study, including Australia (9,695 steps), Switzerland (9,650 steps), and Japan (7,168 steps).

When you combine all of this sitting with America’s array of calorie-dense food options, you get another feature of American exceptionalism: our obesity rates. At 40 percent among adults, the U.S. obesity rate is double the average of most European countries and eight times higher than Korea’s or Japan’s. Although the precise relationship between weight and health is contentious, the nonpartisan Commonwealth Fund has stated bluntly that America’s obesity levels are responsible for roughly one-fifth of deaths among American adults ages 40 to 85. One should neither reduce obesity to a function of walking nor reduce America’s sedentary lifestyle to its inability to build sufficient homes in and near urban areas. But more homes built near central business districts would likely reduce driving times and hopefully increase total aerobic activity.

If America’s housing shortage makes us less healthy, America’s doctor shortage ensures that treatable illnesses go unchecked and lead to more expensive cases. The U.S. has fewer general practitioners per capita than most rich countries, in part because our long and expensive medical education encourages doctors to become highly paid specialists. And along with this lack of affordable and accessible primary care, we have the highest rate of avoidable deaths of any rich nation. (Examples of the OECD’s definition of “avoidable” mortality include deaths related to alcohol, shootings, accidents, and influenza.) Expanding the number of primary-care physicians would reduce the chances of treatable conditions, such as moderate hypertension, blooming into costly maladies, such as heart disease.

This has all been quite gloomy, so let me end with two somewhat optimistic observations. The U.S. has world-class health care in some categories, such as cancer treatments. American men have the lowest rate of deaths from prostate cancer among rich countries, due in part to aggressive screening. And breast-cancer mortality rates are falling faster in the U.S. than in similar nations. These facts suggest that the U.S. is not utterly incompetent but rather selectively competent, and that if we refocus our health-care policies on certain tangible outcomes, we can improve quickly.

Another stunning fact is that immigrants to the U.S. live as long, or longer, than just about any group of people in the world. In fact, foreign-born Americans live so much longer than native-born Americans—seven years longer for men, and 6.2 years longer for women—that immigration alone accounted for roughly half of America’s total life-expectancy gains from 2007 to 2017.

What’s this about? Maybe self-selection bias among immigrants makes them more conscientious than the typical native-born American. Maybe they are more likely to move to urban areas, like New York City, that have more walking, less smoking, and generally healthier behaviors. Maybe some combination of foreign-born habits and U.S. health-care coverage is a good formula for a long life. I truly don’t know. But I’d like to.

America’s unusually high mortality rate is our national shame. It ought to be our national obsession.

Complete Article HERE!

After death, you’re aware that you’ve died, say scientists

Your subjective experience might not end the moment your heart stops, research on near-death experiences suggests.

By Philip Perry

Time of death is considered when a person has gone into cardiac arrest, which is the cessation of the electrical impulse that drives the heartbeat. As a result, the heart locks up. This moment when the heart stops is considered by medical professionals to be the clearest indication that someone has died.

But what happens inside our mind during this process? Does death immediately overtake our subjective experience or does it slowly creep in?

Scientists have studied near-death experiences (NDEs) in an attempt to gain insights into how death overcomes the brain. What they’ve found is remarkable: A surge of electricity enters the brain moments before brain death. One 2013 study, which examined electrical signals inside the heads of rats, found that the rodents entered a hyper-alert state just before death.

Some scientists are beginning to think that NDEs are caused by reduced blood flow, coupled with abnormal electrical behavior inside the brain. So, the stereotypical tunnel of white light might derive from a surge in neural activity. Dr. Sam Parnia is the director of critical care and resuscitation research, at NYU Langone School of Medicine, in New York City. He and colleagues have investigated exactly how the brain dies.

Our cerebral cortex is likely active 2–20 seconds after cardiac arrest.

In previous work, Dr. Parnia has conducted animal studies looking at the moments before and after death. He’s also investigated near-death experiences. “Many times, those who have had such experiences talk about floating around the room and being aware of the medical team working on their body,” Dr. Parnia told Live Science. “They’ll describe watching doctors and nurses working and they’ll describe having awareness of full conversations, of visual things that were going on, that would otherwise not be known to them.”

Medical staff confirm this, he said. But how could people who were technically dead be cognizant of what’s happening around them? Even after our breathing and heartbeat stop, we remain conscious for about two to 20 seconds, Dr. Parnia says. That’s how long the cerebral cortex is thought to last without oxygen. This is the thinking and decision-making part of the brain. It’s also responsible for deciphering the information gathered from our senses.

