Tag: Death And Dying

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Why GPs need better end of life training

By Matt Bowskill

Many GPs lack confidence when it comes to end of life care. Thinking back to my own family’s experiences, I explore the support available for doctors.

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It was cold even for February and my headlights lit up sheets of rain as I pulled into our parking space. I was surprised to see my wife running towards me in the rear view mirror.

“I think you should come inside and sit down,” she said gently. I remember her stood there in her dressing gown and slippers. She was getting completely drenched. But that might be the kind of detail you misremember when your brain is sent into a sudden spin.

“…there’s been some bad news, your Mum rang, your Dad…..his oesophagus, cancer, blah blah blah………they don’t know, they don’t know, they don’t know. You need to call your mum…”

That “they don’t know” turned into more “they don’t know”. For 5–6 weeks, through endless appointments with specialists, scans, and doctor’s appointments. Eventually they did know. A consultant talked Dad and Mum through end of life care options.

But it was his GP who initially referred him after he’d had problems swallowing (he’d been a little sceptical that there was a problem). It was his GP who acted as a day-to-day source of contact in the days, weeks and months ahead.

And it was the same GP who Mum and Dad would visit between hospital appointments — to check in with, for prescriptions to help with pain or sleeping and, more than anything, for someone to talk to.

Challenging conversations

“It can feel overwhelming that the needs and trust of the patient and their carers are solely placed on you. Particularly when you’re working in an out-of-hours setting, or on-call within the practice. You can feel very isolated,” says Dr Elise Long, a salaried GP working in Cardiff.

“I’ve personally felt like I need to further my clinical knowledge of symptom management and my communication skills.”

Elise isn’t alone.

Many GPs find it difficult to discuss death and dying with patients. Research shows that doctors sometimes don’t initiate end of life care conversations and many say they find it more comfortable when the subject is brought up by patients. Clearly, it is a distressing topic.

“There’s bound to be a lack of confidence in some quarters,” says Marie Curie Medical Director, Professor Bill Noble. “It’s never straightforward. So much depends on your experience and training background.”

Some patients say they don’t want further information from GPs. But many want a clear idea about the future in order to start planning ahead. So how do GPs go about assessing these different needs? And how do they effectively approach these very difficult conversations?

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Developing relationships

Zoe Hutchinson qualified as a GP three years ago and now works in Littleport, Cambridgeshire. It’s a remote location, where she says many patients can feel isolated — particularly after being diagnosed with a terminal illness.

She says her undergraduate medical training inspired a passion for palliative care: “It’s an important issue. All our patients face the prospect of needing end of life care at some point”.

Dr Hutchinson embraces her position as the central point of contact for her rural patients. She talks about the time she spends liaising with district nurses and others involved in end of life care, visiting remote patients, identifying the need for ‘just in case’ medicines, and establishing the needs and wishes of the patient and their family.

“But really, having an open conversation with the patient and their family is the most important thing. To do that you need to be able to understand when a patient is ready to have conversations about end of life care. It’s hard. One of my patients suffers from anxiety. I can tell they don’t want to talk about death and dying yet. It’s about really getting to know them,” she says.

I ask several other GPs about what they think makes for good end of life care. They all agree: communication. Specifically: communication based on developing genuine human relationships with patients.

A recent video collaboration between the GMC and National Council for Palliative Care explores the same issue (see it here). Patients and family members talk about the difference it makes to be treated like individuals. GPs talk about the need for us all to talk about death more openly. But when distressing conversations need to be had, it’s important they happen in a planned way, at the right time, in private, and with relevant family members or carers present.

Clarity and communication

After Dad’s diagnosis, I’d call my parents on a daily basis when I couldn’t visit. We were all grasping at that stage: for information, for certainty, for hope. I could sense their frustration as they tried to remember what they’d been told by the consultant or GP.
Often the details seemed jumbled or confused. It seemed to me like things hadn’t always been explained particularly well. When I mentioned this to Mum recently, she said the GP had been very good, but it seemed he was hearing updates about Dad’s condition for the first time from them.

When you feel all at sea, clear communication is like a lifebelt. Asking patients to repeat information to make sure they’ve understood it is one technique GPs use. But there’s another question: has information about the patient been shared as effectively as possible between people involved in caring for the patient?

It’s a problem that’s being tackled through electronic tools like EPaCCs(electronic palliative care coordination systems), with which healthcare professionals involved in palliative care can share information more effectively.

This gives everyone involved access to timely information. It also helps identify those patients who are approaching the end of their life, so important conversations can take place and the wishes of patients and families considered. And it ensures patients can be referred to services at the right time.

