The following answers questions found with the textbook: The Ultimate Challenge, Coping with Death, Dying, and Bereavement by Marilyn Hadad
Enjoy!! 

What are the differences between loss, grief, and bereavement? 

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            Grief refers to the natural process and perception of any loss and is uniquely experienced physically, psychologically, and socially. (Rando, 1991, p. 11) Grief is a process that changes and appears over time and can affect feelings, attitudes, physical health, and changes in behaviours with others. (Rando, 1991, p. 11) Grief also affects individuals in different ways and requires work to experience it as it can be taxing on the mind and body and healing. (Rando, 1991, p. 16) Grief can take different forms, such as inhibited, complicated, absent, delayed, chronic, distorted, and unanticipated grief. (Rando, 1991, pp. 81-83)

            Loss refers to any deprivation of something meaningful and can be easily and uneasily recognizable, negative and positive, and can create feelings of grief. (Rando, 1991, pp. 15-16) Loss can occur physically or tangibly, such as in the death of a loved one or losing a precious piece of jewellery. (Rando, 1991, p. 12) Physical losses may be easily recognizable and negative and can produce feelings of grief due to the physical deprivation related to the loss. (Rando, 1991, p. 13) Symbolic loss may not be recognized as easily, can be positive or negative, and will relate to a person's psychosocial nature. (Rando, 1991, p. 12) For example, a person can experience a symbolic loss in a failed marital relationship or even by becoming empty-nesters as parents. Symbolic losses can be experienced as a secondary loss to a physical loss in changing or disrupting the status quo. (Rando, 1991, p. 13) For example, a parent may experience a physical loss in their child's death and a symbolic loss of their identity as their parent, or even in future events, such as watching the child get married. Loss can also be classified as a competency loss, graduating from college and no longer being a student, a developmental loss, needing a cane to walk due to arthritis in the knees, or losing freedom when becoming a responsible parent to a new baby. (Rando, 1991, p. 13)

            Bereavement is a state that a person who is grieving or suffering a loss will experience. (Portal, 2021) A bereaved person will experience loss, grief, and mourning following the event and will respond or act in a particular way depending on the loss. (Hadad, 2009, p. 59) The bereavement state is natural and necessary during the grieving process. Still, it can also be a vulnerable time by producing ill physical and mental side effects, posing a health risk. (Rando, 1991, p. 86) Societal norms, government policies, labour laws, and even airlines appreciate that individuals need bereavement time and accommodation during times of grieving.

In summary, bereavement is a natural process resulting from a person experiencing a physical or symbolic loss during their grieving period.

 

What are some emotional, cognitive, and behavioural/physical reactions to grief? 

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            Hadad lists three categories of grief reactions which include emotional, cognitive, behavioural and physical reactions. (Hadad, 2009, p. 60) Cognitive reactions include feelings of alienation, pessimism, decreased motivation, confusion, rumination, and searching for meaning. (Hadad, 2009, p. 60) Emotional reactions include ambivalence, fear, despair, guilt, loneliness, sadness, anger, anxiety, and hopelessness. (Hadad, 2009, p. 60) Physical reactions include heart palpitations, sweating, shortness of breath, fatigue, headaches, and digestive problems. (Hadad, 2009, p. 60) Behavioural reactions include sighing, social withdrawal, substance use, avoidance, crying, and self-destructive behaviour. (Hadad, 2009, p. 60)

            Other common emotions and reactions include sorrow, hostility, relief, jealousy, disbelief, distractability, decease in concentration, inability to make decisions, feelings of unreality, cynicism, hypervigilance, sleep and eating disturbances, lethargy, trembling, hot flashes or chills, and nervousness. (Hadad, 2009, p. 60)

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Describe the elements of Elisabeth Kubler-Ross's Stage Model. 

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             Kubler-Ross's stages of grief provides an organized way in understanding or categorizing the emotions a grieving person may feel, in no particular order and over an unspecified length of time. (Hadad, 2009, p. 61) The first stage is denial and isolation, where a person may respond with denial, shock, disbelief, isolation, may feel alone and may not be ready to speak with others about what they are going through. (Hadad, 2009, p. 61) The second stage is anger, where a person outwardly expresses their anger towards themselves, doctors, their loss, or even the environment. (Hadad, 2009, p. 61) Kubler-Ross notes that the anger is being displaced and can be rational depending on the situation. (Hadad, 2009, p. 61) The third stage is bargaining, which is considered a natural response to avoid the inevitable through making promises in hopes of being rewarded with a change in the outcome. (Hadad, 2009, p. 61) Bargaining can be seen as a way for someone to gain control in their lives through changing their thoughts or behaviour to have a desired effect. The fourth stage is depression, resulting from feelings of hopelessness and profound loss, usually after the anger and bargaining stage. (Hadad, 2009, p. 62)  Depression can be rooted in loss, anxiety, guilt, pain, weakness and directed inward or towards multiple sources. (Hadad, 2009, p. 62) The final stage of grief described by Kubler-Ross is acceptance. Acceptance occurs when the person is calmer and has made peace with no longer fighting, delaying, or avoiding the situation. (Hadad, 2009, p. 62)  Acceptance can be confused with giving up, which is not the case, as the person has come to terms with their situation. (Hadad, 2009, p. 62)

    

Explain the major elements of Catherine Sanders' Integrative Model. 