According to Dr. Parnia, during this period, “You lose all your brain stem reflexes — your gag reflex, your pupil reflex, all that is gone.” Brain waves from the cerebral cortex soon become undetectable. Even so, it can take hours for our thinking organ to fully shut down.

Usually, when the heart stops beating, someone performs CPR (cardiopulmonary resuscitation). This will provide about 15% of the oxygen needed to perform normal brain function. “If you manage to restart the heart, which is what CPR attempts to do, you’ll gradually start to get the brain functioning again,” Dr. Parnia said. “The longer you’re doing CPR, those brain cell death pathways are still happening — they’re just happening at a slightly slower rate.”

Other research from Dr. Parnia and his colleagues examined the large numbers of Europeans and Americans who have experienced cardiac arrest and survived. “In the same way that a group of researchers might be studying the qualitative nature of the human experience of ‘love,’” he said, “we’re trying to understand the exact features that people experience when they go through death, because we understand that this is going to reflect the universal experience we’re all going to have when we die.”

One of the objectives is to observe how the brain acts and reacts during cardiac arrest, throughout both the processes of death and revival. How much oxygen exactly does it take to reboot the brain? How is the brain affected after revival? Learning where the lines are drawn might improve resuscitation techniques, which could save countless lives per year.

“At the same time, we also study the human mind and consciousness in the context of death,” Dr. Parnia said, “to understand whether consciousness becomes annihilated or whether it continues after you’ve died for some period of time — and how that relates to what’s happening inside the brain in real time.”

Complete Article HERE!

The US Civil War drastically reshaped how Americans deal with death

– Will the pandemic?

An art installation by Suzanne Brennan Firstenberg in remembrance of Americans who have died of COVID-19, near the Washington Monument in Washington, D.C.


More than 1 million people living in the United States have died of COVID-19 during the past two years.

The numbers paint a clear picture of devastation, though they can’t capture the individual and familial pain of losing loved ones – which will no doubt transform many more millions of Americans’ lives.

The impact of this mass death on American society as a whole is less clear, especially since the pandemic is not over. While there have been a few moments of public remembrance – 700,000 white flags placed on the National Mall, and President Joe Biden’s brief words noting the “one million empty chairs around the dinner table” – the country is only beginning to grapple with the shared grief of so many deaths.

Instead, there is public discord surrounding those who died. In a country divided over basic facts about the virus, deaths have been exploited for political purposes, or wrapped into conspiracy theories.

As a scholar of religion who has studied the history of death in America, I am quite preoccupied with how the country makes sense of, honors and remembers the COVID-19 dead. The magnitude of death today immediately brings to my mind the event that killed the second-highest number of Americans: the Civil War.

My first book, “The Sacred Remains,” looked at the conflict’s impact on Americans’ attitudes toward death, during another period of extreme division and overwhelming loss of life.

Preserving the dead

Roughly 750,000 people died in the Civil War, or 2.5% of the country’s population at the time – the equivalent of 7 million Americans dying today.

The unprecedented death toll had profound consequences on American cultures of death for generations, particularly through the emergence of the funeral industry.

Throughout the 19th century, most Americans died, and had their bodies tended to, at home. Last moments with the corpse were with loved ones, who were responsible for washing and preparing it for the final rituals before burial, generally in local churchyards.

But the Civil War provided an opportunity for a game-changing development. Embalming was an innovative method of preserving bodies that allowed some Northern families to have their war dead retrieved from the mostly Southern battlefields and brought back to be buried in Northern soil.

The display of President Abraham Lincoln’s embalmed body after his assassination was a pivotal moment in this transformation. His corpse was transported on a train from Washington, D.C., to Springfield, Illinois, with frequent stops in many Northern cities where it was put on display for grieving Americans.

A black and white illustration shows a line of people paying respects at a funeral.
A drawing depicts Americans viewing Abraham Lincoln’s body at City Hall in New York City in 1865.

As embalming became more common, it helped legitimize a new class of professional experts: funeral directors, whose homes became a mix of business, mortality, religion and their own domestic life. By the early 20th century, this new business had established a fairly standard American way of death, centered on the viewing of an embalmed body to bring a community together.

Americans’ relationship to their dead would never be the same. The intimacies the living had with the dead before the Civil War gradually disappeared, as funeral homes managed the care of more and more bodies.


