̽��ֱ�� of Cambridge - death

A silent epidemic of grief

cjb250 — Mon, 01 Mar 2021 08:48:01 +0000

Major changes in bereavement care have occurred during the COVID-19 pandemic, amid a flood of demand for help from bereaved people, according to new research from the ̽��ֱ�� of Cambridge.

Beyond the pandemic: find better ways to talk about death

lw355 — Tue, 08 Sep 2020 09:00:40 +0000

COVID-19 has forced millions of people to confront the prospect of dying earlier than they expected and under extraordinary circumstances. Now more than ever we need to find ways to talk about death, suggests Laura Davies, from the Faculty of English.

Bereaved children missing out on vital support in UK schools, study finds

Anonymous — Tue, 18 Jun 2019 08:46:20 +0000

A lack of clarity on government and school policies on mental health and bereavement has led to “confusion and disagreement” on the forms of support schools should offer, says the study, which was conducted for the child bereavement charity Winston’s Wish.

Researchers led by Professor Colleen McLaughlin found a “random approach” among schools, with students reporting receiving “only little or no help at all” following the death of a parent or sibling, and academic pressures monopolising the resources available.

Teachers feel ill-equipped

Although schools recognise bereavement as a high priority, teachers say they feel ill-equipped to offer support to bereaved children, even avoiding intervention through fear of doing more harm than good.

Consequences of parental loss can include mental and physical health problems, as well as lower educational attainment. Yet evidence suggests in many cases this can be mitigated by well-managed school support, at a time when a child’s family, also coping with grief, may not be able to provide the consistent support needed.

One parent dies in the UK every 22 minutes. These parents leave behind around 41,000 dependent children a year, which is more than 100 newly bereaved children each day.

̽��ֱ��new study, Consequences of childhood bereavement in the context of the British school system, brings together a wealth of research about children who have lost a mother, father or sibling before the age of 18, with a specific focus on support from school.

“Profound effects” of loss

̽��ֱ��effects of losing a loved one are profound for children, the researchers found, with consequences for mental and physical health but also social and educational impacts, including an increased risk of under-achieving or even dropping out of school.

Psychological reactions include fear, helplessness, anxiety, anger, lower self- esteem and insomnia. While these are normal responses to the profound distress caused by the death of a parent or sibling, the support available to children immediately after a death appears to have a strong impact on their mental health longer term, research shows.

Bereavement can also make children particularly vulnerable socially, the study shows, with those from disadvantaged homes not only at increased risk of losing a loved one but already facing tougher social challenges. Having someone to talk to is vital for children and adolescents following a loss, yet one fifth of bereaved participants studied reported not having talked to anyone – a trend that correlated with an increased risk of being bullied, participating in bullying or assaults.

Schools well-placed to support

Strong social networks are key in reducing the negative effects of child bereavement, researchers found, and UK and international experts agree that schools are particularly well-suited to offer support. “Schools often already understand the needs of the individual student and are one of the arenas where children spend most of their waking hours,” says the study.

Exploring how the current British school system deals with bereavement, researchers found a lack of clarity on governmental and school policies on mental health and bereavement, leading to “both confusion and disagreement on the forms of support schools should offer and the extent of that support”. This had led to a “somewhat random approach”.

While a small number of schools have a “planned, managed and holistic response to bereavement”, most do not, and staff “often feel isolated when facing issues related to emotional wellbeing”.

Academic pressures

̽��ֱ��“highly pressured” climate in English schools, with a focus on academic outcomes eating up time and resources, made it harder to give time and attention to vulnerable pupils, researchers found. Yet the opportunity to “share difficult thoughts” with someone helped build children’s resilience, directly reducing the difficulties they would experience and the potential for high-risk behaviour.

Professor McLaughlin said: “Our review of research reinforces that grief itself is not an illness. ̽��ֱ��path that a child takes after the death of a parent or sibling is dependent on the context and multiple aspects. Some pathways make young people very vulnerable, while others do not. Support in the environment is vital, and schools are key in this.

