Death across the lifespan: Age differences in death-related thoughts and anxiety

Death Anxiety in Patients With Advanced Cancer and Their Family Caregivers

CONTEXT

Death anxiety is associated with fears of suffering and uncertainty at the end of life. It is also relevant to patients' family caregivers, who can experience fears about the patients' death and dying.

OBJECTIVES

This study investigates the prevalence of death anxiety in advanced cancer patients and their family caregivers and its association with sociodemographic and medical characteristics.

METHODS

We recruited patients with UICC stage IV solid tumors from in- and outpatient oncology and palliative care settings. We administered the Death and Dying Distress Scale to assess clinically significant death anxiety. We analyzed its association with sociodemographic and medical characteristics using simultaneous multiple linear regression analyses.

RESULTS

Death anxiety was prevalent in 37% of patients (N = 481) and 75% of family caregivers (N = 140). Most frequent death anxiety concerns were "feeling distressed about the impact of one's own death on loved ones" (52% of patients) and "feeling distressed about running out of time with their loved one" (69% of family caregivers). Patients who experienced high death anxiety were more likely to be younger (standardized β = -0.1; P=0.005) and have known about their diagnosis for less time (standardized β = -0.1; P=0.046). Being female predicted higher death anxiety in patients (β = 0.12; P=0.041) and family caregivers (β = 0.32; P=0.002).

CONCLUSION

The results indicate that death anxiety is a common, clinically significant problem in patients with advanced cancer and their family caregivers, emphasizing the need for targeted psychological support.

Strategies of coping with existential concerns in educationally active older adults

OBJECTIVES

Old age is the stage of life when people are the most vulnerable to existential experience. These concerns intensify in late adulthood when individuals become increasingly prone to reflection and inclined to evaluate their lives. The study aimed to explore how older people who are active learners dealt with their existential concerns.

METHOD

The study was based on the qualitative approach and grounded theory. The data collection methods were narrative interviews and semi-structured interviews. Eighteen interviews were conducted. The narrators were students of Universities of the Third Age.

RESULTS

An in-depth analysis of the collected empirical material revealed three themes that helped us understand how study participants differentiated their ways of dealing with self-perception of aging, effectiveness, and performing developmental tasks. This also allowed us to distinguish three main strategies educationally active older adults used to cope with existential concerns: repression, escape, and engagement.

CONCLUSION

The study's results indicate that confrontation or avoidance of existential problems can be perceived as a factor contributing to developing an older person's identity in two different ways. On the one hand, the readiness to face existential concerns leads to maturity in old age, a high level of social adaptation, supporting others, and, at the same time, focusing on oneself while ignoring existential concerns, which may contribute to held age identities that are younger than actual age.

The Psychopathological Predictors and Effects of Death Anxiety

Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.

Delay of Gratification, Gender Role Attitudes, and Death Reflections Predict Death Anxiety

Previous work has established that gender, age, and self-control can predict Death Anxiety (DA), the distress that centers around thoughts of one's mortality. However, it has not been determined if DA is associated with Delay of Gratification (DG; a tendency to forgo immediate rewards to receive a more favorable outcome in the future), attitudes toward gender roles (as compared to gender identity itself), and Death Reflections (DR; positive goals that occur when contemplating death). To examine these relations, 131 adults (45% women; aged 23-67 years) completed questionnaires that assess these constructs. We found that greater DG, egalitarian gender role attitudes, and engagement with DR were all associated with reduced DA. Gender identity was not associated with any variable, including DA. Age correlated independently with DA, but not when included in the regression models. These results demonstrate that elements of self-regulation and prosocial attitudes may predict baseline DA.

Longevity as a Responsibility: Constructing Healthy Aging by Enacting within Contexts over the Entire Lifespan

Studying aging now requires going beyond the bio-psycho-social model and incorporating a broader multidisciplinary view capable of capturing the ultimate complexity of being human that is expressed as individuals age. Current demographic trends and the lengthening of life expectancies allow the observation of long-lived individuals in full health. These super-agers are no longer an exception. Indeed, individuals can have a good quality of life even over age 70 and living with chronic or neurodegenerative diseases. This change is driven in part by the cohort effect observed in people who are about to age today (e.g., better schooling, more advanced health conditions, and technologization) but more so by the gradual overcoming of ageist views. An aged person is no longer seen as a quitter but rather as one empowered to direct their own trajectory of potentially healthy longevity. According to this vision, this article proposes a situated lifespan perspective for the study of aging that integrates pedagogical models of developmental ecology with psychological theories of optimal experience to understand the individual motivational perspective on aging. At the same time, it does not disregard analyzing the daily and cultural contexts in which everyone situates and that guide aging trajectories. Nor does it forget that aging people are body-mind (embodied) organisms that, with contexts and through motivations, seize opportunities for action (affordances) to evolve in an optimal way during their lifespan. This theoretical reflection sheds new light on the aging process and on future trends in healthy longevity research.

