Does Morphine Speed Up Death At The End Of Life?

— What We Know

By Jennifer Anandanayagam

Morphine, an opioid medicine that is prescribed for pain relief, is not without controversy. When there are strong concerns about substance abuse and addiction to the narcotic, people often wonder things like “Is it safe to take morphine?” or “How long does morphine typically stay in your system?”

If you were to talk to hospice care workers, you’d probably hear that this powerful pain relief medication also gets a bad rap in their world. One of the common concerns is if giving morphine to your dying loved actually brings about their death sooner.

According to palliative care professionals, when proper dosage and timeliness of administration are followed, there is no basis for this fear. In fact, according to Hospice of the Chesapeake‘s Director of Education and Emergency Management, Elisabeth Smith, giving the right amount of morphine to someone who’s having trouble breathing might actually help them breathe better. For someone with breathing difficulty brought on by conditions like terminal lung disease, “it can feel like you’re drowning, gasping for air,” explained Smith. “Morphine opens the blood vessels allowing more blood circulation within the respiratory system. This makes it easier for the lungs to get the bad gases out and the good gases in. The patient becomes calm, their breathing slows down.”

Morphine doesn’t speed up death

It’s easy to see how the notion of morphine bringing death sooner to someone who’s dying came about. We can blame creative outlets like movies and books and also the lived experiences of some people who report seeing their loved ones’ lives slip away while on the opioid.

But morphine, when administered correctly, can bring a lot of relief and improve the end-of-life experience of someone, mainly because it blocks pain signals and helps with a lot of distressing sensations someone might be feeling in the final moments before death (per Crossroads Hospice & Palliative Care), like shortness of breath, pain, restlessness, and agitation.

Palliative care professionals are well-versed in how to start, sustain, and increase (when needed) morphine dosage according to the requirements and comfort levels of their patients (per Canadian Virtual Hospice). When someone is first put on the narcotic, the dose is very low and this dosage is maintained until the person gets used to it. Only a large dose can prove harmful (a fatal overdose might require 200 milligrams). That being said, morphine, like other pain medications, comes with its own set of side effects like drowsiness, digestive issues, stomach cramps, and weight loss (per Mayo Clinic). As explained by Elisabeth Smith from Hospice of the Chesapeake, sometimes suffering can prolong death too and it can look like the person passed away sooner when morphine was administered to them, simply because their discomfort was taken away and death was allowed to come in its own time.

Should you be concerned about administering morphine?

Ultimately, no one can answer that question but you, but hospice care workers urge loved ones to be correctly informed of the intricacies of why morphine is given in the first place and how it’s done in a professional setting. 

Pain is part of the dying process and if pain medications such as morphine can relieve some of the suffering, it might be one of the kindest things you can do for your loved one. You might be giving them a little more independence to be able to eat and drink without discomfort, sleep better, and even maintain better cognitive capabilities (per Vitas Healthcare). Ask questions from healthcare professionals and have them explain what the drug does exactly. Sometimes, having the right knowledge can assuage some of your fears. 

Dr. Daniel Lopez-Tan from Legacy Hospice shared that the idea that morphine speeds up death could have arisen because the opioid is commonly associated with end-of-life care. “The patient is dying of other causes and morphine only softens the symptoms of the last moments of life … One of the effects of morphine called respiratory depression does not occur with small, controlled doses of short-acting opioids, especially when under the supervision of a healthcare professional,” added the doctor.

Complete Article HERE!

I’m a death doula

– These are the most common regrets people have before they die

From staying in sexless relationships to putting off downsizing, these are the issues that come up time and time again

By Sadhbh O’Sullivan

There are few as well acquainted with the dying, and their regrets, as death doulas. Also known as end-of-life doulas, they provide support to people through terminal or life-limiting illnesses by improving their quality of life, and death.

This encompasses everything from helping with logistics to providing emotional support to those at the end of life and their loved ones.

i spoke to three death doulas to understand the biggest regrets of the dying, the living who love them, and steps we could take to avoid those same regrets and have a better end of life.

Staying in unhappy (and sexless) relationships

Emma Clare, who is a chartered psychologist and death doula, says that the most common, though unspoken, regret she hears is about relationships.

“I often hear people say that they wish they’d left either unfulfilling or unhappy relationships sooner. A lot of people have regrets about spending a large part of their life in situations that didn’t feel true to themselves or have any fulfilment.”

She says when we’re confronting death, we feel a lack of intimacy and closeness acutely – including sexual intimacy.

“As humans we look for intimacy and that doesn’t go away because we’re dying. If anything, it increases because people are aware they have a limited time left and they want to have that connection with other people.”

Not downsizing or decluttering

“We all know we’re going to die, but we just put it to the side, even with a terminal diagnosis,” says Jane Depledge, a doula based in North Powys, Wales. When patients are told that treatment is going to stop, that lack of preparation “hits them”, she says. Getting a will in place, transferring over health insurance, or discussing their wishes are all simple things that we don’t want to face, but will feel better for it.