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Gold plating end of life care

But what else can be done to improve the quality of support GPs can offer? Everyone I spoke to talked about the need for more training with a palliative care focus.

In 2013, the Royal College of General Practitioners and Marie Curie formed a partnership to improve the end of life care offered by GPs. Since 2015, the partnership has produced a series of one-day end of life masterclasses for GPs, run by experts across the UK. More classes are planned for later in 2016.

“When you ask GPs what they need to know about palliative care they say they need: confidence about communication, knowledge about symptom control and good relationships with local nursing service,” says Professor Noble. The masterclasses there cover the issues GPs themselves have identified as things they need to know more about. Also covered are medical-legal issues and general changes to policy and practice.

“GP training gives you a good base to start from. The problem is you need to know something about everything,” says Dr Michael Brookes, an RCGP/Marie Curie Clinical Fellow who helped run several of the sessions. “It’s impossible to train for every eventuality. We need to give people the skills to deal with end of life effectively. That also means fostering a hunger for self-improvement.”

Another outcome of the partnership has been the Palliative Care End of Life Toolkit, which supports patients and GPs at the end of life. “End of life care is one of the biggest things you can do to make a difference. You can see the effect being able to support a ‘good death’ has on everyone,” says Dr Brookes.

Both Dr Long and Dr Hutchinson attended our masterclasses. “It was an amazing opportunity to meet and hear from palliative care leaders. And amazingly, given the calibre of speakers, it was completely free,” says Long.

“I’d always been interested in end of life care during my GP training,” says Dr Hutchinson. “I’m already putting tips on prescribing ‘just in case’ medicines into practice, and the advice on difficult ‘bad news’ conversations was invaluable. Training has improved. But the masterclasses help to gold plate it.”

What next?

When I ask Professor Noble what he thinks needs to be our next focus, his answer is immediate: 24/7 end of life care. More needs to be done to make sure high-quality 24/7 end of life care is available to patients within communities. GPs are a central point of contact for patients who’ve been affected by terminal illness, and their families. They play a crucial role in delivering this service effectively.

“At the moment GPs very rarely provide out-of-hours care to their own patients. It’s sometimes handed over to emergency call systems. And that’s problematic,” says Professor Noble. “Continuity matters more in end of life than in any other area. Patients shouldn’t have to go over the same ground again and again.”

Six months after his initial diagnosis, Dad was rushed into hospital for what would be the final time. Mum remembers the GP being limited in his ability to do all that much during the previous six months. He was more a point of contact — someone to talk to when things got tough. But Dad liked him. That was important

After Dad died, the GP rang my mum to offer his condolences. “Any time you want to come in and talk, we’re here for you,” she remembers him saying. It meant a lot. It still does.

To find out more about how Marie Curie provide care and support at the end of life, visit their website.

Complete Article HERE!

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Death Talk Is Cool At This Festival

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A chalkboard "bucket list" stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.
A chalkboard “bucket list” stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.

In a sunny patch of grass in the middle of Indianapolis’ Crown Hill Cemetery, 45 people recently gathered around a large blackboard. The words “Before I Die, I Want To …” were stenciled on the board in bold white letters.

Sixty-two-year-old Tom Davis led us through the thousands of gravestones scattered across the cemetery. He’d been thinking about his life and death a lot in the previous few weeks, he told us. On March 22, he’d had a heart attack.

Davis said he originally planned to jot, “I want to believe people care about me.” But after his heart attack, he found he had something new to write: “I want to see my grandkids grow up.”

Others at the event grabbed a piece of chalk to write down their dreams, too, including some whimsical ones: Hold a sloth. Visit an active volcano. Finally see Star Wars.

The cemetery tour was part of the city’s Before I Die Festival, held in mid-April — the first festival of its kind in the U.S. The original one was held in Cardiff, Wales, in 2013, and the idea has since spread to the U.K., and now to Indianapolis.

The purpose of each gathering is to get people thinking ahead — about topics like what they want to accomplish in their remaining days, end-of-life care, funeral arrangements, wills, organ donation, good deaths and bad — and to spark conversations.

“This is an opportunity to begin to change the culture, to make it possible for people to think about and talk about death so it’s not a mystery,” said the festival’s organizer Lucia Wocial, a nurse ethicist at the Fairbanks Center for Medical Ethics in Indianapolis.

The festival included films, book discussions and death-related art. One exhibit at the Kurt Vonnegut Memorial Library had on display 61 pairs of boots, representing the fallen soldiers from Indiana who died at age 21 or younger.

