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Publication Date


Document Type



School for Social Work


Older people-Hospital care, Older people-Psychology, Medical social work, Catastrophic illness-Psychological aspects, Intensive care units-Psychological aspects, Hallucinations and illusions, Hypnagogia, Self psychology, Older adults, Critical illness, ICU, Hypnagogic hallucinations


Modern medical technology is advancing rapidly. Older adults can now survive critical illnesses, such as heart attacks, which once would have been fatal. Medical treatment in ICU units creates difficulties for patients, due to invasive procedures, lack of sleep and sedating medications which cause hypnagogic hallucinations. Literature reports indicate that ICU patients often experience PTSD due to these hallucinations. This is the first study of the psychological dynamics of recovery for ICU patients over 65 who survived a critical illness. This study had two purposes: first, describing the coping patterns of older adult survivors of critical illness and second, demonstrating the value of mixed methods for understanding complex issues. Unique research results were obtained by using both quantitative and qualitative approaches, informed by social work clinical wisdom. With the baby boom generation aging and medical technology advancing, social workers will encounter critical illness survivors in increasing numbers. Thus the results of this study will be useful to patients, their families and medical social workers. This study utilized the theoretical constructs of Self Psychology and Psychological Agency. In addition, this study explored possible developmental stages in later life. This exploratory study addressed: What happens when a patient who was expected to die, survives? How do patients understand their survival psychologically? How do unreal, hallucinatory experiences impact ICU patients? Do patients experience Post-traumatic Stress Disorder (PTSD) or Post-traumatic Growth (PTG)?




viii, 271 p. : col. ill. Dissertation (Ph.D.)--Smith College School for Social Work, 2013. Includes bibliographical references (p. 209-217)