Emma Clare adds that this includes very practical decisions.

“People wish they’d downsized their home earlier and cleared out their stuff, and now they’re aware their often adult children are going to have to deal with that and feel a big sense of guilt. That means regret from the family too: they’re then left sorting that out and haven’t had the conversation about what was and wasn’t treasured and should be kept.”

Being in hospital instead of at home

“People often don’t realise they have choices”, says Depledge, so when a person is dying they panic and send them to hospital. Though for some people hospital care is essential, she says it is always worth asking and looking into ways their loved one could die at home.

Not being prepared

The emotional and physical burden of caring for someone at the end of life can take its toll on both the carer and the patient, who may feel huge guilt at being ‘a burden’. People often regret being inadequately prepared for everything that needs juggling, and not realising what support they can get.

“Carers can claim immediate Government grants to care for someone who is dying,” explains Depledge. “Knowing that could have enabled someone to take time off work or give up work to care for and be with a loved one.”

Not being able to say goodbye to friends

When a person is dying, they tend to want to surround themself with the things and people they love most – but so often, they are lonely, says Depledge.

“I think a lot of people avoid visiting people when they get a terminal diagnosis because they worry they don’t know what to say,” she explains. “But actually I hear a lot of upset from the people who are dying, saying that they feel like their friends have gone quiet or disappeared and they feel very lonely. And that’s needlessly lonely because at the funeral there are lots of people there.”

Not saying how you really felt

Amanda Waring, a death doula working in West Sussex says that the biggest regret she comes across is from people who feel they didn’t “heal their relationship, or speak frankly”.

“Regret stems from a lack of honesty. This is true even for exceptionally difficult conversations where someone has wronged the other and the only catharsis is if you bring it into the open and it takes a lot of courage.”

She says this can range from apologising for harsh words spoken at a bedside, to being honest about deeper rooted, historical conflicts, to sharing feelings of love and pride that were perhaps not made clear before.

“Bravely speaking up and trusting your gut is the key to avoiding all regrets really,” adds Emma Clare.

Complete Article HERE!

Dogs Feel Grief Too

— Here’s How We Can Help Them

By

“Grief affects our pets just as much as it does us,” Lorna Winter, an expert in dog behavior, tells Newsweek. So when a pup loses their favorite person, how can we help them?

We spoke with two professional dog behaviorists, and a veterinary medical officer, to find out what we can do to help a pet in mourning. It’s common knowledge that dogs can display a wide range of emotions akin to humans, meaning that they can also experience loss.

“Changes in primary caregivers can also be a big shock for them too as it’s a routine change and it’s not what they were used to,” Winter, a director of the UK Dog Behavior Training Charter and co-founder of Zigzag, continued.

Extra Affection

It can be easy to pinpoint when a dog is grieving, with common signs and symptoms including lethargy, loss of appetite and changes in behavior. Winter said that people close to the dog must try to make them feel more comfortable, to support them through the difficult time.

“Touching and cuddling releases oxytocin in a dog, especially when it’s with someone that they know and are bounded with. It feels nice for us too, so snuggle up,” Winter said.

Winter advises people keen to help grieving dogs to set some time aside within their day to connect with the mourning canine, and to make sure they’re having their emotional and physical needs met.

“It will be a tough time for them, so spend time with the dog, meet their needs and pamper them! That might be just petting your dog or laying together on the couch and watching television,” she added.

Animal behaviorist Kaelee Nelson echoed Winter’s advice. The San Diego-based behaviorist told us that a dog’s comfort should always be prioritized when they’re in mourning or emotional pain.

“Spend more time with your pet, making sure to give them extra affection and companionship to help alleviate feelings of loss and loneliness,” Nelson said.

She added that if the dog were to have a particular item that reminds them of the person that has moved or passed away, like a piece of clothing, that it should be left with them for comfort.

Danny Cox is the chief veterinary medical officer of Petzey, an on-demand digital service that connects pet owners with professional veterinarians.

Cox is in agreement with Winter and Nelson on the importance of paying a close eye to mourning pets, and providing them with as much extra attention as they need. He added that it would be a good idea for those keen to help settle their emotions to develop or follow a routine.

“Routines can offer pets stability. It’s important to maintain or establish a routine, and to monitor for signs of depression or anxiety,” Cox told us.

Nelson adds that this can be achieved by walking or feeding a dog at a similar time a day, or at the time they used to do these activities.

“This can provide a sense of security during a confusing time,” Nelson explained.

Keep Them Distracted

All three animal specialists shared that grieving dogs would benefit from having their minds taken off their dark situation. Just like us, dogs enjoy a change of scenery or a new activity in difficult times, and a distraction can definitely lift their spirits.

The easiest way to do this would be through exercise and stimulation, which can look like anything from a walk to an enrichment activity.

