People’s experiences of death and dying are profoundly affected by social and cultural differences.
Socio-economic factors such as standard of living, economic infrastructure, diet, environmental disasters, war, sexual pervasiveness, disease etc all interconnect to affect the way in which they frame an individual’s experience of death and dying. The unequal distribution of resource throughout the world and the differing levels of food shortage, disease, war and natural disasters need to be taken into account when considering how health care workers can improve the needs of people who are dying.
Culture, identity and personal beliefs all have a profound impact on an individual’s choices in the context of the dying process. Ethnicity, cultural differences, religion, personal beliefs, individual preferences and choices etc can all affect care needs and social practice at the end of life. People’s experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As Britain becomes increasingly diverse, cultural difference is a central feature of many clinical interactions.
Death of the elderly
Social attitudes towards the elderly, particularly by younger people, can have a significant impact on older people’s end-of-life experience and the level and quality of care they receive. Help the Aged has suggested that categorising death due to ‘old age’ reveals how we tend to assume that these deaths are ‘timely’ or ‘natural’ and therefore less worthy of our time and concern (Block 1, Unit 4, page 117).
It is instructive to consider the impact of such views. If elderly people are seen by society as expected to die any time soon then they can be seen as less worthy and their quality of life less important. Resources tend to be directed towards younger people and society can view saving or prolonging the life of a younger person as more desirable than that of an elderly patient. Society can view elderly people as a burden as they are not economically productive and can take up a disproportionate amount of time and money in health and care services.
End-of-life care for elderly people can focus on their physical needs and not their emotional and social needs. In community care for older people, the overwhelming emphasis on physical needs has created a serious lack of attention to their social needs (Block 1, Unit 4, page 118). Care needs for the elderly are regularly seen as a medication issue with pills to extend their life expectancy even though the quality of life may not necessarily be improved. Elderly people often approach their life end without any emotional or social support and this can lead to depression with little self-worth. They can see themselves as a burden to their families and their failing health and fear of an institutional death can lead them to consider suicide. It is sadly ironic that the pills given to older people to extend their lives are the means by which some choose to bring them to an end (Block 1, Unit 4, page 118).
An understanding of the social exclusion of elderly people can inform social practice. Health care workers need to know the signs of emotional distress in the elderly and look at care plans which engage them in the community and focus on improving their social and emotional needs. Health care workers need to work with the individual to identify personal preferences which can improve their quality of life. For some elderly people, cultural differences may result in an expectation that their end-of-life needs are provided for by their immediate family. Indeed, in some cultures, the elderly live with their offspring who offer direct support. In western societies, there is a greater reliance on the State and personal resources to provide end-of-life care. Those that can afford to provide their own end-of-life care are expected to make a contribution....
References: K260, The Social Context of Death and Dying, (Block 1 Units 3, 4 & 5) page 116,117, 118, 120, 121 and 123.
K260, The Social Context of Death and Dying, Block 1
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