Basic Integrated Care Skills for Non-Medical Staff: Likelihood of Death

The 10 Reasons Why

Kate looked at Roger and said: “I am feeling more and more empowered each day. Peter is opening up to me.  However, he keeps talking about dying and about his non-stop cough.  How do I best support him?”

Many of the same principles required for supporting someone going through pain and loss can also be applied to assisting someone who is battling a terminal illness. In a previous article on 10 Tips For Supporting Someone Through Emotional Pain and Loss, I spoke about the principles of being present, of listening, and validating. I also spoke about the power of reframing, and knowing the appropriate time to recommend professional help. Kate has been learning how to use and implement these principles when meeting with Peter. But now she needs some technical knowledge and basic information.

“Kate, there is a lot you can do,” said, Roger, “let’s start with the 10 most common causes of death in the US.” This bit of knowledge foundation will give you the tools you need for your next few sessions with Peter.”

As Roger mentioned, learning about the most common causes of death is a good first step, as you embark on the noble endeavor to learn the basic skills of Integrated Care.

Below are the 10 most common reasons why your patients and clients are likely to die.

1.    Heart disease

As the number one cause of death in the United States, when one of your patients or clients dies, it will likely be due to heart disease, one out of four times. Heart disease, also known as cardiovascular disease, tends to affect men, like Peter, more commonly than women. Heart disease can be grouped according to many different forms, including and not limited to heart failure, arrhythmias, angina (or pain), and coronary artery disease, among others. The essential point here is to emphasize the deadly nature of heart disease. Knowing this will help provide you with the confidence you need to speak with your patients and clients regarding the importance of lifestyle modification, including healthy dieting, exercise, and other protective healthy habits.

2.    Cancer

Cancer is the growth and spread of abnormal cells that become so uncontrollable and disorganized that normal vital organs and body functions suffer compromise.  Because this is essentially cellular growth and reproduction, some parts of the body are more prone and susceptible to cancer (lung, colon, breast) than others (heart, nails).  This also means some cancers have a better prognosis when compared to others.  Peter was recently diagnosed with prostate cancer, which can be slow growing and slow to spread, depending on the particular type.  His cancer was localized and detected at an early stage, and he had a 99% chance of living longer than 5 years.  With this type of prognosis, anyone with Peter’s condition would more likely die from other causes than from prostate cancer.

3.    Chronic lower respiratory disease

Chronic lower respiratory disease is generally known as Chronic Obstructive Pulmonary Disease (COPD), with emphysema or chronic bronchitis, as common examples.  Asthma, also commonly known, is also a type of chronic lower respiratory disease.  Peter was also diagnosed with COPD, whose cause is tobacco smoking, 80% of the time.  The best way to stop the progression of COPD is through smoking cessation.  Because Peter continued to smoke, one great way Kate could help him would be using this invaluable information to address the needed steps to stop smoking.

4.    Accidents

Yes, accidents, the fourth leading cause of death for your adult patients and clients.  They account for two hundred thousand deaths per year, meaning that every three minutes, one person is expected to die from an accident.  These accidents are in the form of violence, motor vehicle accidents, sport injuries, and opioid overdoses.  They can also result from falls and injuries, due to physical and sexual abuse.  The above described as accidents can be prevented for the most part, and raising awareness among all of us who work with patients and clients should be encouraged and regarded as a good first step.  For example, reminding our patients and clients to wear their seat belt when riding in a car and stay away from driving while intoxicated, can be powerful ways to make a difference in their lives.

5.    Cerebrovascular disease

Cerebrovascular disease, commonly known as “stroke,” is similar to cardiovascular disease in terms of cellular mechanisms.  It has four main types, whose elaboration is beyond the scope of this article.  However, it is important to know that uncontrolled hypertension (elevated or high blood pressure) and hypercholesterolemia (high cholesterol) and smoking are some of the main risk factors for cerebrovascular disease.  The same lifestyle modification, including diet and exercise, that helps decrease your risk for cardiovascular disease also applies to delivering protection against cerebrovascular disease.

6.    Alzheimer’s disease

The complications of Alzheimer’s disease are the direct cause of associated death.  In the final stages, patients and clients tend to become bed-ridden.  While the prevention for Alzheimer’s is not totally clear, there are several steps that patients and clients can take, similar to recommendations already described to help prevent cardiovascular and cerebrovascular disease.  In order words, smoking cessation, regular exercise, and healthy diets have all been found to be protective factors.  Furthermore, continued mental activity, like reading, writing, and learning something new, like a new language, or a new instrument can significantly reduce the likelihood of developing Alzheimer’s disease.