“Exercise is a great stress reliever for dogs, so take them on interesting walks to help them feel more relaxed when they are at home,” Winter said.

“Spend time with them, play games with them and teach them some new tricks with positive reinforcement training to help boost their mood and create positive feelings.”

She also suggested involving chews in more pressing times as chewing, despite being a soothing activity for dogs, can also help to release endorphins.

“If they’re social, rope in their doggy friends and let them play together. They’ll feel better to have the comfort of their own species when they’re feeling sad,” Winter added.

Nelson also champions the power of playtime in helping a grieving pet slowly move on. She encourages those keen to help a mourning dog to engage in regular play and exercise with them to help distract them and keep them physically healthy too.

“This can really help to elevate their mood,” she said.

Another thing that the trio can agree on is that pet dogs may act out when going through a difficult time, and that it’s important for new or recurring owners to be patient with them and give them time to adjust to this new reality.

Cox does add that if a behavioral change persists or becomes severe, concerned carers should speak with professional veterinarians for guidance.

Nelson agrees: “If your pet’s behavior changes drastically or they stop eating or drinking, it may be time to consult a veterinarian. They can provide additional advice or prescribe medications to help with anxiety or depression.”

While every pet is unique in breed and temperament and may grieve differently as a result, it’s crucial that those supporting a dog in mourning understand that while the dog’s in mourning, their love and support will absolutely help them process their love lost.

Complete Article HERE!

Why California Doesn’t Know How Many People Are Dying While Homeless

Eduardo Adrian Aviles Garza, known as ‘Monkey,’ prays at a memorial in December commemorating the 201 unhoused people who died in Santa Clara County in 2023.

By Vanessa Rancaño

Nearly a decade ago, David Modersbach had what he thought was a straightforward question: How many unhoused people had died that year?

The grants manager and his team at Alameda County Health Care for the Homeless knew people were dying on the streets, but they wanted more than anecdotal evidence; they wanted data that could show them the big picture and help them hone their strategies.

They queried the coroner’s bureau and were stunned by the response: only a single death had been reported.

“We realized there’s a lot of work to do,” Modersbach said.

What followed was a bootstrap campaign to fill the data gap. It took years, and the work was sometimes lonely, often tedious and consistently heartbreaking. When the team finally released its first report in 2022, detailing deaths from 2018–20, they counted 195 people in Alameda County who died while homeless in 2018, plus another 189 people with recent histories of homelessness whose housing status couldn’t be verified at their time of death.

a man with glasses and long hair, wearing a flannel shirt, sits behind a computer
David Modersbach works in his office in Oakland. Modersbach has spearheaded Alameda County’s efforts to count the deaths of unhoused residents.

As more Californians have fallen into homelessness — a number greater than 181,000 at last count (PDF) — more have died while unhoused, but the state’s ability to track these deaths and assess the scope of the problem hasn’t kept pace.

Spurred in part by Alameda County’s efforts, which are considered a national model for the field, the state recently began taking steps toward collecting this data. In 2022, California added a field to death records for homelessness status, and this year, a law went into effect that empowers counties to set up homeless death review committees to determine the root causes of homeless mortality.

California is among several jurisdictions across the country seeking this data. The pandemic put a spotlight on the health vulnerabilities accompanying homelessness, and that has led to growing national interest in the topic, said Barbara DiPietro, senior director of policy for the National Health Care for the Homeless Council. A recent study from researchers at the University of Pennsylvania and NYU found the death rate of people experiencing homelessness increased 238% between 2011 and 2020.

“One of the things that hopefully we took away from COVID is that homelessness is a public health issue,” she said. “Not only is living unhoused very dangerous and high risk for people experiencing homelessness, this isn’t good for communities either.”

Researchers said the data is critical in assessing whether the state’s public health interventions for people on the streets work.

“That is how we work to change things,” said Dr. Margot Kushel, director of the UCSF Benioff Housing and Homelessness Initiative. “One of the problems with not reporting it is that it makes it harder to act.”

But getting statewide — let alone national — data detailing the number of unhoused deaths requires meticulous reporting on the part of local agencies. In the case of Alameda County, it was a system Modersbach had to build from scratch.

How they count

For each homeless mortality report, Modersbach and his colleagues first scour thousands of county death records, searching for clues that suggest homelessness: words like “encampment,” “tent” and “shelter.” They then cross reference that list with a database of everyone in the county who has experienced homelessness in the past five years — itself a bespoke repository that draws on the agency’s healthcare data and records from the county’s shelter and homeless assistance programs. To capture anyone they might miss, they cull information from service providers, media accounts and a public online portal for submitting tips about deaths.

Since they began tracking homeless mortality, the team has traced an 80% increase in the number of deaths, which rose from 195 in 2018 to 351 in 2022, the most recent year for which data was reported. Over the same period, homelessness in the county jumped by nearly the same amount — or 77% — from 5,496 people to 9,747.