“Young people want schools to acknowledge the bereavement but also to provide a safe space to continue as normally as possible or to have special attention – depending on the child. Teachers want to help badly but space to discuss how to respond and to form a process is being pushed out. They too are asking for help.

“There is a need for a holistic integrated response from schools, and it’s very important that young people are listened to as part of that process.”

Memories of bereavement

Faculty of Education researchers have also gathered the experiences of adults who lost parents and siblings as children. Their moving account, published today in a separate report, Voices of adults bereaved as children, reinforces the message that meaningful support is important in the aftermath of bereavement and that schools are key in providing it.

On interviewee recalled: “I just heard my father, sort of, scream in a really animal sort of way. It was a sound that I’d never heard before and even now I feel the sound physically in my body and that’s what it was like for me as a child. ... It was just like being stabbed all over my body. I just felt this, sort of, physical pain and I kind of knew, although I didn’t know, I knew from this awful sound that I heard that my mother had died.”

Another said: “I think if I just dealt with it, sooner in a way, especially when I was younger... if I’d have spoken about it ...and in secondary school, I mean I got through it, but when I think back it was a horrible time.”

Winston’s Wish is calling on all schools in the UK to develop a bereavement plan. ̽��ֱ��charity also urges the schools inspectorate Ofsted to ensure that the revised Inspection Framework takes account of the impact of bereavement on children and young people’s lives, and proposes that all trainee teachers receive core bereavement training.

It has developed a free downloadable guide to supporting bereaved children. It offers guidance on creating a bereavement policy and a procedure for when there is a death in the school community. ̽��ֱ��charity’s freephone national helpline is also available for teachers to discuss and seek advice and guidance about specific cases.

̽��ֱ��free guide for schools and the schools strategy document can be downloaded at www.winstonswish.org/schools

Support for bereaved children in schools is patchy and inadequate, and teachers feel they lack the skills to help, according to a report from the Faculty of Education.

Teachers want to help badly but space to discuss how to respond and to form a process is being pushed out

Colleen McLaughlin

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Study identifies factors linked to dying comfortably for the very old

cjb250 — Thu, 05 Oct 2017 08:22:01 +0000

In a study published in the journal BMC Geriatrics, the researchers argue that their findings highlight the need to improve training in end-of-life care for all staff, in all settings, and in particular to address the current shortage of palliative care doctors in the NHS.

As life expectancy increases, so more and more people are dying at increasingly older ages, often affected by multiple conditions such as dementia, heart disease and cancer, which make their end-of-life care complicated. In the UK, in just a quarter of a century the proportion of deaths occurring at the age of 85 or older has risen steeply from around one in five in 1990 to almost half of all current deaths.

Older people living with dementia commonly report multiple symptoms as they approach the end-of-life, and if these symptoms are not adequately controlled, they may increase distress and worsen an individual’s quality of life.

While some people close to the end-of-life may prefer to die at home, only a minority of the ‘oldest old’ (those aged 85 years and above) actually die in their own homes. In the UK, fewer older people die in hospices or receive specialist palliative care at home than younger age groups, and the trend for older deaths is gradually moving away from death in hospital towards long-term care facilities.

Little is known about symptom control for ‘older old’ people or whether care in different settings enables them to die comfortably. To address this gap in our knowledge, researchers from the Cambridge Institute of Public Health examined the associations between factors potentially related to comfort during very old people’s final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. This involved a retrospective analysis of data for 180 study participants aged between 79 and 107 years.

̽��ֱ��researchers found that just one in 10 participants died without symptoms of distress, pain, depression, and delirium or confusion, and most people had in fact experienced combinations of two or more of these symptoms. Of the treatable symptoms reported, pain was addressed in the majority, but only effectively for half of these; only a fraction of those with depression received treatment for their symptom.

Compared with people who died in hospital, the odds of being reported as having died comfortably were four times as high for people whose end-of-life care had been in a care home or who died at their usual address, whether that was their own home or a care home.