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             Sander's integrative model describes a motivational, physiological, and biological understanding of a person experiencing grief related to the stress response and the autonomic nervous system. (Hadad, 2009, p. 65) The flow between the model stages is unique to the individual, free-flowing, may overlap or regress, and has no fixed timeline. (Hadad, 2009, p. 66) The stages are shock, awareness of loss, conservation-withdrawal, healing, renewing, and possibly fulfillment. (Hadad, 2009, pp. 65-66)

             In the shock phase, the sympathetic nervous system is overly stimulated to increase adrenaline and other homeostatic changes, which assists the person in dealing with the initial difficult time while leaving them feeling disoriented, numb, and with a weakened immune system. (Hadad, 2009, p. 65) With time, the parasympathetic nervous responds to the awareness of the loss, returning the person's physiological balance closer to normal. (Hadad, 2009, p. 65) Awareness of loss softens the initial emotions and allows the person to experience the emotions associated with the loss while increasing stress and depleting energy from the immune system. (Hadad, 2009, pp. 65-66) The third phase is conservation-withdrawal which can appear to be a form of depression but is described as a person withdrawing socially to rest and regenerate, which allows healing to the immune system and mental outlook. (Hadad, 2009, p. 66) Towards the end of the phase, the person comes closer to either moving forward, act as if nothing happened, or giving up. (Hadad, 2009, p. 66) The third phase allows a person to feel strong enough to decide, which takes them towards the fourth phase of healing. (Hadad, 2009, p. 66) In the healing phase, a person may feel they have control, a new identity, can forgive, and may even feel hope for the future. (Hadad, 2009, p. 66) The final described phase is renewal, where the pain is no longer constant, allowing the person to navigate their new life with success and competence while feeling strength and joy in continuing their life. (Hadad, 2009, p. 66)

            The immune system takes on the following progression: increase in sympathetic nervous system firing = increase of adrenaline à slight decrease in sympathetic firing and a slight increase of parasympathetic nervous system firing = weakened immune system à energy conservation = rest and return to a normal immune system to allow healing.

A sixth phase was described as fulfillment, where a person may feel as if they had grown or found a purpose while healing from their grief and circumstances. (Hadad, 2009, p. 66) Fulfillment allows a person to create and find meaning in their loss and their new life and identity. (Hadad, 2009, p. 66)

 

Compare and contrast Simon Rubin's Two-Track Model of Bereavement and the Dual Process of Grief proposed by Margaret Stroebe and her colleagues.

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            Rubin's two-track model of bereavement examines two tracks relating to a bereaved person's ability to process their grief and move through their mourning. (Hadad, 2009, p. 67) The first track examines the person's ability to maintain control in their lives and function under stress, which affects their daily activities, relationships, perception, and emotional investment in tasks. (Hadad, 2009, p. 67) The second track examines the bereaved person's relationship to their loss, including their memories, memorialization, and rumination. (Hadad, 2009, p. 67) Rubin's two-track model examines if a person can move through their grief and mourning. A bereaved person may appear to function well in the first track, accomplishing their daily tasks and maintaining their relationships, but may do poorly in the second track, complicating their distress or ability to move forward. (Hadad, 2009, p. 67)

            The dual process of grief model examines how a person can move forward with their grief by moving between phases of restoration-orientation and loss-orientation. (Hadad, 2009, p. 67) Restoration orientation refers to the bereaved taking on the tasks their deceased had completed, and loss-orientation refers to missing the person while forming a new relationship with them. (Hadad, 2009, p. 74) The model believes that a person may not have a choice but to switch been the two orientations because it allows them to avoid the loss while confronting the loss, depending on what tasks they must absorb from their deceased. (Hadad, 2009, p. 74)

            The two models are similar in that they both examine a person’s ability to function in their daily lives while maintaining control, their ability to process their grief and mourning, and their ability to confront their relationship with the deceased. (Hadad, 2009, pp. 67, 74) Rubin’s two-track model mainly examines if a person can do well in both tracks, determining how well they are moving forward in their grief and mourning by comparing their abilities within the two tracks (Hadad, 2009, p. 67). In contrast, the dual-process requires a person to switch between the two out of the necessity of completing their daily functions and activities, which allows them to understand the process, work, and do what must be done while grieving. (Hadad, 2009, p. 74)  

 

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What does Esther Shapiro believe is missing from existing models of grief and bereavement? 