Behind the numbers are snapshots of how and where people are dying. A body found in a car. An overdose at an encampment. People mangled by cars or trains; others charred. Modersbach finds the tableau at once unsurprising and shocking.

“We see the same inequities in our mortality data that are reflected in homelessness,” he said. Black people are overrepresented, comprising 48% of the unhoused population and accounting for 44% of the deaths — though they represent only 19% of deaths in the county’s general population.

People who are unhoused die at five times the rate of those with housing and do so more than two decades sooner — at an average age of 52.

The data shapes decisions

Most of the deaths could be prevented, said Amy Garlin, Medical Director for Alameda County Health Care for the Homeless.

“You could say almost all of these deaths are preventable if you go far enough upstream,” Garlin said.

The largest share, 44% of the deaths among the homeless population, were caused by acute or chronic medical conditions, like heart disease, cancer, diabetes and infections. Some of those appear to have been more immediately avoidable, Garlin said. “If these people had had medical care, they may not have died this year.”

At an encampment along East 12th Street in Oakland, Angel Gonzalez, 40, remembered the friends he’d known there who had died. An asthma attack claimed one, exposure another and a third succumbed to a fever. Though Gonzalez said he didn’t know what had caused the fever, he said people are often sick, and rat bites are common.

“Health-wise here, it’s bad,” he said.

There’s frequent violence, too. Gonzalez described a drive-by shooting that killed one friend and wounded others. But what claims most people in the camp, he and others said, is overdoses.

“The fentanyl is killing mostly everybody,” Gonzalez said, explaining that people unwittingly use fentanyl-laced meth or other drugs. “It’s kind of scary.”

a man stands in front of some cars and tents and belongings in an encampment
Angel Gonzalez, 40, at an encampment on East 12th Street in Oakland, has seen many deaths at the camp, including from fevers, exposure, asthma attacks and gunshot wounds. But the most common cause by far is drug overdoses.

The mortality data compiled by Modersbach’s team reflects this, with an alarming rate of overdose deaths among unhoused residents that is 44 times the general population’s. In response, they’ve expanded their harm reduction services, focusing on naloxone distribution and installing dispensers in shelters.

At the East 12th Street camp, Gonzalez pointed out a purple dispenser on the street corner. Though Modersbach’s team had not installed it, it still proved lifesaving, Gonzalez said, when a friend recently used one of the naloxone sprays to reverse an overdose.

Alameda County Healthcare for the Homeless received a grant from the Centers for Disease Control and Prevention in 2023 to fund overdose response, a key part of their strategy to reduce mortality, and Modersbach credits their data for helping them get it.

In Minnesota, the only state with a statewide robust system for tracking homeless mortality, public health officials took a similar approach. A report on deaths between 2017 and 2021 showed unhoused people in the state were 10 times more likely than the general population to die of an overdose. Shortly after that data was released in 2023, state lawmakers passed drug overdose prevention legislation that expanded harm reduction and housing programs for people experiencing homelessness, decriminalized drug paraphernalia — a first for the U.S. — and funded “safe recovery sites” that offer clean needles, fentanyl testing and will eventually offer supervised drug consumption.

“Having the data was really useful in making the case for some of those things, both with legislators and with the public and advocates,” said Josh Leopold, senior advisor on health, homelessness and housing at the Minnesota Department of Health.

Alameda County’s latest homeless mortality report is now prompting the team to focus on how to extend palliative care services to unhoused people with terminal illnesses. Garlin estimates almost one-fifth of those who died in 2022 would likely have been eligible for hospice care.

What’s next in the ‘labor of love’

Modersbach’s team is also working to automate the most tedious aspects of compiling the county’s homeless mortality report and aims to launch a public dashboard later this year that will make information available quarterly.

“The biggest challenge is that we do not have timely data that we can act upon more quickly because of the workarounds that we have to do to get an accurate count,” Modersbach said. “We’re almost always looking backwards.”

The county’s latest tally, for 2022, was released at the beginning of 2024.

Santa Cruz, San Diego, San Mateo, Sacramento, Los Angeles and San Francisco are among the counties with varying degrees of reporting on homeless deaths. In Santa Clara County, an early champion of this work, a public dashboard tracking homeless mortality is updated nightly. A spokesperson for the Medical Examiner’s Office credited its partnership with a third-party vendor with allowing it to return results so quickly. So far this year, the dashboard listed 51 deaths.

Across the country, about two dozen jurisdictions have homeless mortality reports that are issued with some regularity, according to DiPietro of the National Healthcare for the Homeless Council, which tracks these efforts. But because the reporting isn’t standardized, it’s difficult to draw comparisons between them, she said.

a computer screen shows a tally of numbers
Statistics on homeless mortality in Alameda County on David Modersbach’s computer in his office in Oakland on March 15, 2024.