Death anxiety and religiosity in a multicultural sample: a pilot study examining curvilinearity, age and gender in Singapore

This study investigated the association between multidimensional death anxiety and religiosity in multicultural Singapore by examining potential variations by age and gender. We also explored the possibility of a curvilinear effect, where highly religious or non-religious individuals report lower death anxiety than moderately religious people, forming an inverted U-curve pattern. Data were collected from 110 participants using questionnaires that assessed death anxiety and religiosity. Parametric and non-parametric tests were then conducted. The findings showed that women had significantly higher death anxiety and religiosity than men, and highly and moderately religious people had significantly higher death anxiety than non-religious people. People of all age groups had similar levels of death anxiety. These findings highlight the importance of developing targeted death anxiety interventions that integrate spiritual aspects in Singapore so that clinicians can provide culturally competent care.

Death Anxiety is Associated With Less Health Behavior for Individuals Low in Action Orientation

Research has shown that death anxiety relates to less health behavior. The present study proposes that action orientation moderates this association. That is, it is hypothesized that death anxiety and health behavior relate negatively only in individuals low in action orientation. German adults (N = 187; aged 19-86) provided self-reports on health behavior, action orientation, death anxiety, social desirability, and sociodemographics. Analyses yielded a significant moderation effect of action orientation on the link between death anxiety and health behavior over and above significant relationships of action orientation, social desirability, age, and gender, respectively, with health behavior. As hypothesized, a significantly negative association of death anxiety and health behavior was found only given low action orientation but not among high action orientation individuals. This suggests that self-regulation plays a decisive role in whether death anxiety and health behavior relate to each other.

Does time heal all wounds? An investigation of time, grief, and attitudes toward death

When experiencing the loss of a loved one, individuals adapt and change how they understand death, how they interpret the meaning of the loss, and how they remember the deceased. In the present study (N = 164), we investigated whether the time since the loss - recent or distant - was associated with individuals' bereavement, attitudes toward death, and their meaning of death. We found that individuals who experienced a recent loss reported more grief and more negative death attitudes compared to individuals who experienced a loss more than 5 years ago. Moreover, the bereavement appeared to completely mediate the time since the loss and the individuals' attitudes about death. The findings suggest that time-dependent adaptations after a loss shifts individuals' death attitudes, grief symptoms, and thoughts about death.

Influencing factors of nurses' short-term bereavement reactions after patient death

An online cross-sectional survey was performed among 181 nurses in mainland China who experienced their most recent patient death within the last month. Multivariate linear regressions were used following bivariate analysis to identify influencing factors for their short-term professional bereavement reactions. More intensive reactions were associated with the nurse's fewer experiences of patient death; the nurse's employment in the intensive care unit rather than the emergency, oncology, geriatrics, or internal medicine departments; and the patient experiencing more pain in the last few days. Higher reaction scores were also reported by nurses who lost the patient more than 1 week prior.

The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version

Objective

Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts.

Methods

The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death.

Results

Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death.

Conclusion

The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.

Social relations and exclusion among people facing death

In line with current policies and service developments related to palliative care, more people are dying at home. This situation has provoked discussions about the importance of non-medical issues related to death. The process of dying is often long, with many phases, and the social aspect is a major part of it. Our focus in this article is on dying as a social process. Social relationships are significant and play a meaningful role in enhancing the well-being of older adults approaching the end of life. Meaningful social relationships tend to change over time; however, and the process of dying may exacerbate such changes in and challenge these relationships. The aim of our study was to examine how social relationships are experienced and (re)constructed among older adults (70-83 years old) during the process of dying, in a Finnish context. We were interested in the nature and type of these relationships, and in the possible new forms of expression that may emerge during this process. Our empirical data were based on interviews with seven older adults who were close to death. The analysis revealed processes of exclusion from existing relations. At the same time, we observed new and unexpected relations being initiated, which sometimes became meaningful and supportive. The results highlighted the role of expectations and importance of analysing exclusion from a life-course perspective.

Not so terrifying after all? A set of failed replications of the mortality salience effects of Terror Management Theory

Terror Management Theory (TMT) postulates that humans, in response to awareness of their death, developed complex defenses to remove the salience and discomfort stemming from those thoughts. In a standard paradigm to test this theory, an individual is presented with a death-related prime (Mortality Salience; MS), such as writing the details of their own death, or something neutral, such as watching television. After a distractor task (for delay), participants complete the dependent variable, such as rating how much they like or agree with a pro- or anti-national essay and its author. Individuals in the MS condition typically exhibit greater worldview defense than control conditions by rating the pro-national essay more positively and the anti-national essay more negatively. We completed five separate studies across five unique samples with the goal of replicating and extending this well-established pattern to provide further understanding of the phenomena that underlie the effects of MS. However, despite using standard procedures, we were unable to replicate basic patterns of the dependent variable in the MS conditions. We also pooled all responses into two meta-analyses, one examining all dependent variables and one focusing on the anti-national essay; yet the effect sizes in these analyses did not significantly differ from zero. We discuss the methodological and theoretical implications of these (unintended) failures to replicate. It is not clear if these null findings were due to methodological limitations, restraints of online/crowd-sourced recruitment, or ever-evolving sociocultural factors.