 

           Esther Shapiro believes that existing models of grief and bereavement focus on the individual’s ability to process and move forward from their grief. (Hadad, 2009, p. 75) Shapiro believes that the existing models are missing the family unit’s ability to grieve together as grief is a family crisis that changes and redirects the future course of a family’s development. (Hadad, 2009, p. 75) Shapiro’s proposed model of family grief notes that as individual family member changes so do the dynamics and equilibrium of the entire family. (Hadad, 2009, p. 75) Therefore, the mourning process includes a reorganizing and restructuring of the family dynamics in an attempt to regain harmony and equilibrium. (Hadad, 2009, p. 75)

           An example of Shapiro’s proposed model in the death of a sibling is that individual family members will have their own reactions and process to grieving the death of a sibling as each family member will mourn. Collectively, there will be an equal process of the family having to reorganize their family unit and identifying new roles that can redirect the course of the family dynamic. (Hadad, 2009, p. 75)

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What factors affect the development of the concept of death? 

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                The factors affecting the development of the concept of death are cognitive ability, cultural and religious beliefs, experiences, and social-emotional factors. (Hadad, 2009, pp. 83-84) Cognitive ability mainly indicates a child's verbal intelligence in that it can enhance the communication and organization to understand the concept of death. (Hadad, 2009, p. 83) Religious and cultural concepts are formed based on what death means and what happens after death, such as if the dead will go on living in an afterlife even though their physical body is no longer on earth. (Hadad, 2009, p. 84) Children who have experienced war, a death in the family, or their own illnesses may view the concept of death differently in terms of the physical body no longer being on earth, the different reasons a person can die, and realizing the concept of their own mortality. (Hadad, 2009, p. 84) Finally, social-emotional factors focus on a child's ability to communicate their understanding of death, especially those who suffer from anxiety. (Hadad, 2009, p. 84) Children who suffer from anxiety may have difficulty understanding what is happening in death, particularly when it involves a family member, compared to a stranger. (Hadad, 2009, p. 84) Although one may think, socioeconomic status and gender do not play a factor in developing a concept of death. (Hadad, 2009, p. 83)

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 How do children show their grief? 

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            Worden's research showed that children grieve through feeling like they have less control in their lives and may have lower self-esteem while seeming to be more mature. (Hadad, 2009, p. 85) A grieving child may display anger, physical reactions and illnesses, especially in girls, and more accidents, particularly in boys. (Hadad, 2009, p. 85) Grieving children may also develop anxiety as a result of these reactions. (Hadad, 2009, p. 85) Over time, children will cry less, which will be seen in adolescent boys developing their masculine identity. (Hadad, 2009, p. 85)

            Normal behaviours of children under the age of 12 include crying, fussiness, resistance to change, changes in sleep, eating and eliminating, regression, nightmares, aggression, sadness, noncompliance, magical thinking, phobias, compulsive caregiving, guilt, possessiveness, difficulty expressing grief, difficulty concentrating, defiance, and psychosomatic symptoms. (Hadad, 2009, p. 87)

            Bowlby's research has shown that infants will first protest the separation through anger and pain, then show despair or hopelessness when they know they will not return. Finally, they will detach from people, limiting any future bonds, trust, or connections. (Hadad, 2009, p. 85) Children under the age of eleven may desire objects or photographs of the deceased, known as transitional or linking objects. (Hadad, 2009, p. 86) Adolescents may display grief as affective denial to inhibit the appropriate emotional reaction, even though they understand and accept the death. (Hadad, 2009, p. 86)

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How do children react to the loss of a sibling? 

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            A family that has lost a child has layers of complexity when it comes to grieving. Often, the parent's grief of losing their child overshadows the child, especially if the parent cannot support the child in their grief. (Hadad, 2009, p. 89) Parents often misunderstand a child's grief, presenting as aggression, withdrawal, bedwetting, nightmares, and problems in school work and personal relationships. (Hadad, 2009, p. 89) 

            Schwab described four areas of problems for these children as cognitive distortions, reactions to parental distress, being a replacement child, and parental failure to cope with grief. (Hadad, 2009, p. 90) Children who are not communicating with their parents or adults may form wrong ideas about death and how it affected their family. (Hadad, 2009, p. 89) Children may react poorly to parents who cannot manage their grief, particularly by hiding their grief not to burden their parents. (Hadad, 2009, p. 89) Children may feel neglected, insignificant, and lose their self-worth, affecting future relationships. (Hadad, 2009, p. 89) Children may also be constantly compared to their deceased sibling, affecting their chance to feel valued, and parents lose the chance to see their child's uniqueness. (Hadad, 2009, p. 90) Overall, if a parent cannot cope with their grief, the surviving child is left to face those consequences. (Hadad, 2009, p. 89)

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 What are a child's long-term reactions to the loss of a parent? 