7.    Diabetes

Diabetes is a common disease, though its complications are less known.  When your body is no longer able to control or regulate its blood glucose (blood sugar), your glucose remains high, and it starts to damage other parts of your body.  For example, if the blood vessels and nerves in your eyes are affected, the ramifications can be severe and fatal.  It is not surprising that the risk factors for the leading causes of death can be decreased through lifestyle modification.  Exercise, diet and weight management can both delay the chances of developing diabetes and also help return your patient or client’s glucose levels to normal baseline.

8.    Influenza and pneumonia

The Influenza virus is highly contagious, especially during the winter months; it causes Influenza, which can lead to pneumonia or infection and inflammation (swelling) of the lungs.  When the lungs are inflamed, the flow of oxygen to the bloodstream becomes compromised and breathing is then a difficult task.  Without oxygen, you cannot survive, hence the reason your patients and clients could eventually die from what started as a simple flu.  Your patients and clients can prevent this through vaccination, regular hand washing, and through smoking cessation, and yes, through healthy dieting and exercise.

9.    Kidney disease

Diseases that affect the kidney can be classified as nephritis, nephrotic syndrome, and nephrosis.  And they can, in fact, be fatal.  Similar to the times when your patients and clients may not get proper oxygen from their lung to their bloodstream during inflammation, when kidneys are unable to get rid of the waste from their blood, this waste will cause damage to the rest of the body and death can eventually ensue.  As with other leading causes of death, a healthy diet along with exercise and smoking cessation are protective factors.

10.    Suicide

Speaking with your patients and clients about these other main causes of death can help decrease the likelihood of the tenth leading cause of death—suicide.  Suicide often results from hopelessness and helplessness, and the risk for suicide can be reduced when anyone feels empowered and better understands his or her life situation, knowing that something can be done.  Chronic pain and other chronic general medical conditions are risk factors for suicide.  With the right support, through Integrated Care, we can help decrease the likelihood of suicide in our patient and client population.

“ … However, he keeps talking about dying and about his non-stop cough.  How do I best support him?”  Kate was asking Roger for help.  After hearing about the 10 leading causes of death, Kate decided to start talking to Peter about smoking cessation, other lifestyle modifications, and about death and dying.

When any of your patients or clients dies, there is a 75% chance that it will be due to one of the above 10 reasons.  There will also be a 50% chance that it will be due to heart disease, cancer, or chronic lower respiratory disease.  We have just discussed the ten main reasons why your patient or client is likely to die.  You now know them, and you have a sense of what can be done about them.  Knowledge empowers, and I hope you continue to make a difference in the lives of others, as you continue to learn about basic Integrated Care skills.

References:

1. Centers for Disease Control and Prevention. (n.d.). Up to 40 percent of annual deaths from each of five leading US causes are preventable. Retrieved from www.cdc.gov/media/releases/2014/ p0501-preventable-deaths.html

2. Palfrey, J. (2006). Child health in America: Making a difference through advocacy. Baltimore, MD: Johns Hopkins University Press.

3. Baird, M., Blount, A., & Brungardt, S. (2014). The Working Party Group on Integrated Behavioral Healthcare. Joint principles: integrating behavioral health care into the patient-centered med- ical home. Annals of Family Medicine, 12(2), 183–185.

4. Blount, A., & Bayona, J. (1994). Toward a system of integrated primary care. Family Systems Medicine, 12(2), 171.

5. Cowley, D., Dunaway, K., Forstein, M., Frosch, E., Han, J., Joseph, R., … Unutzer, J. (2014). Teaching psychiatry residents to work at the interface of mental health and primary care. Academic Psychiatry, 38(4), 398–404.

6. Grumbach, K., & Bodenheimer, T. (2004). Can health care teams improve primary care practice? JAMA, 291(10), 1246–1251.

7. Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association.

8. Levant, R. F. (2005). Health care for the whole person. Monitor on Psychology, 36(5), 5.

9. McDaniel, S. H., Belar, C. D., Schroeder, C., Hargrove, D. S., & Freeman, E. L. (2002). A training curriculum for professional psychologists in primary care. Professional Psychology: Research and Practice, 33(1), 65.

10. Patient Protection and Affordable Care Act, 42 U.S.C. § 18001. (2010). Retrieved from www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html