Dying: Real and Imagined Perspectives (Research, Video 3:19)

Even though most people say they dread dying, the good news is that the reality of dying isn’t so bad after all. Many people imagine that dying is worse than it is in reality. This became apparent in two death research studies comparing the affective experience of people facing imminent death with that of people imagining imminent death.

The first study revealed that blog posts of near-death patients with cancer and amyotrophic lateral sclerosis were more positive and less negative than the simulated blog posts of non-patients. Also, the patients' blog posts became more positive as death neared. The second study revealed that the last words of death-row inmates were more positive and less negative than the simulated last words of non-inmates. The last words of these studies suggest that the experience of dying, even from terminal illness or execution, may be more pleasant than one imagines.

Why are some people so afraid of death? Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life, thinks it's partly a human thing that has become more exaggerated during the last century. The American way of dying has gradually become dying in the hospital, maybe in the intensive care unit. Many Americans are dying tethered to machines. Dr. Byock emphasizes the best care possible in a way that is not always seeking to prolong life.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

When Older Adults, Seniors Want to Die (Hospice Nursing Home Story, Research)

Some people think being around dying patients must always be sad because everybody fears death, and no one really wants to die. As a hospice volunteer, I have had several patients who could prove them wrong. These nursing home residents actually stated they looked forward to death and gave reasons that had nothing to do with depression. This is what hospice patient Rose said to me about her upcoming death:

“How old did you tell me I was?” Rose asked.

“You’re ninety-nine, and you’ll be a hundred years old on your next birthday.”

“A hundred years old is too old. I don’t think I want to be that old.”

“There are three other ladies in this nursing home who are older than that. One is a hundred three. We talked to her last week during your wheelchair ride.”

“How much longer will it be before I make a hundred? I don’t know if I want to wait too much longer.”

“It’s only one more month. I remember you said you had spiritual talks with your minister. If you decide to wait, I’ll get you a big balloon that looks like a birthday cake.”

“I guess I could wait. Yes, I think I will wait. That way I can celebrate my hundredth birthday. When I do get to heaven, I can tell everybody I lived to be one hundred.”

And that’s exactly what she did.

(Excerpt from Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes)

But wanting to die is not always that simple. According to this VU University Medical Center research study in Amsterdam about older adults’ death thoughts and wishes, 81.3% never had them. Among those who did, 67% had depressive symptoms, and 20% suffered from a depressive disorder. Wanting to die was associated with depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment.

What can we learn from this research? Certain situations increase the likelihood that an older person wants to die. Although the desire to die may not be related to depressive symptoms, depression should be cause for investigation about death wishes and should be treated.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Barriers and Benefits of End-of-Life Discussions with Doctors (Video 1:56 mins.)

Unless we are sure we will never experience physical death, we should all take advantage of preparing for the inevitable long before illness even comes. Not having productive discussions about end-of-life options hinders opportunities to make informed choices, including the choice of hospice care. However, patients’ reluctance to discuss end-of-life options is not the only barrier to their receiving hospice care. As this research shows, doctors can play an important role in delaying hospice discussions that provide benefits to patients and their families:

In a two-year experiment involving interviews with 215 elderly, terminally ill patients, Yale University Medical School researchers determined that factors most strongly associated with hospice discussions were clinicians' estimate of and certainty about patient life expectancy. Unfortunately, clinicians were unable to anticipate the deaths of a considerable portion of patients (40%). Results concluded that, ultimately, “patients' use of hospice, relies largely on clinician estimates of patient life expectancy and the predictability of disease course.” This is another reason why patients should finalize their end-of-life care wishes in writing well in advance. You can read more here about this research on determining hospice discussion.

What are benefits of having end-of life discussions with doctors? This video, which refers to a study at Boston’s Dana-Farber Cancer Institute, shows how these conversations with doctors promote dignified death journeys that help patients and their families.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”