People living in the community who relied on formal services for support more than once a week, and people who were cared for at home during their final illness but then died in hospital, were less likely to have reportedly died comfortably.

“How we care for the oldest members of society towards the end of their lives is one of the big issues for societies across the world,” says Dr Jane Fleming from the Department of Public Health and Primary Care, the study’s first author. “ ̽��ֱ��UK is not the only country where an urgent review of the funding for older people’s long-term care is needed, along with commitments to staff training and development in this often undervalued sector.

“It’s heartening that the majority of very old people in our study, including those with dementia, appear to have been comfortable at the end-of-life, but we need to do more to ensure that everyone is able to die comfortably, wherever they are.”

̽��ֱ��authors of the study argue that it highlights the need to improve training in end-of-life care for all staff, at all levels and in all settings.

“Improving access to supportive and palliative care in the community should be a priority, otherwise staying at home may not always be the most comfortable setting for end-of-life care, and inadequacies of care may lead to admission before death in hospital,” adds co-author Dr Morag Farquhar, who is now based at the ̽��ֱ�� of East Anglia.

Contrary to public perceptions, the authors say their study demonstrates that good care homes can provide end-of-life care comparable to hospice care for the very old, enabling continuity of care from familiar staff who know their residents. However, they say, this needs recognising and supporting through valuing staff, providing access to training and improving links with primary and community healthcare providers.

“In the UK, we particularly need to address the current shortage of palliative care doctors in the NHS, where training numbers are not going up to match demand, but the shortage is even greater in developing countries,” says co-author Rowan Calloway.

“In the future, community care will be increasingly reliant on non-specialists, so it will be crucial that all members of the multi-disciplinary teams needed to support very frail older people near the end of their lives have good training in palliative and supportive care skills.”

̽��ֱ��study was supported by the Abbeyfield Society, Bupa Foundation, Medical Research Council, and the National Institute for Health Research Collaboration for Leadership in Applied Health and Care Cambridgeshire & Peterborough.

Reference
Fleming, J et al. Dying comfortably in very old age with or without dementia in different care settings – a representative "older old" population study. BMC Geriatrics; 26 Sept 2017; DOI: 10.1186/s12877-017-0605-2

Key findings and policy implications

̽��ֱ��Cambridge City over - 75s Cohort Study

Very old people are more likely to die comfortably if they die in a care home or at home, compared with dying in a hospital, suggests a new study from the ̽��ֱ�� of Cambridge. Yet while the overwhelming majority of very old people reported symptoms at the end of life such as distress, pain and depression, the study found that these were not always treated effectively.

How we care for the oldest members of society towards the end of their lives is one of the big issues for societies across the world

Jane Fleming

Sheila Sund

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Questions of life and death

amb206 — Fri, 04 Nov 2016 12:30:00 +0000

Toast is burning in one of the ward kitchens at St Christopher’s Hospice in south London. Members of the nursing staff rush to open the windows, laughing at this minor disaster. In a room down the corridor a young man called Kevin is confronting a future in which he will play no part. He’s married with two young children – and has terminal cancer. Imagining his boys growing up without him is more painful than the disease destroying him. Kevin and his wife have accepted that he will soon be gone: she wants him to die at home but he doesn’t want to frighten his sons.

These are just two of the moments captured in ̽��ֱ��Time to Die a documentary made in the 1990s by Nikki Stockley. Commissioned by the BBC, the film addresses a subject that remains taboo for many of us: death. Stockley focuses on three people whose lives are ending. They and those they love share their feelings. Doris hopes she won’t linger: she doesn’t want to die “inch by inch”. Hazel has lost interest in clothes and no longer looks in the mirror. She has told the hospice staff that she wants to die at home. Her boyfriend fears he would not cope; often he feels like running away.

Earlier this year, academics from three different disciplines (Emma Wilson, Professor of French Literature and the Visual Arts, Dr Stephen Barclay, Senior Lecturer in General Practice and Palliative Care, and Dr Robbie Duschinsky, Lecturer in Social Sciences) sat down to plan a seminar series that would encourage a broad dialogue about care and dying, using the medium of film as a framework. Wilson, who has a specialist interest in film, proposed that ̽��ֱ��Time to Die would make a powerful starting point.