Mediator role of presence of meaning and self-esteem in the relationship of social support and death anxiety

Introduction

Death anxiety has increased following the COVID-19 pandemic. Although terror management theory has suggested social support, presence of meaning and self-esteem functioned as death anxiety buffers, few existing works have explored the mechanism of how social support, presence of meaning, and self-esteem buffer death anxiety. To identify these mechanisms is the aim of this study.

Methods

Our cross-sectional study was conducted with 1167 people in China from 19 May 2020 to 1 June 2020 during the COVID-19 outbreak. The average age of participants was 26 years. Data were by questionnaire, including demographic information, the Templer's Death anxiety scale, the multidimensional scale of perceived social support, the presence of meaning scale, and the Rosenberg self-esteem scale.

Results

Results using structural equation modeling showed presence of meaning and self-esteem fully mediated the relationship between social support and death anxiety, respectively and sequentially. The proposed model showed good fit of indices: χ² = 243.384, df = 58, p < 0.001; CFI = 0.968, TLI = 0.954, RMSEA = 0.052, SRMR = 0.044.

Discussion

This study demonstrates significant mediator roles of presence of meaning and self-esteem in the relationship of social support and death anxiety. Multi-component interventions are needed to manage death anxiety by targeting increasing social support, presence of meaning and self-esteem and increasing presence of meaning and self-esteem when social support is diminished in the pandemic.

Nursing students' attitudes toward death and stigma toward individuals who attempt suicide

PURPOSE

This study was conducted to assess the stigmatizing attitudes of nursing students toward individuals who had made suicide attempts as well as these students' attitudes toward death.

DESIGN AND METHODS

The universe of this descriptive and cross-sectional study consisted of 650 students studying in the fall semester of the 2017-18 academic year. No sample selection was made and a total of 560 students who agreed to participate in the study were reached. The Stigma of Suicide Scale (SOSS) and the Death Attitude Profile-Revised (DAP-R) were used as data collection tools.

FINDINGS

We found that the students had a moderately positive attitude toward death and, in terms of the DAP-R, they exhibited more Neutral Acceptance and Approach Acceptance. It was determined that the stigma against suicide decreased when positive attitudes toward death increased.

PRACTICE IMPLICATIONS

To reduce stigmatizing attitudes toward suicide, it is important to ensure that students learn about both death and suicide earlier during their education, to design forms of training that aim to eliminate negative beliefs and attitudes toward suicide attempts and to ensure that this training is sustainable.

Cross-cultural validity of the Death Reflection Scale during the COVID-19 pandemic

Background

The global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale (DRS), a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life.

Materials and Methods

The Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, cross-sectional, online survey at a large university in Germany, students, healthcare professionals (HCP) and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations.

Results

1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales (CFI 0.945, SRMR 0.045, RMSEA 0.055). Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales (Spearman’s rho ranging from 0.31 to 0.52).

Conclusion

Further conceptual work for death awareness to explore the construct’s stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic.

Death Anxiety in the Iranian Elderly: A Systematic Review and Meta-Analysis Study

The present study aimed to estimate the standard score of death anxiety in the Iranian elderly. In this systematic review and meta-analysis, national and international databases were searched from inception to January 2022. All the observational studies published in Persian and English, which reported a death anxiety score based on the Templer death anxiety scale, were selected. The standard score of death anxiety in the elderly was 50% (95% CI: 45-56). No correlation was observed between the year of publication (p = .092) and sample size (p = .94) with the standard score of death anxiety in the elderly. With increased age, death anxiety scores declined. Publication bias was not significant (p = .340). Iranian seniors achieved half of the total score of death anxiety, which indicated the average level of death anxiety. Providing training to effectively manage death anxiety is essential to preventing the adverse consequences of extreme death anxiety.

Incidence of Death Anxiety in Palliative Care: A Systematic Review and Meta-Analysis

Objective: To explore the incidence of death anxiety in palliative care patients, find some existing and potential causes, and put forward suggestions. Methods: Publication bias, sensitivity analysis, subgroup analysis, and regression analysis were also conducted to explore the sources of the heterogeneity in our analysis. Results: The 607 studies were obtained, and 20 studies were included after reading the articles and quality evaluation. The incidence of death anxiety in patients was 0.44 (95%CI:0.38,0.51, p < 0.001). and heterogeneity was significant (I2 = 98.2%, p < 0.001). In the test of regression analysis, the average age (I2 = 98.15%, R2 = - 6.99%, p < 0.001); in gender (I2 = 97.84%, R2 = 1.14%, p < 0.001), its heterogeneity was also significant. Conclusion: The incidence of death anxiety is relatively high. More often occur in elderly female patients. This requires more attention to life itself rather than death.