In California, despite the recent efforts to improve this tracking, limited resources will likely continue to hamper the reporting of homeless deaths. Since 2022, when the state added a field on death reports to indicate a person’s housing status, Modersbach has seen some evidence people are filling it out, but he worries many unhoused deaths will continue to go uncounted around the state because the funeral directors, coroners and physicians filling out the reports don’t often have the resources to determine whether someone was housed.

“This is a lonely, costly battle to just put all this information together, not a funded mandate,” he said. “It’s kind of a labor of love.”

In counties with well-established systems for tracking these deaths, Modersbach hopes AB 271, by Assemblymember Sharon Quirk-Silva (D-La Palma), will make a difference. The new law allows counties to create homeless death review committees and access sensitive information about people who died. The data, which includes medical, mental health and criminal records, goes beyond what Modersbach and his team have so far been able to collect, giving them greater insight into the circumstances surrounding a person’s death.

Alameda County assembled its death review committee last year, bringing together officials from several county agencies, homeless service providers and formerly unhoused people with the aim of finding ways to keep more people experiencing homelessness alive.

“It’s just getting started,” Modersbach said, “but this is the future for us.”

Complete Article HERE!

Incurable but not hopeless

— How hope shapes patients’ awareness of their advanced cancer prognosis

Nurturing hope among patients with cancer and their caregivers is possible and includes coping strategies and exploring realistic goals.

By &

Hope is defined as the expectation of achieving a future good. Patients with cancer, whether it is curable or not, prioritize cure as their highest hope.

Patients with incurable cancer wish to be informed about their disease and its treatment, but also need to maintain hope. This inner conflict can impact how they process information about their prognosis.

Prognostic awareness

Physicians are ethically obligated to inform patients about their prognosis so that patients can make cancer treatment decisions that are consistent with their values. When oncologists talk to patients about prognosis, they tend to talk about the extent of the disease (localized or metastatic), the goal of the treatment (curative or palliative) and the estimated survival (short months or many years).

Communication about prognosis can be challenging due to physician factors such as skill in discussing bad news, and patient factors such as denial. Some patients with incurable cancer, who are aware of their prognosis but haven’t accepted it, will say the treatment goal is cure.

Previous research indicates that less than half of patients with incurable cancer are aware of their prognosis. This is often attributed to a failure of communication.

But are patients truly unaware, or are they aware and not accepting of their prognosis? If inaccurate prognostic awareness is due to denial in spite of adequate communication from the oncologist, then interventions to improve communication may be ineffective, misguided or even harmful.

Patients with incurable cancer are more likely to receive end-of-life care concordant with their preferences when they have accurate prognostic awareness. Inaccurate prognostic awareness can lead to conflicting treatment decision-making between patients and oncologists, delayed referral to palliative care and more aggressive care at the end of life.

In a study of patients with advanced lung cancer, those who received early palliative care and had accurate prognostic awareness were more likely not to choose intravenous chemotherapy in the last two months of life, which would have been futile and worsened the quality of their end-of-life care.

How prognostic awareness is measured

Measuring prognostic awareness in patients is challenging because their responses may reflect their hopes rather than their true beliefs. In a recent publication in the Journal of the National Cancer Institute, our research team synthesized data from 52 studies measuring prognostic awareness in patients with advanced cancer.

In the majority of studies, prognostic awareness was conceptualized as a binary entity: patients were asked if their cancer was curable, and their responses were coded as either accurate prognostic awareness (patients knew their cancer was incurable and responded that it was incurable) or inaccurate prognostic awareness (they thought it was curable and responded that it was curable).

A few studies included in our review improved upon the binary conceptualization by incorporating hope in the assessment of prognostic awareness.

These studies asked patients about their belief and their doctor’s belief about prognosis and found that about a third of patients will hold onto hope for a cure (responding that they believe their cancer is curable), even when acknowledging that their doctors were treating them with palliative intent. This discordance was attributed to poor coping.

The role of hope

Hope is a recognized coping strategy in patients with cancer. However, “false” hope may have detrimental effects. Patients may refuse to believe their prognosis and demand aggressive treatments that may cause more harm than benefit.

In the context of advanced cancer, the relationship between hope and hopelessness is balanced by acceptance, which can re-direct hope to new goals beyond cure, such as hope for connection with others and enjoyment of daily pleasures.

Nurturing hope among patients with cancer and their caregivers is possible and includes coping strategies focusing on what can be done (such as control of symptoms) and exploring realistic goals such as dignity and intimacy. Family and spirituality play an important role in supporting patient hope.

Incorporating patient hope into prognostic awareness

We improved upon the binary conceptualization of measuring prognostic awareness by incorporating patient hope, creating a trinary concept: patients who are aware and accepting of their prognosis; aware and not accepting; or truly unaware.

We propose that patients who are aware and accepting should be offered psychological supports to address any negative effects on mood; those who are aware and not accepting should be offered adaptive coping strategies to support their evolving prognostic awareness; and those who are truly unaware will benefit from interventions such as decision-aids and communication training. Early palliative care consultation may be beneficial at each stage of prognostic awareness.