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            Children face major restructuring of their lives when they lose a parent. Their physical environment and psychosocial development are greatly affected because they have lost a person who provides physical, emotional, and spiritual care. (Hadad, 2009, p. 92) These children may have a higher prevalence of psychological disorders in the long term, including depression and anxiety.

            Based on Erikson's attachment theory, long-term reactions can be predicted if certain aspects are not resolved during development. Factors such as trust or mistrust, decreased independence and sense of competence, lack of encouragement, scared of trying things, lack of assertiveness, and feeling inferior. (Hadad, 2009, p. 92) Adolescents usually form their identity of who they are and what they will become, which provides them with a foundation for their lives. (Hadad, 2009, p. 92) If the adolescent tasks are not complete because of the loss of a parent, they may feel as if they do not have a stable identity or role and feel aimless and adrift. (Hadad, 2009, p. 92)    

 

What are the feelings of a dying child and a dying adolescent?  ☹

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            Gathering research from dying children has been a tougher subject to approach, considering the ethical implications and parental feelings. (Hadad, 2009, p. 93) Hadad states that children understand death and their own mortality but may also protect their parents because they can see they are upset. (Hadad, 2009, p. 93) Ill children mourn for their futures, as they understand the complications of their death but are given little information from adults and their doctors. (Hadad, 2009, p. 95) They may have feelings of depression, mistrust, and insecurity. (Hadad, 2009, p. 95) Children and adolescents need to be in full conversation with their parents to prevent them from feeling isolated, insecure, or have no one to trust, particularly when adults think they are doing the right thing by protecting them. (Hadad, 2009, p. 96)

            Dying children have an advanced understanding of irreversibility and finality in death. (Hadad, 2009, p. 95) Children between the ages of three to six have more death-related fantasies and have a negative perspective relating to loneliness and body intrusion. (Hadad, 2009, p. 95) Children between the ages of six to ten have anxiety relating to loneliness and body mutilation. (Hadad, 2009, p. 95) Sadly, these children may not progress through psychosocial tasks. Children may not develop trust or lose autonomy because of the time spent with overprotective parents and healthcare workers and following medical regimes. (Hadad, 2009, p. 95) These children may also have lower self-worth if they cannot feel competence in tasks hindered by less energy or medication side effects. (Hadad, 2009, p. 95)

Adolescents who are dying have reactions similar to adults while believing that death will happen to them, making it hard for medical intervention. (Hadad, 2009, p. 95) Adolescents may not form a sense of self or identity because of their illness. (Hadad, 2009, p. 95) They may have conflicts with their parents because of spending too much time with them or being overprotective. (Hadad, 2009, p. 96) Adolescents may feel isolated from their friends, feel different from their peers, feel lonely, and wish for interaction with their healthy friends rather than only with their parents and doctors. (Hadad, 2009, p. 96)

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What are some common problems a person who has lost a spouse or life partner must confront? 

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            Losing a spouse or life partner comes with various problems, which center around the emotional devastation of living without them and the practical stress of role reorganization. (Hadad, 2009, p. 102) A common problem widowed people experience is a loss of identity and someone to share their experiences with, such as being invited to a wedding or saving money by booking a double occupancy vacation. (Hadad, 2009, p. 102)

            Couples facing life alone face the anticipated problems associated with grief while managing their daily activities. If these couple had children, now the parent must perform their daily activities while managing their grief and raising their child, who has lost a parent. (Hadad, 2009, p. 102) Emotionally, these individuals may have a hard time taking on these tasks because of their grief or natural responses of feeling angry towards the deceased and the situation. (Hadad, 2009, p. 102)

            The surviving partner may confront a variety of reminders and problems centering around mundane daily tasks, such as preparing a meal or sitting down for dinner. (Hadad, 2009, p. 102) They may be consistently reminded of them when they see the shaving products on the bathroom counter or their dog walking sneakers by the front door. The surviving partner, even though hard, may not have a choice but to remove some of these items to prevent being constantly reminded or assaulted with grief.  Unfortunately, the couple left behind will face emotional and physical health problems, especially noted in the first year for men. (Hadad, 2009, p. 103)

Studies have noted men as having a higher prevalence of mental health issues and increased alcohol consumption. (Hadad, 2009, p. 103)  Hadad states that these changes in men are linked to a lack of social support and poor coping mechanisms. (Hadad, 2009, p. 102) Widowed women are likely to be offered help which may help to decrease emotional and physical health problems.  Overall, the partner who is left behind is likely to face extreme loneliness, difficulty moving on, and less optimism, especially if they are elderly. (Hadad, 2009, p. 104)

 

What are the similarities and differences between the experience of a man and the experience of a woman who loses their spouse or life partner?