[Attitudes and anxiety towards death in elderly people from 2different cultures: Spain and Egypt]

BACKGROUND AND OBJECTIVE

There are multiple variables that influence fear of death, as well as attitudes towards it, including age, religiosity, emotional and cultural aspects. Due to the proximity to death, the study of attitudes and death-related anxiety and the variables that influence it in the elderly population is of great relevance. The aim of the present study was to compare the levels of death anxiety, fear of death, attitudes towards death and associated emotional aspects (anxiety and depression) in older adults from 2different cultures, Western and Arab.

MATERIALS AND METHOD

A total of 91 people over 60 years old took part and were divided into 2groups, one of people born in Spain (n=46) and the other of people born in Egypt (n=45). In an individualised assessment, participants completed the DAS, PRAM and the anxiety and depression subscales of the SCL-90-R questionnaires.

RESULTS

Statistically significant differences between groups were observed in fear of death, acceptance and emotional aspects. Predictors of anxiety and fear of death were different for each group.

CONCLUSION

The results show the importance of taking into account cultural, religious and emotional aspects in the evaluation of fear and attitudes towards death in the elderly population.

General population-based study on preferences towards end-of-life care in Southern Thailand: a cross-sectional survey

Background

End-of-life care preferences are potentially due to individual choice and feature variation due to culture and beliefs. This study aims to examine end-of-life care preferences and any associated factors, among the general Thai population. This could inform physicians in regards to how to optimize the quality of life for patients that are near the end of their lives.

Methods

A cross-sectional study surveyed the general population in the Thai province of Songkhla; from January to April 2021. The questionnaires inquired about: 1) demographic information, 2) experiences with end-of-life care for their relatives, and 3) end-of-life care preferences. To determine end-of-life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test.

Results

The majority of the 1037 participants (67.6%) were female. The mean age among the adult and older adult groups were 40.9 ± 12.2, 70.0 ± 5.1, respectively. Half of them (48%) had an experience of observing someone die and 58% were satisfied with the care that their relatives had received. Most participants identified the following major end-of-life care preferences: having loved ones around (98.1%), being free from distressing symptoms (95.8%), receiving the full truth (95.0%), and having meaning in their lives (95.0%). There were no statistically significant differences in regards to end-of-life care preferences apart from being involved in treatment decisions, between adult and older adult groups.

Conclusion

There was only one difference between the end-of-life preferences of the adult group versus the older adult group in regards to the topic of patient involvement in treatment decisions. Furthermore, receiving the full truth regarding their illness, being free from distressing symptoms, having loved ones around, and living with a sense of meaning were important end-of-life care preferences for both groups. Therefore, these should be taken into account when developing strategies towards improving patient life quality during their end-of-life period.

High death anxiety and ambiguous loss: Lessons learned from teaching through the COVID-19 pandemic

For gerontological educators, topics such as mortality, loss, and end-of-life issues often emerge or are central in their courses. However, teaching in the era, and aftermath, of the COVID-19 pandemic has heightened the salience of death and loss, raising questions about best practices and teaching pedagogies to support student learning amidst a global crisis. This qualitative study utilized written narratives collected during the pandemic from students enrolled in an undergraduate thanatology course. Content analysis of written narratives (n = 44) revealed three themes that can help inform strategies to best support student learning during challenging times. Participants desired more flexibility; compassion and understanding; and more targeted resources and socioemotional support. Results have immediate implications for educators teaching during the pandemic and for years to come. We provide recommendations for teaching and learning support, as well as advocate for more university and community-based thanatology and gerontology education offerings.

Impact of the Coronavirus Disease Pandemic on Mental Health among Local Residents in Korea: a Cross Sectional Study

BACKGROUND

This study aimed to evaluate traumatic stress and mental health problems associated with the prolonged coronavirus disease pandemic and to determine the differences across different age groups.

METHODS

A total of 1,151 individuals who visited Gwangmyeong City Mental Health Welfare Center, South Korea, or accessed the website from September 1 to December 31, 2020, were included in the study. Mental health problems such as traumatic stress (Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorder-5); depression (Patient Health Questionnaire-9 and Children's Depression Inventory); anxiety (Generalized Anxiety Disorder-7 and Penn State Worry Questionnaire for Children); suicide risk (P4 Screener); and demographic information were evaluated. The participants were divided into three groups based on age group: children and adolescents, adults, and the elderly.