Wilson said: “What I admire so much about Nikki’s documentary is the openness of the interviews, Nikki’s presence, her connection to her subjects, allowing complex emotions to be put into words. It feels like a work of accompaniment, very patient, very calm, opening up possibilities for a non-intrusive presence of the camera in this community, and a tender, caring work of editing, piecing together a visual narrative.”

̽��ֱ��first of five seminars planned for the current academic year took place last week. Revd Dr Derek J Fraser, lead chaplain at Addenbrooke’s Hospital, talked about the role of his team in supporting patients and those close to them. A screening of ̽��ֱ��Time to Die was followed by a Q and A. Stockley took questions from an audience who included health professionals, members of the public, counsellors and representatives from local hospices. ̽��ֱ��making of a documentary about so sensitive a topic prompted questions about the relationships involved and the editing process.

Stockley spent four weeks filming at St Christopher’s. ̽��ֱ��Time to Die is, perhaps most importantly, a tribute to those it features, the patients and staff of a hospice acknowledged to be a pioneer in end-of-life care. She spoke of the closeness that developed between her team and the people they filmed – and her own emotional response. “I needed to remind myself that my sadness was nothing compared to those I was filming.” She also talked about the difficulty of negotiating a commission to make a film looking at death.

Junior doctors can expect to deal with as many as 40 to 50 deaths a year in the course of their work. Yet most people, in a society that protects itself from the reality of human frailty and mortality, have never witnessed death close up. Stockley suggested that film could offer a “safe way” of exploring some of the things we ask ourselves (how do people die, what’s it like to die) but seldom give voice to. Even the staff at St Christopher’s seldom talk about their own deaths. Medical statisticians have their devised their own code for death – they call it 'negative patient outcome'.

If ̽��ֱ��Time to Die is brave, it is also deeply respectful – and quite rightly so. Film, certainly not one made for general viewing, cannot convey the emotional rawness of death. Death has a smell. It can be messy and protracted. It’s exhausting and deeply sad. Death affects the professionals involved as well as patients and their loved ones. At one point in the documentary, a nurse is overcome by emotion and fights back tears. How do we negotiate the line between personal and professional?

Several Cambridge ̽��ֱ�� medical students attended the seminar. Chris Kassam said: “Working with patients at the end of life can leave you feeling overwhelmed by the magnitude of the experience, and the easy option is to withdraw behind a mask of professionalism. I think the film and discussion helped me to realise that what patients and their families may need most at such times is not a doctor but another human being to simply be there with them."

Health care assistants are among the front line staff who get to know patients best. Aiden Ferguson, a healthcare assistant at Addenbrooke's, said the documentary demonstrated that "professionalism is not nearly enough". He commented: " ̽��ֱ��film crystallises the importance of connecting with others in a way that is deeply present and true - and these connections can be forged with patients who have a terminal diagnosis and those who do not, with friends and family, with someone unknown."

Despite the sadness of its subject matter, there is a gentle optimism about ̽��ֱ��Time to Die – and many of the scenes it captures are revelatory. Patients in palliative care, says a nurse, find it “quite comforting” to see other patients immediately after death. St Christopher’s doesn’t cover the faces of those who die. Instead a single flower is placed on the pillow as the body is wheeled away. Interviews with relatives are reminders that life goes on. “I’ve thrown away his toothbrush,” says Kevin’s wife, shortly after his death. “And now I’m looking at the shoes he wore last time he came home.”

Doctors like to fix things: they train in medicine because they like solving problems and want to make people better. In his introduction, Barclay suggested that this impulse is at the root of the profession’s difficulties with handling death and bereavement.

̽��ֱ��Time to Die is a portrait of a hospice dedicated to end-of-life care. A general hospital faces different pressures, many of them driven by time. Fraser said that time was not always the critical factor – it was often a question of finding the right moment and language for a fairly brief conversation. A personal loss had, he said, “changed profoundly” how he approached his role at Addenbrooke’s. “I’ve learnt that there is sometimes nothing to say – no solution. But to validate sadness is so important.”