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            Men and women in heterosexual relationships experience loss differently than those in same-sex relationships as they may not be provided with the same support found in society. (Hadad, 2009, p. 104) Both men and women experience extreme loneliness and despair and face emotional and physical problems following their partner's death. (Hadad, 2009, p. 103) If the couple had children, then the surviving parent is left with the role of being a single parent while managing their grief along with the children’s grief. (Hadad, 2009, p. 103) Both men and women will experience daily reminders of the loss of their partner and will be forced to learn their partner's tasks. (Hadad, 2009, p. 103) Equally, they will experience a higher prevalence of health problems.

            Men are more likely to experience worse emotional and physical health problems, particularly within the first year. (Hadad, 2009, p. 103) These findings are in line with men who lack a social support network, have a hard time expressing their emotions, and participate in male-gender roles, like household repairs or mowing the lawn. Women are more likely to talk with others over their emotions and grief and maybe offered practical help, which helps them cope effectively with the loss of their husband. (Hadad, 2009, p. 103) Couples who did not have children may have difficulty doing things alone, particularly women eating without their husbands. (Hadad, 2009, p. 103) Both men and women will have difficulty removing their partner’s items, like toiletries, coffee mug, or special blanket. They will both experience daily reminders of their deceased partner.

            Widowed women may miss preparing and eating with their husbands. They may also feel like they have lost their identity, especially if it was strongly connected to their husbands through their last name. (Hadad, 2009, p. 102) Women may feel as if they lost their identity, but men may feel as if they lost their social place because their female partners usually handled those arrangements. (Hadad, 2009, p. 102) Men may not know how to keep in contact with their family or which gifts to buy on special occasions, particularly if their wives had always handled those tasks.

 

What are some common reactions that parents have to the death of their child?

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            Common reactions that parents have to the death of their child include anger, marital problems, stress, despair, confusion, and guilt. (Hadad, 2009, pp. 100-101) While both parents will grieve uniquely, their grief may manifest through their roles within their family unit. (Hadad, 2009, p. 101) Men may react by feeling as if they have failed as the protector and problem-solver in the family, and women may react by feeling that their family structure and nurturing capabilities are gone. (Hadad, 2009, p. 101) Parents will react by having chronic pain, become overbearing or protective, continuously think of their deceased child, and rarely change their opinions on the tragedy of the death. (Hadad, 2009, p. 102)

            Marital problems stem from expecting their partner to grieve in a particular way, a lack of understanding, differences in emotional expression, and difficulty functioning in their assigned roles. (Hadad, 2009, p. 101) Stress manifests as a result of the trauma of losing a child. Stress reactions include headaches, poor eating, sleep disturbances, digestive complaints, heart palpitations, and fatigue. (Hadad, 2009, pp. 100-101) Parents may react by feeling despair, defenceless, and vulnerable. (Hadad, 2009, p. 100) Their lens will change by viewing the world as an unfair and bad place. (Hadad, 2009, p. 100) Early on, bereaved parents will seem confused, have poor concentration and attention, and have difficultly making decisions. (Hadad, 2009, p. 100) They will also feel intense guilt for failing to protect their child, preventing death, not providing adequate care, and being bad parents. (Hadad, 2009, p. 100)

            In a stillbirth, parents react and grieve similarly to losing a child who has lived longer. (Hadad, 2009, p. 107) They will feel disappointed, guilty, feel inadequate, examine their behaviours, and carry the grief for a long time. (Hadad, 2009, p. 107) Abortion may cause parents to have fewer negative feelings, including relief and happiness. (Hadad, 2009, p. 107) Some women may have no reactions, and some may react with guilt, regret, anger, depression, grief, fear, and a violation of personal beliefs. (Hadad, 2009, p. 107) Parents may react to a miscarriage with relief, yearning, depression, anxiety, failure, grief, and a desire to find meaning by talking with others. (Hadad, 2009, p. 108)

 

 

How do terminally ill people generally answer the question, "What is most important for you to achieve?"

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            When asked what is most important for you to achieve, terminally ill people have been surveyed to find answers similar to students who were not facing a terminal illness. Most of the answers fell within four categories: improving the quality and meaning of their lives, achieving relief or comfort, altering the course of the illness, and preparing for death. (Hadad, 2009, pp. 110-111) Students that were surveyed indicated that they wanted to be free of pain and with their loved ones rather than doing things they had never done before. (Hadad, 2009, p. 111)

            Terminally ill people wanted to improve the quality and meaning of their lives. The majority wanted to be home to support their loved ones or lessen the burden of their family members taking care of them. (Hadad, 2009, pp. 110-111) They wanted to achieve physical and emotional comfort while relieving any pain in their body. (Hadad, 2009, p. 111) Most wished to have a medical intervention that would either cure or slow down their disease progression so that they could reach a certain point in their life. (Hadad, 2009, p. 111) Few people wished to achieve death sooner, while some wanted to tie up family business and prepare themselves emotionally and spiritually for death. (Hadad, 2009, p. 111) Some of the terminally ill people expressed their wishes to achieve peace, comfort, and freedom from all or most of their symptoms. (Hadad, 2009, p. 111)

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What characteristics differentiate seniors who fear their own deaths and seniors who accept that death is approaching and inevitable? 