This trinary conceptualization may guide future research to improve our understanding of the impact of hope in the setting of serious illness and help patients receive the right supports in their cancer journey.

Complete Article HERE!

Thanatophobia

— Or the Fear of Dying, May Prevent You From Actually Living

BY Mara Santilli

Despite the best efforts of the death positivity movement, most people do not have a good time going to wakes or memorial services, and that’s completely normal. But for others, the thought of death—whether it’s a loved one dying or themselves—sparks intense fear and panic. “Fear is a natural and important human emotion,” says Mitchell L. Schare, PhD, ABPP, director of the Hofstra University Phobia and Trauma Clinic. But sometimes that fear of dying can be taken to extremes. “When it becomes inhibitory to living life, it becomes a phobia,” says Dr. Schare. Specifically, that phobia is known as thanatophobia, or the intense fear of death and dying.

“Fear is a natural and important human emotion. When it becomes inhibitory to living life, it becomes a phobia.” —Mitchell L. Schare, PhD, ABPP, director of the Hofstra University Phobia and Trauma Clinic

Thanatophobia (also called “death anxiety”) can be considered the “master fear,” says Dr. Schare, since so many other phobias—from fearing spiders to airplanes to illness—can be traced to a fear of death. But as with any kind of phobia, thanatophobia is more serious than just a distaste for thinking about death. It can cause avoidance of anything that might theoretically lead to death or situations in which family members or friends are dying.

There’s so much to unpack when it comes to thanatophobia. Here’s what you need to know about the fear of death, where it comes from, and how someone can cope with thanatophobia.

Is thanatophobia a mental illness?

Like other specific phobias, thanatophobia is considered a type of anxiety disorder1. According to the DSM-5-TR (aka the Diagnostic and Statistical Manual of Mental Disorders, the tool mental health professionals use to make diagnoses), a phobia is a “marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).” For people with phobias (like thanatophobia), their fear or anxiety is way greater than the actual danger they face from their phobia, they go to great lengths to avoid it, and it cannot be explained by another mental health disorder.

Because thanatophobia is a type of anxiety disorder, mental health professionals will apply some of the same techniques used to treat anxiety disorders, such as cognitive behavioral therapy (CBT). (More on that in a bit!)

How common is thanatophobia?

There’s not a ton of data available on the general population, but an estimated 3 to 10 percent of people experience thanatophobia, according to the Cleveland Clinic.

Interestingly, research suggests that the prevalence of death anxiety changes with age in unexpected ways. One 2007 paper published in the journal Death Studies found that death anxiety spikes in young adults in their early ‘20s2, and then dips off. It also found that in women (but not men), death anxiety surges again in their ‘50s. While you might assume that older adults might have more fear of death (because they’re, you know, closer to the natural end of their lives), other research suggests that elderly patients have lower levels of death anxiety3 than their children.

What are the symptoms of thanatophobia?

“Thanatophobia [symptoms] can vary in prevalence depending on cultural, personal, and situational factors,” explains clinical psychologist Alexander Alvarado, PsyD, phobia specialist at Thriving Center of Psychology. Here are some of the common emotional and behavioral symptoms of thanatophobia:

  • Obsessive thoughts, including checking things constantly about your health and well-being (or that of your loved ones)
  • Avoidance behaviors around death or potentially dangerous situations (like refusing to drive or fly in airplanes, for example, out of fear of fatal accidents)
  • Severe anxiety (like feelings of dread, panic, etc.) when thinking about death. This might manifest as physical symptoms of anxiety in the form of heart palpitations, dizziness, chills, nausea, shortness of breath, etc.

This might seem a bit confusing initially; isn’t everyone afraid of dying, at least a little bit? “Having some degree of a fear of death can be functional—it might make you drive more carefully, or take extra care of yourself when you’re sick, so you can live a better quality of life,” says Dr. Schare.

But the tipping point into death anxiety can be how the anxiety manifests. Being so afraid of being in any situation that could involve death (no matter how remote the possibility) that you isolate yourself and never go out is likely closer to thanatophobia, Dr. Schare says as an example.

What causes thanatophobia?

As with any type of anxiety disorder, thanatophobia doesn’t always have a clear-cut cause. But experts believe there are some risk factors or potential triggers worth knowing.

A history of trauma or mental illness

“There isn’t a clear medical cause of thanatophobia, but it’s believed to be related to existential concerns and possibly a history of trauma,” says Dr. Alvarado. The trauma history could be related to significant life changes, such as a personal illness or near-death experience. (This could explain, for example, why nurses and emergency-services personnel had very high levels of death anxiety4 during the early years of the COVID-19 pandemic.) It’s also more likely to be prevalent in people who have a history of anxiety disorders.

