During a follow-up visit, a female patient is describing new onset of marital discord with her terminally ill spouse to the hospice nurse. Which Kübler-Ross stage of dying is the patient experiencing?

Choice A reason: Depression is strongly linked to insomnia in older adults, causing difficulty falling asleep due to rumination, low mood, or altered sleep architecture. Assessing for depression is critical, as it may underlie the sleep disturbance, requiring targeted interventions like therapy or antidepressants to improve sleep and mental health.

Choice B reason: Muscle fatigue may cause physical discomfort but is not a primary cause of difficulty falling asleep. It is more likely to affect sleep quality than initiation. Depression is a more common and significant contributor to insomnia in older adults, making this an incorrect choice.

Choice C reason: Hypertension can be associated with sleep apnea but is not directly linked to difficulty falling asleep. It may result from poor sleep but is less likely the cause. Depression is a more prevalent cause of insomnia, making this a less relevant condition to assess.

Choice D reason: Hypothyroidism can cause fatigue and sleepiness, not difficulty falling asleep. It is less commonly associated with insomnia compared to depression, which significantly disrupts sleep onset in older adults. This condition is less relevant to the patient’s presentation, making it incorrect.

Choice A reason: Non-Hispanic Blacks are projected to grow, but their growth rate is slower than Hispanics due to lower birth rates and immigration patterns. By 2060, they will remain a significant group, but demographic data indicate they will not outpace Hispanics, making this incorrect for the fastest-growing ethnic group.

Choice B reason: Multiracial individuals are increasing due to intermarriage, but their growth rate is lower than Hispanics. Projections show they will form a smaller population share by 2060 compared to Hispanics, driven by high birth rates and immigration. This choice is incorrect, as it underestimates Hispanic growth trends.

Choice C reason: Asians are a fast-growing group due to immigration, but their growth rate is surpassed by Hispanics, who benefit from both immigration and higher fertility rates. By 2060, Asians will increase significantly, but demographic forecasts confirm Hispanics as the fastest-growing group, making this choice incorrect.

Choice D reason: Hispanics are projected to be the fastest-growing racial/ethnic group by 2060, driven by high birth rates, immigration, and a younger population. Census projections estimate they will account for nearly 30% of the US population, surpassing other groups in growth rate due to demographic trends, making this the correct choice.