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            Erikson and research speak on a term called ego integrity. Essentially, ego integrity relates to feeling accomplished and having a positive outlook on life. (Hadad, 2009, p. 118)

             Seniors who fear their own death will have low ego integrity. (Hadad, 2009, p. 118) These seniors will feel they have missed opportunities in life, which leads to a negative and dissatisfied outlook. (Hadad, 2009, p. 118) Fearful seniors will despairingly view their lives as a failure. Seniors experiencing psychological or physical problems may also fear death, as it is likely their emotional health will heighten their perception of death. (Hadad, 2009, p. 118)

             Seniors who accept that death is approaching and inevitable will have higher ego integrity. (Hadad, 2009, p. 118) They will feel accomplished, like they lived a good life with purpose, leaving them with a positive outlook. Some seniors experiencing poor physical or mental health problems may anticipate death as a way to escape their life. (Hadad, 2009, p. 118)

            Pain is not an indication of whether or not a senior will fear or welcome death. Rather, their perception of their pain and life and their pain management will predict their disposition. (Hadad, 2009, p. 118) Seniors who accept that pain is a part of ageing may have a lot of it but may also still fear death. Seniors who have little pain, but have a hard time managing it, may welcome death as a way to escape their pain.

            Gender does not play a role in differentiating senior's disposition on death, as both sexes can feel equal amounts of fear. (Hadad, 2009, p. 119) Religion may not necessarily play a role in a person's perception of death. (Hadad, 2009, p. 119) Religion can play a part in answering questions about what happens after death and provide a source of comfort and community. However, whether a person is religious will not necessarily predict if they will fear dying. Rather, an intrinsically religious person, or religious for themselves in terms of beliefs and complexity, may be more spiritual, leaving them to accept death. (Hadad, 2009, p. 119) Seniors who experience spiritual meaning and self-transcendence will feel inner peace and connection to concepts larger than themselves. (Hadad, 2009, p. 119) Spiritual seniors will accept that death is approaching and inevitable.

  

What are the needs and wants of senior adults at the end of their lives?

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            I am certain seniors, along with any person, wishes and wants to have what is considered a good death. A good death includes symptom and pain management, clear decision making, saying goodbye, and choosing the location. (Hadad, 2009, pp. 119-120) Seniors wish to feel aware, optimistic, prepared, free of conflict, and autonomous. (Hadad, 2009, p. 120) Components of wants and wishes connect to social, emotional, ethical, spiritual, and physical issues. (Hadad, 2009, p. 120) Most seniors wish to achieve peace and acceptance, which may influence their need to prolong or accept that the end is near. (Hadad, 2009, p. 122)

            A study of senior men nearing the end of life wished to live while dying, anticipating the actual dying process, and receiving good health care. (Hadad, 2009, p. 121) Most seniors focus on the quality of their life, which includes participating in hobbies or activities, feeling normal, eating meals they probably should not eat, putting affairs in order, recording messages for their loved ones, making things right, having no fears or regrets, feeling respected and having clear communication with the healthcare team, having pain and symptom management, and spending time with loved ones. (Hadad, 2009, pp. 121-122)

            Other wishes include caring for and protecting their family members as most seniors do not want medical intervention if they would be an emotional or financial burden to their families. (Hadad, 2009, p. 122) They did want to have a prolonged ending if they were in pain, cognitively impaired, or having no real chance of recovery. (Hadad, 2009, p. 122) Medical interventions are preferred only when they can restore a senior to full living and participate in activities. (Hadad, 2009, p. 122) Seniors also wish for a combination of the end-of-life decisions to be made by themselves, their families, and their healthcare team. They are more concerned with the outcome of medical intervention rather than the intervention itself. (Hadad, 2009, p. 122)   

  

How do senior adults react to losing their spouses or life partners of many years? What positive changes may result? What differences are found between males and females? How does self-efficacy affect a senior adult's reactions to losing a spouse or life partner of many years? 