One of my intellectual heroes, sociologist Robert Hertz, wrote a famous essay about death and society in 1907. He argued that social groups represent themselves as immortal, capable of overcoming the death of any member. The community’s survival depends greatly on transcending death, so it transforms the dead into sacred symbols of group identity and social cohesion.

Hertz’s studies focused on death in small societies in Borneo. Yet his exploration of the relationship between the death of the individual and the life of the social group is pertinent now, in the context of the pandemic – as it was in the aftermath of the Civil War.

The victorious Union turned dead soldiers into symbols of the nation. Their deaths were seen as sacred sacrifices to preserve the country. For religion scholars, this is a clear example of American civil religion. In the U.S., civil religion is a patriotic culture that sees America as a sacred, exceptional country, built on shared ideals, myths and traditions.

But the Northern victors did not “control the narrative,” as we say these days. Indeed, a very striking and still-present counternarrative soon developed among the vanquished Confederates after the war. The losers built an alternative civil religious culture, what historians refer to as “the religion of the Lost Cause.”

Women in white dresses and skirts stand in front of a war monument in a black and white photograph.
Daughters of the Confederacy unveil the ‘Southern Cross’ monument at Arlington, Va., in 1917.

For many white Southerners, the battlefield dead did not signal God had abandoned their cause but rather illuminated his support for values associated with the Confederacy – values the United States is still grappling with today. They saw the loss as a temporary setback, but believed that ultimate victory would come if they maintained some form of Southern cultural purity based on notions of racial, regional and religious superiority.

Looking ahead

The politicization of death is not uncommon in American history, particularly during times of profound social crisis. And since the start of the pandemic, the same has happened with COVID-19 victims.

Death during a pandemic is obviously different from death during a civil war. In both cases, however, it is difficult for a divided country to experience unity in the face of an enormous loss of life and to agree on what those deaths mean for the nation.

Unique aspects of the pandemic make national mourning, and united healing, even more complicated. For example, the virus has not taken an equal toll across the country. The death toll shows significant disparities among different economic and racial groups. And the need to prevent contagion has intensified the physical separation between the living and the dead, making some meaningful rites of mourning difficult or impossible.

Many communities have made efforts to commemorate the pain of the pandemic, such as through Dia de los Muertos, a Mexican holiday honoring those who have died. But there have been minimal efforts to help make sense of the deaths on a national level: to rally around a compelling public narrative about the tremendous loss of life and grief. It remains to be seen if Americans will eventually incorporate the losses into a unifying civil religion, or only use them to reinforce polarization.

One million dead and counting will certainly require more efforts, more reflection and more soul-searching to help American society overcome and indeed draw strength from this unimaginable number.

Complete Article HERE!

Death Is No Laughing Matter.

But on DeathTok It Is.

Americans struggle with talking about death. To remedy that, some hospice nurses have taken to TikTok to soothe people’s qualms with macabre humor.

An unlikely group of influencers on TikTok is using cheeky skits and viral songs to change our relationship to mortality.

By Jessica Lucas

Casual TikTok viewers might think of the app as just a feed of Gen Zers doing viral dances and lip-synch reenactments. But the social network has also provided a space for some unlikely influencers: hospice workers, morticians, and funeral directors. These content creators hope that their comedic takes on mortality will help people who find death hard to discuss, especially during the pandemic, in which more than 900,000 Americans have died. DeathTok, as it’s called, is a corner of the platform where skits about end-of-life care, funeral arrangements, and death-worker mishaps bring comfort to those suffering through grief and loss, and clarity to those who are curious about an oft-avoided topic.

Our inability to plainly discuss death and its circumstances stems, in part, from the American ethos of self-reliance, according to Cole Imperi, a well-known author and speaker on the subject of death and thanatology. “We value the story of somebody coming to the U.S with $5 in their pocket and they make it … needing nobody,” she told me over Zoom. The end of life, Imperi explained, sits in direct opposition to this philosophy: As people age and approach death, they rely on others for help. The fear of lost autonomy (be it one’s own or a relative’s) makes planning for, grieving, and processing death hard for many Americans. “We don’t have a lot of practice with knowing how to talk about something that’s painful, scary, or difficult all the way through,” Imperi said. She believes that the humor DeathTok offers can be a useful tool for pushing through this discomfort. “Having humor is critically important when it comes to death and dying,” she said. “Humor is necessary. Humor helps us heal.”

