Death trajectory

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Death trajectory refers to the pattern [1] of dying when a patient is given a projected death date with limited or no medical recourse for the remaining existence of the individual's life. [2] The death trajectory is dependent on the cause of death, whether it is sudden death, chronic illness, or the steady decline in health due to senescence (aging). [3] Death trajectory is analyzed in two separate aspects: duration and shape. Duration refers to the period of time a patient has to live, which can be anywhere from imminent death to several months. [2] Shape refers to how that duration is then graphed. In other words, the shape is "the course of dying, its predictability, and whether death is expected or unexpected". [2]

Contents

Illustration of the premature death trajectory. There is a sharp decline in human function in a short period of time. Sudden Death graph.png
Illustration of the premature death trajectory. There is a sharp decline in human function in a short period of time.

Dying trajectories were first studied in the 1960s by two researchers, Barney Glaser and Anselm Strauss, in an attempt to understand the end of human life from different ailments, including cancer. [4]

Sudden death trajectory

Sudden or premature death occurs when the death of an individual is not perceived to be imminent. In a sudden death trajectory, an otherwise healthy and high-functioning individual will suddenly and unexpectedly die without any observable indications of oncoming demise. People are at a high or normal level of functioning until the moment of death occurs. These types of deaths include fatal accidents and inconspicuous health issues like myocardial infarction or severe stroke. Deaths that align with a sudden death trajectory may happen over the course of a few days or in a matter of seconds.

Chronic malady trajectory

A chronic malady trajectory showing an overall decline in health with intermittent rises and falls in human function. Length of Dying Process.png
A chronic malady trajectory showing an overall decline in health with intermittent rises and falls in human function.

The chronic malady trajectory occurs with types of death caused by autoimmune diseases such as HIV or other incurable illnesses. This process of death is characterized by an overall decline in health accompanied by acute crises and intermittent recoveries. [3] The chronic malady trajectory projects emotional stress or turmoil; [2] the patient may eventually become mentally and emotionally exhausted.

Natural death trajectory

A typical natural death trajectory chronicling a long, steady decline in health over time. Steady decline.png
A typical natural death trajectory chronicling a long, steady decline in health over time.

A natural death trajectory is typically a long, steady decline due to old age. [5] In these cases, the death trajectory is based on how the mind and body degenerate, including the speed of organ failure. In these cases, it is much easier to anticipate a person's death. [6]

Medical care

When someone has an estimated death date and a death trajectory, the patient's caregivers generally cease curative care and proceed to provide palliative or comfort care. [2] Curative care refers to situations where the patient still feels it is possible to use current medical care to recover or become stable enough to carry on with life. Comfort care, or hospice care, is reserved for patients who acknowledge they will not be able to recover.

See also

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A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include arthritis, asthma, cancer, chronic obstructive pulmonary disease, diabetes, Lyme disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

Epidemiological transition

In demography and medical geography, epidemiological transition is a theory which "describes changing population patterns in terms of fertility, life expectancy, mortality, and leading causes of death." For example, a phase of development marked by a sudden increase in population growth rates brought by improved food security and innovations in public health and medicine, can be followed by a re-leveling of population growth due to subsequent declines in fertility rates. Such a transition can account for the replacement of infectious diseases by chronic diseases over time due to increased life span as a result of improved health care and disease prevention. This theory was originally posited by Abdel Omran in 1971.

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Natural history of disease

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Hospice care in the United States Overview of hospice care in the United States

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Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person's goals.

An informal or primary caregiver is an individual in a cancer patient's life that provides unpaid assistance and cancer-related care. Due to the typically late onset of cancer, caregivers are often the spouses and/or children of patients, but may also be parents, other family members, or close friends. Informal caregivers are a major form of support for the cancer patient because they provide most care outside of the hospital environment. This support includes:

Deathbed phenomena Range of phenomena reported by dying people

Deathbed phenomena refers to a range of experiences reported by people who are dying. There are many examples of deathbed phenomena in both non-fiction and fictional literature, which suggests that these occurrences have been noted by cultures around the world for centuries, although scientific study of them is relatively recent. In scientific literature such experiences have been referred to as death-related sensory experiences (DRSE). Dying patients have reported to staff working in hospices they have experienced comforting visions.

Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low under five mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.

References

  1. "Patterns of Functional Decline at the End of Life". Stanford School of Medicine. Stanford Medicine. 19 April 2013. Retrieved 5 May 2017.
  2. 1 2 3 4 5 Corr & Corr (2012). Death & Dying, Life & Living, Seventh Edition. Cengage Learning. ISBN   978-1111840617.
  3. 1 2 "Preparing to say Good-Bye" (PDF). University of Hawaii. Retrieved 8 December 2016.
  4. "Trajectory of Dying". University of Washington. Archived from the original on 6 March 2015. Retrieved 20 November 2014.
  5. Dolejs, Josef; Marešová, Petra. "Onset of mortality increase with age and age trajectories of mortality from all diseases in the four Nordic countries", National Center for Biotechnology Information
  6. Gerstorf, Denis; Ram, Nilam; Lindenberger, Ulman; Smith, Jacqui (2013). "Age and time-to-death trajectories of change in indicators of cognitive, sensory, physical, health, social, and self-related functions". Developmental Psychology. 49 (10): 1805–1821. doi:10.1037/a0031340. hdl: 11858/00-001M-0000-0024-EC54-F . PMID   23356526.