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            Seniors react to losing their partners similarly to younger people. They will feel lonely, anger, sad, guilt, anger, and depressed. (Hadad, 2009, p. 124) Seniors may perceive their health to deteriorate, and their physical health may actually be deteriorating because of their emotional health. (Hadad, 2009, p. 124) For these seniors, their connection and attachment to their deceased spouse grew following death, which increased their comfort in their loss. (Hadad, 2009, p. 124)

             Positive changes to these seniors include exploring and learning new roles within themselves, feeling stronger and resilient, determination to live a self-sufficient and independent life, creating new meaning and purpose, and strengthening their connections outwards to their community, God, or charities. (Hadad, 2009, pp. 124-126)

            Widowed women had an increase in self-esteem and widowed men experienced personal growth in managing their finances and homes. (Hadad, 2009, p. 125) Both men and women gained psychological rewards in their grief. Men are likely to remarry and have a harder time coping because of inhibition of their emotions and the inability to take on their wives ' roles. (Hadad, 2009, p. 125) Women may have greater social support, enjoy their freedom, are less likely to remarry, and cope better than males. (Hadad, 2009, p. 125) Men may show an increase of poor health, depression, higher death rates and may receive significant social support. (Hadad, 2009, p. 125) Widowed men were likely to express acceptance and resignation, while women were more likely to carry on and be stoic. (Hadad, 2009, p. 126) Widowed women who felt comfortable being alone may change friendship patterns by volunteering or becoming friends with other widowed women as their married friends may no longer continue their friendship. (Hadad, 2009, p. 126) Older men may cope better if they are open in speaking about their grief. (Hadad, 2009, p. 126) These men may also fair well if they choose to live their lives without worrying about their partner's feelings. (Hadad, 2009, p. 126)

Self-efficacy affects a senior adult's reactions to losing a partner because it will predict their ability to adapt in different ways during widowhood. (Hadad, 2009, p. 125) Seniors who have a lowered perception of their ability to function will do poorer in widowhood. (Hadad, 2009, p. 125) For example, a husband who lived many years with his wife, always cooking fresh meals and cleaning up the kitchen, may feel less competent to do so once their wife has died. This husband may have a harder time adapting to widowhood because he feels weaker in cleaning and cooking before and after the death of his wife. It may seem as if he is experiencing more grief but really is experiencing a harder time adapting to the loss of his wife.  (Hadad, 2009, p. 125)

 

 What are the feelings of senior adults whose child died many years before? 

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                Senior adults who have lost their child many years ago may never get over the loss of their child, no matter how long ago the death occurred. (Hadad, 2009, p. 126) One study found that bereaved Israeli senior mothers can vividly remember the emotional and physical reactions they had when they heard the news. (Hadad, 2009, p. 126) The intensity of their feelings at the time of death may not lessen with time, but they do become more accepting of it in their life. (Hadad, 2009, p. 126)

            Found within the research study, adults may feel ambivalent towards their own death because death will connect them to their lost son or lead to their deceased son's second and final death. (Hadad, 2009, p. 127) The mothers in the study may have idealized their sons, neglected their social circle, and maintained their sons as the center of their lives. (Hadad, 2009, p. 126) These mothers gave space in their minds and home to grow their grief over time, leaving a void that could never be filled. (Hadad, 2009, p. 127)

 

Why is suicide hard to define? 

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                Suicide is hard to define because the definition itself is limited and may not consider the specific environment, situation, or circumstances surrounding the death. (Hadad, 2009, p. 132) The Oxford dictionary defines suicide as a person intentionally killing themselves. (Hadad, 2009, p. 132) However, the World Health Organization's study on suicide defines suicide as an act leading to a fatal outcome, where the person knew or expected death and initiated or carried out the act knowing it would bring the desired outcome of death. (Hadad, 2009, p. 132) Still, the WHO's definition may be problematic because it may be hard to know if the person knew or expected a fatal outcome. (Hadad, 2009, p. 132)

            There have been a few notable situations where it would be hard to know if someone died by suicide. A few examples mentioned in the textbook include those who jumped from the World Trade Center buildings, those who are considered martyrs or dying for their beliefs, those who die through the influence of a cult leader, and those who ingest potential lethal substances. (Hadad, 2009, p. 132) The poor souls affected by the World Trade Center attacks could have jumped to prevent a harsher death of the collapsing towers, and their deaths were legally deemed homicidal. (Hadad, 2009, p. 132) Those flying the planes that day would not have considered themselves dying by suicide; rather, they were dying for their beliefs and cause or even for their afterlife beliefs of freedom.

            Another consideration that makes suicide hard to define is that the standard definition implies a person taking an active component to lead to death. Passive suicide refers to people who take minimal action to initiate death. (Hadad, 2009, p. 132) Some people refrain from certain actions or do nothing in some instances, but the outcomes still lead to death. (Hadad, 2009, p. 132) The examples provided in the textbook include those who refuse life-saving medical treatment or those who stand in the path of a train. (Hadad, 2009, p. 132) Another example could include a person not leaving a burning house or a person unable to swim to safety while drowning. I believe each scenario will have unique circumstances to determine whether a person died by suicide or even by accidental or unintentional suicide.  