Loved ones dying early

People who have experienced the death of a loved one, especially if they did not have a thorough understanding of death at that time, could be susceptible to developing thanatophobia, says clinical psychologist Tirrell De Gannes, PsyD, anxiety disorder specialist at Thriving Center of Psychology. It might be more pronounced for people who have an over-reliance on loved ones, he adds, and therefore fear what could happen if that person were to die.

Religious, spiritual, or philosophical beliefs

People have different religious, spiritual, and philosophical outlooks on death and what the aftermath of that process might look like, says Dr. Schare, whether that’s a spiritual “better place” that someone believes in, or a rebirth. Those beliefs might moderate the fear in some respects, he adds.

Other times, people believe in none of the above, and that doesn’t mean that they automatically have thanatophobia. It’s just that the fear of dying could be more pronounced if people emphasize the “unknown” aspect of what happens after death.

Interestingly, a 2017 meta-analysis published in the journal Religion, Brain & Behavior found the people who were least likely to have death anxiety were the atheists and the extremely religious5. “It may well be that atheism also provides comfort from death, or that people who are just not afraid of death aren’t compelled to seek religion,” said the researchers in a press release.

How is thanatophobia diagnosed?

If a mental health professional suspects you could have thanatophobia, or any phobia, the diagnosis involves clinical interviews. The therapist will ask you questions to assess how your fear (and its symptoms) impact your life, Dr. Alvarado says. They will take notes on how much death is a focus, adds Dr. De Gannes, whether or not the person has any sense of relief, and whether or not it affects their behaviors, such as isolating from other people or not participating in activities that could be a risk of injury or illness.

How is thanatophobia treated?

As with other specific phobias, thanatophobia is often treated with CBT. This research-backed practice will help patients challenge and change their negative thought patterns around death, says Dr. Alvarado.

Exposure and response prevention therapy (ERP) is a specific type of CBT that is commonly used with phobias. The goal is to help someone learn to manage their phobia by getting exposed to it gradually in a safe, controlled setting. “The goal is to reduce avoidance behaviors, and potentially introduce mindfulness practices to help cope with existential concerns,” adds Dr. Alvarado. No, this doesn’t involve seeing a dead body in therapy or something. Dr. De Gannes says a therapist might try the following exposures instead: talking about the topic of death, practicing having an end-of-life conversation with a loved one, and/or imagining consequences after the death of a relative.

ERP has varying intensities and styles, says Dr. Schare. It can be very literal, done in real-world environments. Think: a therapist taking someone who is afraid of bridges on a walk over a bridge, and speaking with them afterward to recap what happened and help the person understand that they are safe, he explains. Exposure therapy can also be done in virtual reality or imaginary environments, where the person, guided by a mental health professional, enters a scenario in which they could have a near-death experience, allowing them to confront that anxiety around it head-on.

Coping with thanatophobia

It is possible that the fear of life gets more pronounced with age, as people start to have more prominent health issues and start to become closer to death, says Dr. Schare. But the bottom line is that phobias and anxiety disorders can be cured, he says. The cognizance that you and your loved ones will die at some point does not go away, but people can become better equipped to cope with it.

Some coping strategies can include daily mindfulness, meditation, and journaling to help you stay present and focused on the here and now, as well as to process the fears, suggest Dr. Alvarado. You also might find relief and some additional coping skills from talking to other people in support groups about phobias, and of course from individual therapy.

Avoiding death and anything to do with it is not the most helpful way to cope with thanatophobia. “Shying away from the topic of death only increases the mystery and fear of it,” says Dr. De Gannes. He emphasizes that it’s important to normalize the concept of death in conversations to demystify the fear and help you continue to live your life.

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Understanding Hospice Home Care

— A Complete Guide

Navigating the later phases of a loved one’s life may be an extremely emotional and difficult experience. During these difficult times, hospice home care arises as a source of comfort and support, providing a compassionate alternative to typical hospital medical treatment. This specialist care focuses on improving the quality of life for those in the final stages of a terminal illness by giving them the dignity, respect, and peace they deserve at home.

The Essentials of Hospice Home Care

Hospice home care exemplifies a compassionate approach to end-of-life care, providing a beacon of comfort and dignity to those in their final stages of life. Unlike traditional medical treatments geared at curing diseases, hospice care focuses on quality of life, providing comfort and support to both patients and their families. This comprehensive care paradigm is holistic, addressing patients’ psychological, social, and spiritual needs as well as the physical symptoms of their sickness.

At the heart of hospice home care is the dedication to respecting a patient’s choices, allowing them to spend their final days surrounded by loved ones in the familiar comfort of their own home. Pain treatment is an important part of this therapeutic method. Expertly trained healthcare experts work diligently to manage symptoms and reduce discomfort, allowing patients to live as fully and comfortably as possible.

Beyond physical care, hospice home care offers emotional and psychological assistance. Hospice staff provide counseling and grief assistance because they understand that patients and their families are going through one of the most difficult times of their lives. This guarantees that families are not alone in their journey, giving them a shoulder to lean on both during and after the patient’s life.