Among the professionals in the audience was Michelle Reynolds, Acting Head of Staff Counselling at Cambridge ̽��ֱ��’s Counselling Service. She said: “ ̽��ֱ��combination of the film and Fraser’s own testimony made the seminar an evocative experience. Twenty years have passed since the making of the documentary – and the need for good palliative care is as great as ever. Death doesn’t change its impact on the family, friends and the professionals involved. No-one is immune.”

We don’t know when or how we will die: death is one of the life processes that defies organisation. But with careful planning, an acknowledgment of our wishes and the support of skilled professionals and loving family and friends, there is much we can do. ̽��ֱ��Time to Die shows no happy endings but demonstrates how much caring means. Kevin dies at St Christopher’s, as he had wanted, with his wife with him. Hazel dies at home, quietly and gently in her boyfriend’s arms. Standing in a rainswept churchyard after Hazel’s funeral, he is quietly proud.

̽��ֱ��seminar series continues on Wednesday, 9 November 2016 with guest speakers Professor Bee Wee, NHS England's National Clinical Director for End of Life Care and Dr Anna Elsner, ̽��ֱ�� of Zurich. Professor Wee will discuss developments in national policy and practice in palliative and end of life care since the withdrawal of the Liverpool Care Pathway for the Dying. Dr Elsner will discuss a documentary exploring end-of-life care in Switzerland, 'Die weisse Arche'/' ̽��ֱ��white ark' (2015) and the Ars Moriendi (arts of dying) tradition. All welcome, no charge, booking required.

Inset image: Physician; credit: Yuya Tamai.

An ambitious seminar series began last week with a discussion of a remarkable documentary. Filmed in a pioneering hospice, ̽��ֱ��Time to Die addresses a subject that remains taboo for many. Joining the conversation are health professionals, medical students and members of the public, as well as those interested in film and ethics. ̽��ֱ��series continues on 9 November 2016.

̽��ֱ��film and discussion helped me to realise that what patients and their families may need most is not a doctor but another human being to simply be there with them.

Chris Kassam, medical student

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Life and death

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Opinion: Here’s what people in their 90s really think about death

Anonymous — Thu, 19 May 2016 19:42:31 +0000

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

̽��ֱ��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: “ ̽��ֱ��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.”

̽��ֱ��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.

Most of the older old don’t fear death and some even look forward to it. Broo_am (Andy B)/Flickr, CC BY

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. ̽��ֱ��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.

Jane Fleming, Senior Research Associate, ̽��ֱ�� of Cambridge

This article was originally published on ̽��ֱ��Conversation. Read the original article.

̽��ֱ��opinions expressed in this article are those of the individual author(s) and do not represent the views of the ̽��ֱ�� of Cambridge.

Jane Fleming (Department of Public Health and Primary Care) discusses attitudes to death among the very old.

Pat Pilon

Pat, August 20, 2011 - Curb

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“It’s not worth me having a long-life lightbulb”: Attitudes to death among the very old

cjb250 — Tue, 05 Apr 2016 18:00:10 +0000

Improvements in our environment and lifestyles, as well as significant medical and healthcare advances, mean that more and more people are living to a very old age. According to a report published last year by the Office of National Statistics, the number of people aged 90 or more at the time of their death has tripled in the past three decades in the UK.

“Despite the dramatic rise in the number of people living into very old age, there is far too little discussion about what the ‘oldest old’ feel about the end of their lives,” says Dr Jane Fleming from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge, who led the study. “We know very little, too, about the difficult decisions concerning their end of life care.”

In a study part-funded by the National Institute for Health Research, researchers interviewed 33 people over 95 years old from the Cambridge City over-75s Cohort and for 30 of these and for 9 people too frail to be interviewed in person, a ‘proxy’ – a relative or member of care-home staff, for example – about attitudes towards death, dying and end-of-life care. ̽��ֱ��responses are at times poignant and occasionally humorous, but provide a fascinating perspective on the views of an often overlooked minority.