RESULTS

The results showed that 24.7%, 20.9%, 16.8%, and 20.5% of the participants were at high-risk for traumatic stress, depression, anxiety, and suicide, respectively. The difference in the proportion of high-risk groups by age of all participants was significant for traumatic stress, depression, anxiety, and suicide risk. In particular, the percentage of high-risk groups in all areas was the highest in the adult group. Also, in most areas, the ratio of the high-risk groups for children and adolescent group was the lowest, but the suicide risk-related ratio was not (adolescent group: 20.9%, adult group: 25%, elderly group 9.3%).

CONCLUSION

These results suggest that there is a need for continued interest in the mental health of the general population even after the initial period of coronavirus disease. Additionally, this study may be helpful when considering the resilience or risk factors of mental health in a prolonged disaster situation.

The perspectives of successful ageing among older adults aged 75+: a systematic review with a narrative synthesis of mixed studies

Older adults 75 and above are a fast-growing segment of the population. However, few studies have investigated what it means to age successfully from their perspective. This group of older adults face challenges that might characteristically differ from younger older adults. Therefore, the aim of this study was to conduct a systematic review of the perspectives of older adults aged 75 and above regarding what it means to age successfully and to summarise the findings through a narrative synthesis. We also aimed to provide a snapshot of inhibitors and facilitators to achieve successful ageing. A systematic review of the 75+ older adults’ perspectives was conducted across PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Qualitative, quantitative and mixed-methods original peer-reviewed studies were included. After reviewing 4,661 articles, 15 articles met the inclusion criteria and 15 themes were identified. They ranged from biomedical components such as physical functioning to psychosocial components such as relationships, reflections on life and past experiences, preparations for death and environmental factors. The findings revealed that as people age, their definition of successful ageing changes, expanding the current conceptualisation of successful ageing by including additional factors that can act as facilitators and/or inhibitors, such as death and environmental factors. The findings also highlight the need for further research on theory development by considering age-related differences and the perspectives of under-studied populations.

Who is really at risk? The contribution of death anxiety in suicide risk and loneliness among older adults during the COVID-19 pandemic

Isolation and quarantine imposed during the COVID-19 pandemic increased the age-related risk for depression and suicide. However, not all older adults endure the same distress levels. We aimed to identify those at higher risk of depression, perceived loneliness, and suicide, comparing self-reports of depression, loneliness, suicide risk, and death anxiety among 277 participants in three age groups recruited through social media. Older adults reported fewer depression symptoms and lower distress levels but greater suicide risk. Death anxiety was found predictive of depression and suicidality, offering an important criterion for assessing who is really at risk among the non-homogeneous group of older adults.

Factors associated with facilitating advance care planning based on the theory of planned behaviour

BACKGROUND

In Japan, educational support for advance care planning is still limited, and the factors facilitating advance care planning practice have not been identified. The aim of this study is to identify the factors associated with advance care planning practice in Japan using the theory of planned behaviour.

METHODS

We conducted a cross-sectional study through a nationwide online questionnaire survey with 446 Japanese residents aged 20 years and older. After categorizing participants into two groups based on who performed advance care planning, comparisons were made (univariate analysis) regarding attitudes towards advance care planning, willingness to perform advance care planning, subjective norms, sense of control in performing advance care planning, presence of and relationship with a family doctor, experience of seeing or using a ventilator, and degree of self-determination (Autonomy Preference Index) as well as sociodemographic data. In addition, a logistic regression analysis was performed using the factors with significant differences in the univariate analysis as independent variables and the existence of the implementation of advance care planning as a dependent variable.

RESULTS

The group with advance care planning consisted of 106 participants (23.8%), and the group without advance care planning comprised 340 participants (76.2%). Through logistic regression analysis, age (odds ratio: 1.020), subjective norms (odds ratio: 3.276) and experience with mechanical ventilation (odds ratio: 1.997) were extracted as significant factors influencing advance care planning implementation.

CONCLUSIONS

Advance care planning may be facilitated by providing support not only to the patients but also to their family members to be positively disposed towards advance care planning and by offering comprehensive education regarding using a ventilator.

The effectiveness of a brief intervention to increase the likelihood of advance care planning among college students

Advance care planning (ACP) is atypical in the United States, especially among young adults. We designed and evaluated the effectiveness of a brief intervention about the benefits of perceived control and planning for end-of-life. Participants (N = 188) were randomized into three conditions and completed a cross-sectional questionnaire. Participants who received the intervention were less likely to worry about not getting enough care and more likely to anticipate completing verbal and written ACP within three months than were comparison group participants. Findings suggest the potential of brief interventions to raise awareness about the benefits of ACP and enhance completion among young adults.

Who wants to live forever? Age cohort differences in attitudes toward life extension

INTRODUCTION

Biomedical technology holds the promise of extending human life spans; however, little research has explored attitudes toward life extension.

METHODS

This survey asked young adults (n = 593), younger-old adults (n = 272), and older-old adults (n = 46) whether they would take a hypothetical life extension treatment as well as the youngest and oldest age at which they would wish to live forever.