Although some find death-based comedy unpalatable, many TikTok viewers agree with Imperi’s estimation that the levity of a well-placed joke can sometimes make difficult situations easier. When I spoke with Penny Hawkins, a 59-year-old hospice quality-control manager from Washington, she explained how she uses comedy to educate others. “If you’re talking about a really heavy subject like death and you’re able to put kind of a funny spin on it, it makes it a little more palatable. It’s not quite so scary,” said Hawkins, who has more than 300,000 followers on her nurse_penny TikTok account. She encourages viewers to be curious about human anatomy by explaining what happens to failing bodies. For example, to tackle the misconception that hospice patients need to stay hydrated, Hawkins danced to the viral song “Just Water,” by the TikTokers Bryansanon and Tisakorean. To caption her video, she wrote: “If your dying person isn’t taking fluids, that’s ok. Their body is shutting down and doesn’t need it.” The chorus, which repeats the line “It’s just water!,” serves as a whimsical background to Hawkins’s blunt explanation.

Three scrolling tik tok feeds with a hospital gurney and ekg machine in background.

Hawkins has also used macabre comedy to illuminate the realities of hospice care. In one video, about the use of morphine at the end of life, an exasperated Hawkins appeals to the camera and feigns anger at a family who wants to withhold morphine from a dying loved one out of fear that they’ll become addicted. “They’re suffering and they’re dying,” Hawkins’s caption reads. “Addiction is the least of their worries.” Hawkins told me hospice patients aren’t typically at risk of developing an addiction, because many of them are not in end-of-life care long enough to become addicted (for instance, the median length of stay for Medicare recipients in hospice is about 18 days). As uncomfortable and dark as the video may be, it underscores Hawkins’s overall message that learning more about dying bodies and end-of-life care can only help.

Beyond the medical aspects of death and dying, some videos also warn people about one of the largest hurdles after a loved one’s passing: logistics. Lauren Taylor, a 28-year-old former funeral director who lives in Florida, shares farcical family stories on TikTok—such as a quarrel between a mistress and a wife over the burial of a shared lover—to make the point that planning is key. “Being preplanned, having everything written down ahead of time, and letting others know what your wishes are is so important,” she told me over the phone. Taylor, who asked to use her maiden name to protect her family’s privacy, has more than 400,000 followers on her account, @lovee.miss.lauren, and said she has witnessed how traumatic unplanned funerals can be for families and wants to inspire forethought. “These comedic situations where you kind of wonder, Is this real? It happens more often than people think,” she said. “It can be comical to talk about after the fact, but when you’re living in the moment, it’s the most stressful thing ever.”

While DeathTok has been a useful tool for families navigating their relatives’ mortality, it’s also helped death workers themselves cope with the demands of their job. Julie McFadden, a 39-year-old hospice nurse in California, told me that of her close-to-700,000 followers, her fellow medics are the loudest voices in her comments section. “Any of my videos that are more dark, that could be slightly offensive to some, I’m always 100 percent supported by nurses,” she said. In one video, she recounts the time she noticed that a patient was dead even though the rest of their family did not (set to the audio of a person screaming “Don’t worry!” in a panicked tone). The clip spurred other nurses to share similar stories, and one thanked her for her “positive outlook” on such difficult situations. McFadden told me that though nurses are taught how to care for and save patients, many aren’t coached on how to handle death psychologically. “As a community, it’s nice to come together and make light of the things we know are messed up,” she said. “What else are we going to do if we don’t laugh about it?”

When death workers make these short, funny videos, they provide more than just comfort to their colleagues or the bereaved. Their TikToks can be soothing even for patients dealing with a terminal diagnosis. Val Currie, a 32-year-old undergoing treatment for Stage 3 recurrent metastatic cancer, told me that DeathTok provides a much-needed release, and has helped her have discussions with her partner about end-of-life care. “I’m learning to laugh at the process,” she said. If viewers can laugh at death, then they can talk about it. And if they can talk about it, healing may not be too far behind.

Complete Article HERE!

When the Death Certificate Omits the True Cause of Death

Having accurate death records saves lives.

By Jane E. Brody

A combination of journalistic curiosity and advancing years prompts me to read obituaries regularly. I routinely check for ages and causes of death that can help inform what I write about and how I live.

Increasingly, I’ve noted in published reports that people are often said to die of “complications of” some disease, rather than the disease itself.

For example, in an obituary published on Jan. 9 in The New York Times for Dwayne Hickman, who starred in the television sitcom “The Many Loves of Dobie Gillis,” a spokesman attributed his death at 87 to “complications of Parkinson’s disease.” And another, published two days earlier for Lani Guinier, a legal scholar and champion of voting rights, stated that she succumbed at 71 to “complications of Alzheimer’s disease.”