̽��ֱ��age of the older people was so great that most of their contemporaries had died, so death was a regular feature of life and many spoke of living on borrowed time. “As people get older, as their friends die, there’s an element of ticking them off,” said one proxy.

Many of the older people referred to “taking each day as it comes”, expressing thankfulness for where they were in life and content, at this stage, to take life one day at a time, not worrying too much about tomorrow. There was a sense of life ticking along until something drastic happened. “It is only day-from-day when you get to ninety-seven,” said one.

Although one interviewee described only being “three-quarters of the way” through their life, others knew and accepted that they were going to die soon. One son-in-law describes his elderly mother-in-law giving a long-life light bulb to her granddaughter, saying: “Something for you, it’s not worth me having”. Most of the interviewees felt ready to die. “I’m ready to go,” said one woman. “I just say I’m the lady-in-waiting, waiting to go.” Some felt they were a nuisance to others, while others were more desperate in their desire to reach the end, suggesting they had simply lived too long. “Please don’t let me live ’til I’m a hundred,” one woman said to her proxy.

Several proxies discussed conversations that they had had about euthanasia. A son described a vivid memory of accompanying his mother to visit one of her friends who had dementia: “She said ‘Gordon, if I ever get like that, for goodness sake put a...’, it was her words, not mine, ‘put a pillow over my head, will you?’”

Most were not afraid of dying, either reporting that it did not worry them or their proxies saying they had not expressed any worries or fears about it. For some this absence of fear was rooted in positive experiences of others’ dying: One interviewee said of her parents: “They were alive, then they were dead, but it all went off as usual. Nothing really dramatic or anything. Why should it be any different for me?”

Proxies reported that death was rarely talked about: “That generation, they didn’t actually discuss death much, I don’t think,” said one. A few, however, talked openly about death and the future – one proxy described a conversation: “She said, ‘I should think I’ll snuff it soon, don’t you?’ I said, ‘I don’t know, you tell me’ and she just laughs. I mean, she… You can laugh with her about it, you know.”

Discussion of funeral preferences was more common than talking about death, although the extent of discussions varied. Some had made their preferences clear and had made plans themselves and paid for their funerals in advance. Others noted the difficulties of discussing funerals – one proxy described a conversation with her mother: “I said, ‘Do you think you would want to be buried or cremated?’ And she said, ‘Well, cremated, I think.’ I find it very difficult talking to her. I don’t feel that I can. You see, I say to my children ‘Oh, that’s a nice song on the radio. Oh, perhaps I’ll have that at my funeral’. And you couldn’t to my mum.”

̽��ֱ��manner of death was of more concern than its imminence. Although some said they had not really thought about dying, many explicitly expressed the wish to die peacefully, pain free and preferably while asleep – to “just slip away quietly.”

“I’d be quite happy if I went suddenly like that,” said one interviewee, snapping their fingers.

When asked whether, if they had a life-threatening illness, they would want to receive treatment that would save their life or prefer treatment that would just make them comfortable, few people chose life-saving treatment. “Make me comfortable” was a far more typical response and proxy informants tended to echo the older people’s dominant preference for comfort rather than life-saving treatment.

Few people wanted to be admitted to hospital in the event of such an illness, though rarely gave reasons. One care home manager explained about her resident: “If she went to [hospital] quite poorly, I think she would be full of anxiety and I think it would exacerbate any illness she had. I think she would find it alarming actually.”

Family members were often aware of preferences. One niece said of her aunt: “She's dead against going. She doesn't like hospitals. She doesn't want to go.” Her aunt, she said just wanted to go to bed and go to sleep without going into hospital – “I think that's her ideal, just dying in her own home.”

A handful of interviewees viewed well-intended medical interventions as prolonging life unnecessarily, an issue usually, but not exclusively, raised by proxy informants. One 98-year-old couldn’t “see any point in keeping people alive”. One proxy described being annoyed when the doctor gave her relative a pneumonia injection: “She had no quality of life… was ready to go … [but] there was no consultation with us at all about it.”