RESULTS

Age cohorts did not vary in their willingness to use life extension; however, in all three age cohorts, a plurality indicated that they would not use it. Men indicated a higher level of willingness to use the life extension treatment than women. Younger-old and older-old adults indicated that they would prefer to live permanently at an older age than younger adults.

DISCUSSION

If a life extension treatment were to become available that effectively stopped aging, young adults may be likely to use such a treatment to avoid reaching the ages at which older cohorts say they would prefer to live forever.

Emotional responses to mortality salience: Behavioral and ERPs evidence

Terror Management Theory (TMT) suggests that death-related thoughts activate proximal defense which allows people to suppress or rationalize death awareness. So far there is no direct evidence to support the emotional response in the proximal defense process. The current research aimed to address this issue by examining behavioral (e.g., accuracy and reaction time) and neural responses (e.g., P1 and N400 amplitude) related to emotional arousal following death-related thoughts during proximal defense. Before engaged in emotional words (e.g., anxiety, fear and neutral) judgment task, participants answered questions that referred to emotional and physical changes about death to induce mortality salience (MS). In the control condition, participants received similar instructions concerning the experience of watching TV. Behavioral results showed that longer reaction time of words was seen in control group than MS group. The ERPs results showed that after reminders of death-related thoughts, in condition of MS, fear words elicited larger P1 ERP amplitudes, while the control group did not have this effect, which might reflect that emotional words caused different early attention patterns between MS group and control group. Moreover, compared with control group, larger N400 ERP amplitudes were elicited in condition of MS, suggesting larger cognitive inhibition of words processing caused by emotional reaction. The above results indicate that the early stages after mortality salience will induce fear and anxiety, but soon these negative emotions are suppressed and are at a lower level of accessibility. This result provides electrophysiological evidence for the proximal defense hypothesis of terror management theory.

The intertwining of reconciliation and displacement: a lifeworld hermeneutic study of older adults' perceptions of the finality of life

PURPOSE

This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults.

METHOD

Participants were recruited from a major project on older adults' life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach.

RESULTS

The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir's existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice.

CONCLUSIONS

The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues.

Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward

BACKGROUND

Elderly people frequently express the wish to die: this ranges from a simple wish for a natural death to a more explicit request for death. The frequency of the wish to die and its associated factors have not been assessed in acute hospitalization settings. This study aimed to investigate the prevalence and determinants of the wish to die in elderly (≥65 years) patients hospitalized in an internal medicine ward.

METHODS

This cross-sectional study was conducted between 1 May, 2018, and 30 April, 2019, in an acute care internal medicine ward in a Swiss university hospital. Participants were a consecutive sample of 232 patients (44.8% women, 79.3 ± 8.1 years) with no cognitive impairment. Wish to die was assessed using the Schedule of Attitudes toward Hastened Death-senior and the Categories of Attitudes toward Death Occurrence scales.

RESULTS

Prevalence of the wish to die was 8.6% (95% confidence interval [CI]: 5.3-13.0). Bivariate analysis showed that patients expressing the wish to die were older (P = .014), had a lower quality of life (P < .001), and showed more depressive symptoms (P = .044). Multivariable analysis showed that increased age was positively (odds ratio [OR] for a 5-year increase: 1.43, 95% CI 0.99-2.04, P = .048) and quality of life negatively (OR: 0.54, 95% CI 0.39-0.75, P < 0.001) associated with the likelihood of wishing to die. Participants did not experience stress during the interview.

CONCLUSIONS

Prevalence of the wish to die among elderly patients admitted to an acute hospital setting is low, but highly relevant for clinical practice. Older age increases and better quality of life decreases the likelihood of wishing to die. Discussion of death appears to be well tolerated by patients.

What do teachers think of death education?

This study sets out to address a gap in research into teachers' attitudes and opinions toward death education. To meet this objective, two complementary instruments were designed and validated: the Death Education Attitudes Scale-Teachers (DEAS-T), which showed suitable psychometric values, and the Death Education Questionnaire-Teachers (DEQ-T). The sample comprised 683 teachers from a range of schools. The results show moderately positive attitudes toward death education. Variables such as gender, age, type of teacher, and religious beliefs all influenced results. The findings argue in favor of the inclusion of death in education and teacher training.

Health care utilization as a predictor of death anxiety in older adults

The relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N = 3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient-provider communication and alleviate patients' death anxiety. Future research should explore the directionality between study variables.

