Approaching Death

Asuhan Menjelang Kematian

pada Lansia

Sheizi Prista Sari

Fakultas Keperawatan
Universitas Padjadjaran
 Contents

1. Introduction to Death
2. Stages of dying and Related
factors
3. Physical responses
4. Psychosocial responses
5. Spiritual responses
Why talk about death?
 Setiap yang bernyawa akan merasakan mati. Dan
sesungguhnya pada hari kiamat sajalah disempurnakan
pahalamu. Barangsiapa dijauhkan dari neraka dan
dimasukkan ke dalam syurga, sungguh, dia memperoleh
kemenangan. Kehidupan dunia itu tidak lain hanyalah
kesenangan yang memperdaya (Ali Imran: 185)
 Terminal Care

Aims to make the dying process

comfortable
 The Future of Death
Death is diverse.
Death is slowing down.
Death is increasingly old.
Death is merging into ageing.
Death used to be acute now it is chronic.
25% die with dementia. May increase to 50%.
Death is increasingly accompanied by
multiple morbidities, disabilities and
dysfunctions.
How Do People Die
 Dying in distress

Why is dying uncomfortable?

What about YOU? What are YOUR
worries about YOUR death?
How do you prefer to die?
 Concept of Good death
Communication
Symptom relief
Autonomy
Completing unfinished business
Optimal treatment (not to hasten or
prolong death)
 4 steps of managing terminal events

Anticipation
Preparation
Facing the event
Bereavement
 Preparation
Preparing patient
Preparing family
Dealing with issues like
When will be it..?
What it will be like?
Where to die?
Whom to be present?
Unfinished business?
 Facing the event

Physical symptom relief

Planning for crisis management
Psycho spiritual issues
 Common Responses/ Physical
Sensations
Tightness in the chest

Shortness of Breath

Lack of Energy

Panic Attack-like symptoms

 Psychosocial Aspects
Socio cultural and religious background
Social isolation and loneliness
Meaningfulness of everyday

Important factors
Engage in a process of dying

Life review (Butler, 1963)

 Stages of Bereavement

Kubler-Rost (1969)
 Following Factors
(Restinas,1988)

1. Very old persons see themselves as

confronting impending death
2. They are used the sick role and their
gradual decrease of vitality
3. Roles have already been redefined
4. Death may truly be timely for older persons
 Kastenbum (1978)
Assumptions as older persons being
ready for timely death as evidence of
our societys ageist attitudes

Less fear of death among older

persons than among younger ones,
older adults are also more concerned
about being in control and life after
death (Thorson, Powell, 1988)
 Others Factors
Person who has had positive experiences of
coping and is relatively well adjusted usually
approaches the stress of being close to
death with adaptation and acceptance.

(Kohn, Menon, 1988; Kowalski, 1986;

Matthews, 1979)
 Social
Taboo Topics
Social Isolation
Abandon the dying person
 Spiritual Aspects
Play an important part
Three spiritual needs (Doka, 1993):
To search for the meaning of life
To die appropriately
To find hope that extends beyond the grave
 Spiritual care (Hall, 1997)
Preparation for death and afterlife
Anger over dying
Seeking forgiveness for past wrongs
Searching for peace
Needs of a family coping with loss
 General Health Care Needs
Stabilizing and supporting vital functions and
facilitating integrated functioning
Determining functional deviation and
adjusting treatment
Relieving distressing symptoms and suffering
Assisting client and family interaction
Supporting a client and his or her family in
coping
Good Communication Skill
Hierarchy of Dying Persons Needs
(Ebersole & Hess, 1998)
Thank You