“Death is clearly a part of life for people who have lived to such an old age,” says Dr Fleming, “so the older people we interviewed were usually willing to discuss dying, a topic often avoided.” However, most had only had discussions regarding end-of-life preferences with health care professionals, rarely with family members. Nonetheless proxies tended to feel they knew their relative’s preferences, though the study found in a couple of instances relatives’ guesses were wrong. A care home manager commented that it was not necessarily with older people themselves that professionals broached the topic: “Historically what happens in hospitals is they tend to... if it’s not asked beforehand they go straight to the relatives. They won’t broach it with the individual, which is actually […] against the Data Protection Act, and it’s nobody else’s business. But it is how the culture of hospitals works unfortunately.”

However, the same care home manager pointed to the practical difficulties of having conversations about end-of-life care preferences: “I’ve not had long discussions, because of [her] hearing problem. It’s very difficult to write them down on paper. And she’s got to shout the answer back at you and you’ve got to re-clarify it.”

“In our previous research we found the majority of people who die in their 90s or 100s are dependent on others because of very high levels of disability and cognitive impairment by the last year of life,” explains Dr Fleming. “Over recent decades most people dying in very old age have moved into care in their final year or died in hospital. To plan services to best support rising numbers of people dying at increasingly older ages we need to understand their priorities as they near the end of life.”

“Now so many more people have reached a great age before they die, it’s important we know about their views and their concerns, particularly in relation to end-of-life care,” says Dr Morag Farquhar, the study’s other lead author. “These are difficult conversations to have and no one wants to have to face their own death or that of a loved one. But having these conversations before it is too late can help ensure that an individual’s wishes, rather than going unspoken, can be heard.”

Reference
Fleming, J., Farquhar, M. et al. Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care – Qualitative Research within a Population-Based Cohort Study. PLOS ONE; 5 April 2016; DOI: 10.1371/journal.pone.0150686

Death is a part of life for people over 95 years old, who mainly live day-to-day, concludes a rare study of attitudes to death and dying amongst the very old. ̽��ֱ��research, from the ̽��ֱ�� of Cambridge and published today in the journal PLOS ONE, finds that this group is willing to discuss dying and their end-of-life care, but is seldom asked.

“She said ‘Gordon, if I ever get like that, for goodness sake put a...’, it was her words, not mine, ‘put a pillow over my head, will you?’”

Juhan Sonin

Memm, 100 years in the making (cropped)

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Uncovering the afterlife of ancient Egypt

sjr81 — Thu, 25 Feb 2016 15:31:24 +0000

Going beyond the images of mummies, animal-headed gods, pharaohs and mystery often associated with ancient Egypt, Death on the Nile explores the beliefs and working practices behind these objects and reveals fascinating new information on how they were made.

Golden yellow, and covered from head to toe in bright hieroglyphs and pictures in reds, greens and blues, the set of coffins belonging to the man named Nespawershefyt (also known as Nes-Amun) was one of the very first gifts to the Fitzwilliam collection, given by two members of the ̽��ֱ�� of Cambridge in 1822, just a few years after the Museum was founded in 1816.

̽��ֱ��following year, Giovanni Belzoni presented the ̽��ֱ�� with the seven-ton granite sarcophagus lid of Ramesses III which he had retrieved from the Valley of the Kings. These and other gifts, as well as material from excavations, for which the Museum was a sponsor, created the remarkable collection of Egyptian coffins at the Fitzwilliam today.

̽��ֱ��coffins of Nes-Amun are not only incredibly beautiful, they also contain valuable clues to the man who commissioned them and to precisely how Egyptian coffins in his time were made. It is one of the finest coffin sets of its type in the world and in an outstanding state of preservation.

To uncover its hidden secrets, the coffins have been extensively studied with X-radiography at the Museum. And in February this year, the inner coffin was sent for CT scanning at the radiology department of Addenbrooke's Hospital, part of Cambridge ̽��ֱ�� Hospitals (CUH).