These festivals grew out of a larger movement that includes Death Cafes, salon-like discussions of death that are held in dozens of cities around the country, and Before I Die walls — chalked lists of aspirational reflections that have now gone up in more than 1,000 neighborhoods around the world.

“Death has changed,” Wocial said. “Years ago people just died. Now death, in many cases, is an orchestrated event.”

Medicine has brought new ways to extend life, she says, forcing patients and families to make a lot of end-of-life decisions about things people may not have thought of in advance.

“You’re probably not just going to drop dead one day,” she said. “You or a family member will be faced with a decision: ‘I could have that surgery or this treatment.’ Who knew dying was so complicated?”

With that in mind, the festival organizers held a workshop on advance care planning, including how to write an advance directive, the document that tells physicians and hospitals what interventions, if any, you want them to make on your behalf if you’re terminally ill and can’t communicate your wishes. The document might also list a family member or friend you’ve designated to make decisions for you if you become incapacitated.

“If you have thought about it when you’re not in the midst of a crisis, the crisis will be better,” Wocial said. “Guaranteed.”

About a quarter of Medicare spending in the U.S. goes to end-of-life care. Bills that insurance doesn’t cover are usually left to the patients and their families to pay.

Jason Eberl, a medical ethicist from Marian University who spoke at the festival, said advance directives can address these financial issues, too. “People themselves, in their advance directive will say, ‘Look, I don’t want to drain my kids college savings or my wife’s retirement account, to go through one round of chemo when there’s only a 15 percent chance of remission. I’m not going to do that to them.’ ”

The festival also included tour of a cremation facility in downtown Indianapolis. There are a lot of options for disposing of human ashes, it turns out. You can place them in a biodegradable urn, for example, have them blown into glass — even, for a price, turn them into a diamond.

“It’s not inexpensive,” Eddie Beagles, vice president of Flanner and Buchanan, a chain of funeral homes in the Indianapolis area, told our tour group. “The last time I looked into it for a family, “it was about $10,000.”

A crematorium tour was part of the festival, too. Metal balls, pins, sockets and screws survive the fire of cremation.
A crematorium tour was part of the festival, too. Metal balls, pins, sockets and screws survive the fire of cremation.

“Really, when it comes to cremation, there’s always somebody coming up with a million dollar idea,” Beagles added. “If you can think of it, they can do it.”

Beagles showed us a pile of detritus from cremated human remains. He picked up a hip replacement — a hollow metal ball — then dropped it back into the ashes.

I’m a health reporter, so I know a fair amount about the things that could kill me, or are already killing me. But watching this piece of metal that used to be inside a human be tossed back onto the heap gave me pause. I’m thinking about what I might write on a “Before I Die” wall. I still don’t know — there are many things to do before I go. But I’m thinking about it a lot harder now.

Complete Article HERE!

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On Death and Dying: Opening the door to discussion

by Tara Baysol, Living with Cancer

After I was diagnosed with brain cancer, I developed a desire to have really tough conversations about death and dying with my family so that I could share my thoughts with them and feel less alone on this journey that’s been full of uncertainty. At first, this was quite challenging for me and my family, but one of the things that has really helped us to be able to have these tough conversations was my realization that this topic was not something unique and exclusive to me and people like me, but rather a conversation we all should be having regardless of age, health, and condition.

TaraBaysolNobody lives forever and even though some people may seem to have better odds than others, tomorrow is not guaranteed to anyone. Unfortunately, our society makes death and dying very frightening because the only time people get asked about their wishes and end of life care is when death seems to be looming directly over them. This prevents us from developing any level of familiarity, comfort, and acceptance with this topic.

In an effort to confront this problem and try to combat this societal barrier, I began advocating for my entire family to have these conversations and revisit them regularly so that when the time comes we are each able to revisit this topic as a familiar concept opposed to completely foreign and devastatingly unbelievable circumstances.

While there are very real emotional and social challenges associated with addressing this topic, I’ve become incredibly empowered by the idea that there are still things out there that I have a choice over. This has been a very rewarding and welcomed realization after struggling to manage the overwhelming feelings of uncertainty and loss of control that formed after my diagnosis.

My intention is not to instill paranoia about death or dying, but rather begin to open a door for each of you to have those tough conversations about your future wishes regarding being comforted, supported, treated, and remembered when the time arises. At no point are you giving up hope by talking about this topic. You are simply ensuring that your wishes regarding the eventually inevitable circumstance that everyone will face are communicated and respected.

 

Complete Article HERE!

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To Be Happier, Start Thinking More About Your Death

By Arthur C. Brooks

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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!

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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!

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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!

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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.

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