 

What are the effects of suicide prevention programs in schools? 

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            The effects of a suicide prevention program in schools show conflicting results because there is no correlation in preventing suicidal behaviours. (Hadad, 2009, p. 143) Prevention programs may reduce the likelihood of suicide attempts, but it does not prevent thinking about suicide. (Hadad, 2009, p. 143)

            Another effect of the suicide prevention program was to provide education to the students on suicide. Students were taught to recognize and acknowledge the warning signs within themselves and their peers and ask a responsible adult for help. (Hadad, 2009, p. 143) Students also increased their conflict resolution skills through peer intervention. (Hadad, 2009, p. 143) Further, the program's effects helped students change their attitudes about suicide by providing them with knowledge on the topic. (Hadad, 2009, p. 143) The knowledge provided to the students trained them to detect suicide warning signs and know who to report them to. (Hadad, 2009, p. 143)

            Suicide prevention programs provide information to students and teachers. Teachers are taught to confront suicidal students by listening to them carefully, asking direct questions, validating or honouring their feelings by not denying them of their feelings, and staying with them while seeking intervention. (Hadad, 2009, p. 143)  

 

What is suicide postvention? What should it consist of?

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            Suicide postvention is a carefully prepared plan to help and guide schools to respond to suicide appropriately. (Hadad, 2009, p. 143) The plan is created to minimize chaos while having a solid direction to handle the after-effects of suicide. (Hadad, 2009, p. 143)

            The postvention plan consists of a team handling the postvention, providing suicide education to students and teachers, and establishing and maintaining relationships within the community. (Hadad, 2009, p. 143) The postvention plan is implemented within 24 hours of the suicide, with teachers learning first to inform their students. (Hadad, 2009, p. 143) The plan can include counsellors available for students, teachers, and staff and specific displays of grief, including a moment of silence. (Hadad, 2009, p. 144) The postvention plan will also appoint a media liaison to handle media inquiries and speak with parents. (Hadad, 2009, p. 144) Finally, if the postvention plan is enacted, the postvention team will need to meet to evaluate or modify the plan for future postvention plans. (Hadad, 2009, p. 144)

 

Why might suicides among young people often occur in clusters?

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            Suicide may occur in clusters among young people due to media coverage of a suicide and an attempt to copy that person's suicide. (Hadad, 2009, p. 140) Evidence has shown that suicide rates increase in young people after the media coverage of a suicide, notably following Kurt Cobain's death. (Hadad, 2009, p. 140) Suicide in young people usually occurs in clusters that are triggered by one person dying of suicide. (Hadad, 2009, p. 140) Young people may prearrange with a group of peers to die by suicide simultaneously or in the same way, leading to a cluster of suicides. (Hadad, 2009, p. 140) They may have lower inhibitions about suicide following the first suicide or even glamorize suicidal idealization as a way to solve problems. (Hadad, 2009, p. 140)

            Young people may also lack suicide prevention education, may show characteristics of depression, and may have higher risks that would lead to suicidal idealization. Risk factors include a prevalence of psychological or personality disorders, environmental stress based on social isolation or family circumstances, substance abuse, and previous attempts of suicide. (Hadad, 2009, pp. 133-134)

Suicide may also occur in clusters amongst young people if their communities lack leaders to take on the role and offer access to support and counselling, suicide education, and crisis intervention. (Hadad, 2009, p. 140) Finally, suicide may occur in clusters if misinformation is spread through social media websites and if authorities of these sites fail to remove, block, or restrict certain content that promotes or idealizes certain suicides.

 

Why is it difficult to determine the actual suicide rate of senior adults? 

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            Similarly, it is difficult to determine the actual suicide rate of senior adults as it is difficult to define suicide. (Hadad, 2009, p. 140) The actual rate may be too over-encompassing or under-encompassing as it may not be possible to know a senior's intentions or expected outcomes in their actions. A senior may unknowingly take too much of their medication, leading to a lethal dose. The senior may have intentionally or unintentionally taken too much, but by definition, they actively ingested a lethal dose, leading to death. (Hadad, 2009, p. 140) On the opposite side, a senior may passively die by suicide simply by choosing to speed up their death by not taking their life-saving medicine. (Hadad, 2009, p. 141)

            It is also difficult to know a senior's intention or desired outcome because they may be reluctant to seek help for their age-related conditions and thoughts and may lack a community support network. These seniors may have difficulty accepting help, feel like a burden to others, and may not believe in asking for help. (Hadad, 2009, p. 141) Seniors may also have pain and chronic illnesses that can be seen as a way to escape their pain. However, common predictors for suicide amongst younger people cannot be correlated to seniors. (Hadad, 2009, p. 142) It may be harder to know a senior's intention or desire to die because they are less likely to communicate their distress, even when many factors are present. (Hadad, 2009, p. 142)

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