Julie Dawson, Head of Conservation at the Fitzwilliam Museum and co-curator of the exhibition, said: “ ̽��ֱ��inner coffin box is made up of a multitude of pieces of wood, including sections from at least one older coffin. Evidence of re-use includes cuts across old dowel holes, patching to change the profile of the coffin sides and a number of places where old mortise holes have been filled in and new ones cut beside them. Wood was a precious commodity and the craftsmen were incredibly skilled at making these complex objects from sometimes unpromising starting materials.

“ ̽��ֱ��radiographs and scans also reveal how people tried to restore or preserve the coffins in the past. Some parts of Nespawershefyt’s coffins are held together with 19th century ironmongery. Without these old repairs the coffins might not have survived so well, but they are quite intrusive on the original object and have rusted into the wood in places, causing damage.”

Examining the surface revealed other surprises, including several 3,000 year old fingerprints, suggesting that the craftsmen moved the lid of the inner coffin before the varnish had dried. NesAmun clearly commissioned his coffins during his lifetime, presumably at the point where he could afford a set worthy of his status as a priest of Amun-Re.

However, by the time of his death he had risen in rank and his new titles — as supervisor of craftsmen's workshops in Karnak and the supervisor of temple scribes of Amun-Re — had to be inscribed over the top of the old ones. This shows the importance attached to being properly prepared for death in ancient Egypt, even while one was still alive.

̽��ֱ��Nes-Amun coffin set is one of many stunning objects in Death on the Nile, the majority from the Fitzwilliam’s collections and complemented by loans from the British Museum and the Musée du Louvre. Through scientific analysis, the woods and the pigments and varnishes used by the craftsmen to make the decoration have been identified.

Evidence of working practices, from the variety of tool marks found on the wood to the drawing and painting techniques used to make the images, have been revealed through close study and a range of imaging techniques.

All this information helps bring us closer to the people who made the coffins as do the very human touches and stumbles – secret repairs hidden underneath a perfect finish, mistakes in drawings that had to be changed in the final painting and even the odd practice doodle on the underside of a coffin box.

A series of reconstructions will show how some of the coffins were made and, in a live conservation area, visitors will be able to examine in more detail the scientific techniques and the materials and construction methods uncovered during the project.

Helen Strudwick, Egyptologist and exhibition co-curator said: “This is a chance for us to encourage visitors to look more closely at these extraordinary objects. A coffin artisan in ancient Egypt had to deal creatively with many practical problems and sometimes restrictions on materials available because of the economic or political climate. Objects always had to be tailored to cost, but the finish had to meet the high aspirations of the customer. ̽��ֱ��coffins show the skill and care with which the Egyptians prepared for the afterlife.

“To us, for whom death is a taboo subject, this seems like a morbid preoccupation. In fact, it was an obsession with life and an urgent wish to ensure its perfected continuation.

“This is also a very appropriate exhibition for our bicentenary year. Not only did the Museum’s collection of Egyptian artefacts start with the gift of a beautiful set of coffins, that gift was also given in the year that Egyptology as a subject was born: 1822 was the year that Jean-François Champollion first announced his theories on the hieroglyphic script. And, as part of the ̽��ֱ�� of Cambridge, it is an excellent opportunity for us to bring the research we are carrying out on the Museum’s Egyptian coffin collection to the attention of a wider audience.”

Death on the Nile: Uncovering the afterlife of ancient Egypt is at the Fitzwilliam Museum, Cambridge 23 February – 22 May 2016. Admission is free.

̽��ֱ��Fitzwilliam Museum is marking its bicentenary anniversary celebrations with an exhibition on its remarkable collection of Egyptian coffins.

To us, for whom death is a taboo subject, this seems like a morbid preoccupation. In fact, it was an obsession with life.

Helen Strudwick

Death on the Nile - Teaser Trailer

Full length view of coffin from the coffin set of Nespawershefyt, About 1000 BC

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