What, I wondered, does that mean? How is it recorded on death certificates? And does it result in accurate mortality statistics needed for assigning priorities for medical research and allocating resources?

I looked up the complications of Parkinson’s and Alzheimer’s diseases. Someone with Parkinson’s disease may have poor balance and die from a fall, for example, but Parkinson’s is actually the underlying cause of the death. Similarly, people with Alzheimer’s disease often have difficulty swallowing and may accidentally inhale food and develop a fatal pneumonia; such secondary infections are listed as the cause of death for as many as two-thirds of these patients.

The result can be seriously misleading information, said Dr. James Gill, the chief medical examiner for the state of Connecticut. While pneumonia may be the proximate cause of death, Alzheimer’s disease, which is why the patient developed pneumonia in the first place, is the “specific underlying cause that started the chain of events and should be listed as the cause of death,” he said.

In fact, one study from 2014 suggested that the real death rate from Alzheimer’s in 2010 may have been more about six times higher than the number of deaths reported to the Centers for Disease Control and Prevention. Likewise, if someone with Covid-19 develops pneumonia and dies, their death certificate might say that pneumonia was the cause of death, but in reality it was a coronavirus infection.

I asked Dr. Gill, who heads the College of American Pathologists Forensic Pathology Committee, why this matters. “In order to prevent deaths, we want to know what’s causing them, which influences medical practice and the awarding of research grants,” he said. “If many dementia deaths are hidden, the disease is not getting enough funding.”

More dramatically, Dr. Gill added, “Having accurate death certificates saves lives. It enables us to identify new and trending diseases and take appropriate action.” If someone is living or working in a building with a poorly installed or maintained furnace, for instance, they may be exposed to toxic levels of carbon monoxide that could eventually cause fatal cardiac and respiratory failure. The cause of death might be recorded as cardiac arrest, but in fact was a result of carbon monoxide poisoning, and the presence of the faulty appliance would likely be missed and could result in further casualties.

In a research review published in the magazine Today’s Geriatric Medicine, Dr. Emily Carter, a geriatrician affiliated with the Maine Medical Center, and co-authors noted that the data submitted on death certificates can affect families with regard to life insurance, estate settlement, genetic risk factors and finding closure. They estimate that major errors, like incorrect cause or manner of death, occur in 33 to 40 percent of death certificates that are completed at academic institutions like their own in the United States.

An analysis of death certificates at their own institution found that cardiac or respiratory arrest were incorrectly entered as the immediate cause of death on 11 of the 50 documents they reviewed. As Dr. Gill said, “Everyone who dies, dies of cardiopulmonary arrest. The critical question is: Why did this happen? Let’s say someone dies of a stomach hemorrhage. What caused it? Stomach cancer, an ulcer or what?”

There are many reasons for the high rate of inaccurate or incomplete death certificates, starting with the meager attention paid to the subject in medical school and the hectic pace in many medical settings. Speed is sometimes dictated by the need to release a body to a funeral home for burial or cremation.

The C.D.C. has estimated that 20 to 30 percent of death certificates, though not necessarily inaccurate, “have issues with completeness.” The agency stated that heavy workloads, insufficient information about a death or inadequate training can result in death certificates that are incomplete or inaccurate.

Furthermore, many deaths are certified by coroners, who are elected or appointed to their positions and may have bachelor’s degrees in forensic science, but are usually not doctors. They can be subject to political or family influence and may fail, for example, to list opioid overdose as a cause of death. Even when death certificates are completed by medical examiners, who are usually doctors, they may not be trained in forensic pathology and could miss the real cause of death. A death following a fall, for example, might have been accidental, or it could have resulted from an underlying disease or even homicide.

According to a blog post from Womble Bond Dickinson, a trans-Atlantic law firm with headquarters in London, “the death certificate may be critical in a lawsuit” to help determine “the nature of the death,” factors that contributed to it, when it occurred and illnesses that may have played a role.

If the death was the result of a medical illness, the death certificate is usually completed by the physician in charge, Dr. Carter and her colleagues wrote in their review. However, they emphasized, a medical examiner should certify all other causes, including deaths related to hip fracture which could have resulted from an accident, and deaths related to a history of malicious injury that could be a homicide.

Unfortunately, despite what you may see in films and on TV, autopsies today are performed less and less often. Families often have to pay for them out of pocket. Between the high cost of autopsies and the increasingly limited resources to do them, they have become a dying breed.