Social support serves emotion regulation function in death anxiety among people living with HIV/AIDS

Several studies have reported the independent roles of social support and emotion regulation in death anxiety. However, there is sparse literature on mediating role of emotion regulatory mechanisms in the link between social support and death anxiety. This study examined whether social support predicts multidimensional death anxiety as a function of emotion regulation strategies (cognitive reappraisal and expressive suppression) among people living with HIV/AIDS. Participants were 186 people living with HIV/AIDS (mean age = 34.16 years, standard deviation = 11.16; 56.5% women) drawn from the HIV/AIDS care unit of a tertiary health care institution in south-eastern Nigeria. Data were obtained by means of self-report measures of death anxiety, social support, and emotion regulation. A serial mediation analysis was conducted using Model 6 of the Hayes PROCESS macro for SPSS® which applies two mediators for each single analysis in a regression-based, path-analytical framework. The results showed that emotion regulation strategies, especially expressive suppression, was the indirect pathway through which social support from friends and significant others reduces death anxiety in aspects of death acceptance and death thoughts, but not for externally generated death anxiety and death finality. The mediation mechanism through family support was found for only death acceptance. Findings support existing mental health research and theories elucidating core social mechanisms of emotion regulation in relation to mental health and highlight the recognition of functional roles of multidimensional support in comprehensive case management services for helping people living with HIV/AIDS maintain their health. The study endorses improved social networks as part of the overall care for people living with HIV/AIDS.

Relationship Between Religious Orientation and Death Anxiety in Elderly Individuals

This study aims to identify the relationship between religious orientation and death anxiety in elderly individuals aged 65 and over. This study is cross sectional in nature. It was conducted with the participation of 250 individuals aged 65 and over who were registered in Family Health Centers in the city center located in the eastern part of Turkey between February and June, 2018. The participants' Religious Orientation Scale mean score was found to be 53.03 ± 9.91, and Religious Orientation Scale mean score was found to be significantly higher in married people, in graduates of high school, in those who had social security, and in those who lived with their spouse (p < 0.01). Death Anxiety Scale mean score was found to be 7.73 ± 2.28, and Death Anxiety Scale mean score was significantly higher in those who lived with their children (p < 0.05). No statistically significant relationship was found between Death Anxiety and Religious Orientation. Elderly individuals were found to have high religious orientation and death anxiety. It is recommended that the factors that increase death anxiety should be identified, interventions should be provided to decrease these factors, and elderly people should be provided with social services for their religious needs.

General thoughts of death and mortality: findings from the Komo-Ise cohort, Japan

AIMS

Death ideation (thinking about/wishing for one's own death, thinking that one would be better off dead) is linked to an increased mortality risk. However, comparatively little is known about more general thoughts of death (GTOD) where no wish to die or life value is expressed. This study examined whether GTOD predicted mortality in a community-based cohort of older adults.

METHODS

Data came from the Komo-Ise cohort study in Gunma prefecture, Japan. The analytic sample comprised 8208 individuals (average age 61.3 (range 47-77)) who were asked in wave 2 of the study in 2000 if they had 'Thought about death more than usual, either your own, someone else's or death in general?' in the past 2 weeks. Death data were obtained from the municipal resident registration file. Cox proportional hazards regression analysis was used to examine associations.

RESULTS

During the follow-up period (2000-2008), there were 672 deaths. In a model adjusted for baseline covariates, GTOD were significantly associated with all-cause mortality (hazards ratio 1.66, 95% confidence interval 1.20-2.29). Stratified analyses showed an association between GTOD and mortality in men, older subjects (⩾70 years), married individuals and those with higher social support.

CONCLUSIONS

GTOD are associated with an increased mortality risk among older citizens in Japan. Research is now needed to determine the factors underlying this association and assess the clinical relevance of screening for GTOD in older individuals.

End-of-life measures in Huntington disease: HDQLIFE Meaning and Purpose, Concern with Death and Dying, and End of Life Planning

BACKGROUND AND PURPOSE

Huntington disease (HD) is a progressive neurodegenerative disorder. There are no HD-specific measures to assess for end-of-life (EOL) preferences that have been validated for clinical use. The purpose of this study is to demonstrate reliability and validity of three HD-specific EOL measures for use in and clinical research settings.

METHODS

We examined internal reliability, test-retest reliability, floor and ceiling effects, convergent and discriminant validity, known groups' validity, measurement error, and change over time to systematically examine reliability and validity of the HDQLIFE EOL measures.

RESULTS

Internal consistency and test-retest reliability were > 0.70. The measures were generally free of floor and ceiling effects and measurement error was minimal. Convergent and discriminant validity were consistent with well-known constructs in the field. Hypotheses for known groups validity were partially supported (there were generally group differences for the EOL planning measures, but not for meaning and purpose or concern with death and dying). Measurement error was acceptable and there were minimal changes over time across the EOL measures.

CONCLUSIONS

Results support the clinical utility of the HDQLIFE EOL measures in persons with HD.