Spiritual care is also an important component of hospice home care, allowing patients and their families to examine life’s core concerns, make peace with unresolved issues, and, if applicable, strengthen their spiritual connections. This component of treatment is tailored to the individual’s beliefs and desires, with the goal of providing peace and meaning to patients and their loved ones during this momentous life experience.

Hospice care teams are multidisciplinary, made up of doctors, nurses, social workers, chaplains, therapists, and trained volunteers. Each member contributes their knowledge to build a support network that surrounds the patient and their family with care, love, and understanding. This multidisciplinary approach assures that every imaginable need—whether physical, emotional, or spiritual—is met.

In essence, hospice home care represents a paradigm shift in how we see the end of life. It is about appreciating the importance of every minute and allowing patients to spend time with loved ones, reflect on their life, and transition quietly. Hospice home care helps to reimagine the final chapter of life as one of love, respect, and compassion, rather than despair.

Who Can Benefit from Hospice Home Care?

Hospice care is designed for patients who are facing the end stages of a terminal illness, with a life expectancy of six months or less if the disease follows its usual course. However, it’s not just for the patients; hospice care also significantly benefits the families and caregivers by providing them with educational resources, emotional support, and respite care, helping them navigate through their grief and the caregiving process.

The Core Services Offered

The hospice care team typically includes doctors, nurses, social workers, spiritual advisors, counselors, and trained volunteers. They work together to tailor a care plan that meets the individual needs of each patient and family, which can include:

  • Pain and symptom management: Focusing on alleviating symptoms and ensuring the patient’s comfort.
  • Emotional and psychological support: Addressing the emotional, psychological, and spiritual needs of patients and their families.
  • Companionship and daily care assistance: Helping with daily activities and providing companionship to reduce feelings of isolation and anxiety.
  • Bereavement support: Offering grief counseling and support groups for families before and after their loved one’s passing.

How to Choose a Hospice Home Care Provider

Selecting the right hospice care provider is crucial. It involves considering factors such as the provider’s reputation, the quality of care, the availability of services, and the level of communication and support offered to families. It’s important to meet with several providers, ask questions, and choose one that aligns with the patient’s needs and family values.

The Impact of Hospice Home Care

The importance of hospice home care to patients and their families cannot be emphasized. This approach to end-of-life care has a significant impact on the quality of patients’ final days because it allows them to remain in the familiar and pleasant environment of their own homes. The environment has a significant impact on a person’s well-being, particularly throughout the final stages of life. Being at home rather than in a hospital allows patients to be surrounded by personal memories, things, and the people they care about, which can considerably reduce the emotional load of facing a terminal illness.

Hospice services provide patients with specialized care that addresses their physical, emotional, and spiritual needs. Pain and symptom control are prioritized to allow patients to interact with their relatives and enjoy their remaining time as comfortably as possible. This level of care empowers patients by offering them a sense of control over their lives and the dignity to choose their own treatment and how they want to spend their final days.

Navigating End-of-Life Care with Compassion and Dignity

Families benefit greatly from the extensive support that hospice home care offers. Going through a loved one’s end-of-life process can be emotionally and physically draining. Hospice care teams do more than just attend to the patient; they also assist families with counseling, respite care, and information about what to expect. This assistance is crucial in guiding families through the complexity of sorrow, loss, and the practical aspects of caring. It also allows the family to focus on being present with their loved one rather than being distracted by caregiving or decision-making.

Hospice home care provides significant support to families, which benefits them greatly. Going through a loved one’s end-of-life care can be both emotionally and physically taxing. Hospice care teams do more than just look after the patient; they also provide families with counseling, respite care, and information on what to expect. This help is critical in guiding families through the complexities of grief, loss, and the practical responsibilities of caregiving. It also enables the family to concentrate on being with their loved one rather than being distracted by caregiving or decision-making.

 Component of hospice care cannot be overlooked. Families often find themselves in uncharted territory when a loved one enters hospice care. The hospice team’s role in educating families about what to expect, how to manage symptoms, and how to cope with grief is an essential service that can demystify the dying process and alleviate fears.

In essence, hospice home care profoundly impacts both patients and their families by providing a holistic approach to end-of-life care. It ensures that patients can live their final days with dignity and comfort, surrounded by love, while offering families the support, education, and guidance needed to navigate this challenging journey with grace. This model of care not only addresses the physical symptoms of the patient but also nurtures the emotional and spiritual well-being of everyone involved, making the inevitable transition a shared, supported, and deeply human experience.

Hospice home care displays the power of compassion and dignity in the face of life’s most challenging challenges. Hospice care focuses on comfort and quality of life, guiding patients and families through the end-of-life process with dignity and support. If you or a loved one are considering hospice care, remember that it is a decision that prioritizes love, dignity, and comfort during the most difficult times.