Trends & Ideas

July-August 1997

The Changing Face of Death

It is impossible to predict exactly how we will die, but because we have access to reams of records and statistics on the deaths of those who have preceded us, we are able to draw a fairly clear picture of what death generally looks like in this country. Brad Edmonson, writing in American Demographics, profiles the average American death and describes ways in which it has changed in this century, from causes of death to burial trends.

Thanks to advances in medicine, nutrition, and sanitation, life expectancy in this country has increased by almost 30 years since 1900, to a national average age at death of 76.4 years. Most men (57 percent) die as husbands, but only 26 percent of women die as wives.

Heart disease and cancer are the leading causes of death for both men and women, followed by accidents for men and strokes for women. But expected increases in life expectancy for men—who now lag behind women—will reduce the number of sudden deaths and increase the demand for healthcare services later in life.

In 1900 people led shorter lives, infectious diseases were major killers, and few people died in hospitals. But in 1992 healthcare facilities—hospitals, emergency rooms, and nursing homes—were the scene for 77 percent of U.S. deaths.

Will you die in the state in which you were born? That depends. It varies widely, depending on migration patterns and when the state was settled. In 1992, 76 percent of deceased Pennsylvania residents were also born there, but it is rare for someone who dies in Florida to have been born in that state. Atavism and family ties are strong, however, and retirement and tourist meccas support thriving businesses that ship bodies up north to be buried.

Burial is the choice in the majority of U.S. deaths, but cremation is growing in popularity. Much cheaper than a traditional funeral, cremation is especially popular in California, regarded as a trend-setting state.

Population shifts also have an effect on the nation's patterns of death, as do medical breakthroughs, pollution control measures, behavior, the rate of violent crime, legislation, and many other factors. We cannot avoid death, but we can have an effect on how it will occur.

Harmony in the Schoolyard

An antiviolence program used in more than 10,000 schools in the United States and Canada reduces aggressive behavior in second- and third-graders, according to the results of a study conducted in Washington State and published in the Journal of the American Medical Association.

The Second Step program, developed in 1986 by a Seattle educator, consists of 35-minute sessions taught once or twice a week. The curriculum focuses on anger management, empathy, and problem solving for children from preschool through ninth grade.

The study, directed by David C. Grossman, MD, of the University of Washington, involved 790 second- and third-graders at 12 schools. About half were taught the Second Step program over 16 to 20 weeks. Observers evaluated the children's behavior before the program began, two weeks after it ended, and six months later.

The researchers found that physically aggressive behavior—including kicking, hitting, and shoving—decreased and neutral or positive behavior increased among the children who had taken the course, compared with children who did not take it. The differences were particularly notable in the cafeteria and on the playground.

To many experts, the findings are a positive sign that something can be done to reduce violence among young people. "Safer homes, safer schools, and safer communities are possible," Mark L. Rosenberg, MD, and colleagues at the National Center for Injury Prevention and Control in Atlanta wrote in an editorial that accompanied the study's results.

Grossman called the results encouraging but cautioned, "It's premature to say we've reached the solution." He added that antiviolence programs should be observed longer to see if they reduce violence later in life.

Warm Patients Fare Better

Patients who are kept warm are less likely to have heart problems during and in the 24 hours after surgery, according to a study performed at Johns Hopkins University. And since cardiac trouble is the leading cause of postsurgical death, writes Denise Grady in the New York Times, the study's lessons should help surgeons save lives.

The issue is not new, says Steven M. Frank, MD, the study's director. Because surgery is such intense, sweaty work, surgeons like to keep operating room temperatures at less than 70 degrees Fahrenheit. This practice has been reinforced in recent years as surgeons have begun wearing blood-repellent gowns that protect them from AIDS—and make the work even hotter. Unfortunately, lowering the temperature puts patients at risk of hypothermia, says Frank.

Hypothermia acts as a shock to the patient's system, leading it to release stress hormones that constrict blood vessels and force the heart to work harder—which can cause cardiac arrest or a heart attack. Because of this, surgeons and anesthesiologists have long argued over operating room temperatures. "The surgeons want it as cold as possible," says Frank, an anesthesiologist. "We want it as warm as possible for the patients."

But both surgeons and anesthesiologists can take comfort from the Johns Hopkins study, which examined the cases of 300 elderly surgical patients whose medical histories made them vulnerable to cardiac complications. In 158 of the cases, routine methods were used to warm the patients during and after surgery. The other 142 patients wore a special cover into which heated air was pumped during surgery and for two hours afterward.

In each group, two patients died. On the other hand, the patients who were kept warm did much better following surgery than the others—only 1.4 percent suffered serious heart complications, as compared to 6.3 percent of those who did not wear the heated-air cover.

"By warming the patients, we were able to reduce the incidence of major cardiac events by 55 percent," said Frank. "With this system, you can have a warm patient and a cold room, and everybody's happy."

The Vanishing Secretary?

The traditional office secretary may be going the way of the village blacksmith, writes Alan Farnham in Fortune. In the past decade, the number of secretaries in the United States has fallen by about 20 percent.

There are four reasons for this trend:

  • Reducing the secretarial force allows companies to save money.
  • Corporate downsizing has eliminated many middle managers—and their secretaries with them.
  • Secretarial work is sometimes seen as lacking in social status nowadays.
  • New technology enables executives to perform tasks secretaries once did for them.

Among the latter are Wildfire, an automated phone receptionist that greets callers, takes messages, and reminds executives of appointments; and IBM's VoiceType software, which produces letters that executives have dictated to it. Some companies provide their executives with classes in such office skills as sending e-mail and faxes.

Carole Fungaroli, the author of a book about secretarial work, would like to see those secretarial jobs that remain become less servile. For example, she suggests that companies hire young people to do secretarial work (for, say, two years) in a kind of apprenticeship, after which they would move on to bigger responsibilities. Fungaroli also urges executives to stop asking secretaries for "favors," such as picking up the boss's dry cleaning. Secretaries should be respected for their skills, she says, like other professionals.

If secretarial work does survive, however, it will probably not be because those who perform it are good at sending e-mail. Some secretaries are highly valued because, being talented at office politics, they help protect the executive who employs them. And executives who have secretaries know they enjoy greater prestige than those who do not. So although she or he may bear a different title—"coordinator" or "administrative assistant," for instance—the secretary is unlikely to completely disappear.


Copyright © 1997 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Trends and Ideas-JulAug1997

Copyright © 1997 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.