Cannabis Use and Anxiety Sensitivity in Relation to Physical Health and Functioning in post-9/11 Veterans

Frequency of cannabis use and cognitive vulnerabilities such as anxiety sensitivity (i.e., the fear of bodily sensations), have been independently linked with poor physical health, however the interplay between these health-mental health processes may compound poor physical health and functioning in cannabis users. Thus, the current study evaluated the direct and interactive effects of cannabis use frequency and anxiety sensitivity on physical health and functioning among cannabis-using veterans. Participants (N = 138) were post-9/11 United States veterans recruited from a Veterans Affairs hospital who reported cannabis use in the past six months. Cannabis use frequency in the past month and anxiety sensitivity were significantly negatively correlated with perceived overall physical health. There was a significant interaction between cannabis use frequency and anxiety sensitivity, such that more frequent cannabis use was associated with poorer overall health and role functioning due to health problems among veterans with higher anxiety sensitivity (but not lower). Findings suggest that anxiety sensitivity is a cognitive vulnerability linked to poor perceived physical health and impairment among frequent cannabis users and could be targeted, along with cannabis use, for health-promotion in cannabis users.

Subjective nearness to death and end-of-life anxieties: the moderating role of ageism

OBJECTIVES

Subjective nearness to death (SNtD), or individuals' subjective evaluation of how close they are to death, has been demonstrated to be an important predictor for different aspects of the individual's aging process across the life cycle. However, the relationship between SNtD and anxieties linked with the aging process has not been examined among individuals who may be in the initial stages of experiencing the first physical and cognitive signs of aging. Thus, this study examined the association between SNtD and aging, dying, and death anxieties. Moreover, the role of ageism, or negative attitudes toward older adults, as a moderator for these perceptions regarding the end of life has not been addressed. Moreover, we examined whether ageism serves as a moderator for the aforementioned association.

METHOD

A convenience sample of 1146 Israeli participants, ranging in age from 45 to 65, filled out scales assessing SNtD, aging anxiety, dying anxiety, death anxiety, and ageism.

RESULTS

High levels of SNtD were positively associated with aging, dying, and death anxieties. Moreover, there was a positive association between ageism and the three end-of-life anxieties. Significant interactions demonstrated the moderating effect of ageism for the relationship between SNtD and both aging and dying anxieties, but not for death anxiety.

CONCLUSION

SNtD is an important construct, which is connected to various perceptions and anxieties concerning the aging and dying processes. Moreover, while high ageism mitigates the positive association between SNtD and certain anxieties, the role of ageism is more complicated, and its negative aspects are discussed.

Concern and death anxiety during an ongoing terror wave: The moderating role of direct vs. indirect exposure

The current study examined whether emotional concern over one's security situation is connected with death anxiety during an ongoing terror wave, and whether type of exposure (media exposure vs. contact with witnesses) moderates this connection. A total of 345 individuals, aged 18-70, were sampled during an ongoing wave of terror in Israel and filled out scales measuring death anxiety, concern over security situation, and type of exposure. Results indicated that increased concern was connected with enhanced death anxiety. Moreover, this connection was more pronounced among individuals exposed to the events through the media, in comparison with individuals who had first-hand contact with witnesses.

Age Differences in Age Perceptions and Developmental Transitions

Is 50 considered “old”? When do we stop being considered “young”? If individuals could choose to be any age, what would it be? In a sample of 502,548 internet respondents ranging in age from 10 to 89, we examined age differences in aging perceptions (e.g., how old do you feel?) and estimates of the timing of developmental transitions (e.g., when does someone become an older adult?). We found that older adults reported older perceptions of aging (e.g., choosing to be older, feeling older, being perceived as older), but that these perceptions were increasingly younger than their current age. The age to which individuals hope to live dramatically increased after age 40. We also found that older adults placed the age at which developmental transitions occurred later in the life course. This latter effect was stronger for transitions involving middle-age and older adulthood compared to transitions involving young adulthood. The current study constitutes the largest study to date of age differences in age perceptions and developmental timing estimates and yielded novel insights into how the aging process may affect judgments about the self and others.

Social Relatedness and Physical Health Are More Strongly Related in Older Than Younger Adults: Findings from the Korean Adult Longitudinal Study

Previous research indicates that social relatedness is beneficial to physical health; however, findings on the relative strength of the relationship between these variables have been inconsistent. The present study employed cross-sectional survey (Study 1) and a daily diary survey (Study 2) to examine the link between social relatedness and physical health by age. Using a representative sample of Korean adults (N = 371) aged from 20 to 69, Study 1 examines the link between social relatedness (loneliness, perceived social support) and physical health (physical symptoms, chronic health conditions) using age as a moderator. The results show that participants' age moderates the association between social relatedness and physical health. Study 2 (N = 384) further corroborated the findings from Study 1 by showing that when controlling for the physical symptoms experienced prior to the daily diary reports, the level of loneliness experienced over a 13-day period exacerbates the age differences in the physical symptoms. The present study thus provides converging evidence that social relatedness plays a significant role in physical health, particularly in the older population.