Families can often benefit from knowing the real cause of a relative’s or housemate’s death. Might there be a payout from life insurance? Is there a home problem, like a slippery floor, lack of grab bars in the bathroom or a faulty furnace, that needs correction? Is there an inherited medical condition that can be mitigated to avert further casualties? Could malpractice have caused or contributed to the death?

If a death certificate contains errors that warrant correction, the sooner that’s done the better. In New York State, the funeral firm or medical certifier can usually help with a correction request that’s made within six months of the death. Beyond six months, you would have to fill out an application for a correction.

Complete Article HERE!

Have you considered what happens to your online life when you die?

One way to feel better about the future is making sure the right online data is passed down to friends, family, and partners.

By Roger Fingas

Most of the time people prefer to dodge the topic of death, for the obvious reason that it spawns a lot of uncomfortable thoughts. Yet the realistic and responsible thing to do is acknowledge it and prepare, since death is unavoidable and has huge ramifications for friends and family. This extends to your online life — so what sort of steps should you be taking to soften the digital transition for people left behind?

Step 1: Take advantage of posthumous account settings

Major tech platforms like Apple, Facebook, and Google offer tools to control how your data is handled when you die. Facebook for example lets you appoint a “legacy contact,” someone who can download your data, “memorialize” your account, and/or have your data deleted outright. If you don’t want anyone getting your Facebook content after you go, you can specify that ahead of time. Google offers some of the best tools via its Inactive Account Manager, which shares data selectively and/or deletes your account automatically after a set period. You can read more details in the feature linked below.

Whether or not a company offers dedicated tools, the bereaved can usually request that your online accounts be deactivated. This requires evidence of your death, of course, typically a death certificate. Things can get much tougher if someone wants data access — Apple requires that legacy contacts have both documentation and a special access key, and if they haven’t been appointed as a contact, they’ll have to get a court order if they’re in the US.

The key point here is that if a service is critical to your online life, you should be exploring the options it offers now instead of waiting until you’re knocking on death’s door. It’s one of the easiest things you can do to reduce the burden on loved ones.

Step 2: Share your logins

Under normal circumstances, sharing app and website logins is the last thing you’re supposed to do. But it only takes a moment to realize that if you haven’t written those logins down, you may be denying partners or family critical information — even money, if it’s trapped somewhere like a bank or a PayPal account. Logins are regularly excluded from the data companies are willing (or able) to share with the bereaved.

That makes it vital to build a logbook with usernames and passwords for every online service a loved one might need to access. Major items to check off include:

  • Bank accounts
  • Insurance accounts
  • Phone/TV/internet
  • Government services
  • Online payment services (PayPal, Venmo, etc.)
  • Chat/messaging apps and social media
  • Smart home platforms
  • Cloud storage
  • Photo libraries
  • Music, reading, and video subscriptions
  • Online stores

You might be tempted to use a password manager as a shortcut, but it’s risky.

Your logbook can be something as simple as a text or Excel file, as long as it’s easily accessible. Even better is one on paper, since that can’t be deleted, corrupted, or hacked. Either way, you need to keep your log both updated and protected, for instance by storing a paper logbook in a fireproof container.

If you’re sufficiently thorough, a bonus of this approach is that you might not even need the tools in Step 1. If a trusted person can log into your accounts directly, they can download all of your data and shut things off at will.

You might be tempted to use a password manager as a shortcut. This is risky, however — not only do all of the right people need logins and technical literacy, but they could also eventually be shut out if the app is subscription-based and you’re no longer around to pay. It’s not the worst solution, just one to approach with caution.

Step 3: Make plans with your loved ones

Both the first and second steps can be pointless if you don’t actually talk to your loved ones about them. They need to know what being a legacy contact entails, for example, and the legal hoops they’ll have to go through to retrieve your data or shut down an account. If you have a logbook, it’s important that people know how to find it.

Although the conversation can be tough, your loved ones should know the steps you took and how you’d like your online life to be managed.

This can be one of the toughest parts of preparing for your digital afterlife. No matter how technically savvy they are, a partner isn’t going to enjoy talking about your death, and the conversation gets even more harrowing with young children or elderly parents.

At some point, you’ll probably need to sit down with a legal advisor and add online data to your will. While we can’t make any guarantees, it may make things smoother if you’ve legally authorized access or deletion ahead of time.

Think of it this way — if you can overcome all of these issues, you’ll probably feel a little calmer about the future as a reward.

Complete Article HERE!