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

Death perceptions, grief, and distress in Ultra-Orthodox Jews who witnessed the 2021 Meron disaster

On April 29, 2021, during an Ultra-Orthodox annual communal event in Meron, a crowd rush resulted in the deaths of 45 individuals. Experiencing such events may intensify death proximity (subjective nearness to death, SNtD) and death anxiety, and increase distress. Furthermore, the experience of grief following the trauma may disrupt defense mechanisms that reduce death-related anxieties. Thus, we examined the mediating role of death anxiety on the association between SNtD and distress, and the possible moderating role of grief experiences on this model. Ultra-Orthodox Israeli Jews who experienced the Meron disaster (N = 168) responded to scales assessing demographics, SNtD, death anxiety, and psychological distress. Death anxiety mediated the SNtD-distress link and grief was a significant moderator. Specifically, for individuals low in grief, the association between high death anxiety and increased distress was nullified. Findings are discussed from the perspective of Terror Management Theory.

On the Measurement of Aging Anxiety: Comparative Validity of Two Popular Measures Among Older Adults

Aging anxiety is a distinct form of fear characterized by negative feelings associated with growing older. This study directly compared two common measures of aging anxiety within an older adult sample. Participants completed the Anxiety about Aging Scale, the Personal Anxiety Toward Aging Scale and several related constructs including ageism, expectations regarding aging, dementia worry, and death anxiety. The two measures significantly and strongly associated with one another. The Anxiety about Aging Scale (AAS) showed evidence of convergent validity through significant and strong correlations with ageism, expectations regarding aging, and death anxiety, and a moderate correlation with dementia worry. The Personal Anxiety Toward Aging Scale (PAAS) also showed evidence of convergent validity through strong correlations with expectations regarding aging and death anxiety, and moderate correlations with ageism and dementia worry. Factor analysis showed a better model fit for the AAS. Key findings lend support for the AAS as a psychometrically stronger measure than the PAAS for older adult assessment.

Ageist attitudes and psychological distress in older adults: The moderating role of reflective functioning

Ageist attitudes have been associated with various aspects of psychological functioning in older adults. According to Terror Management Theory, older adults may be seen as a reminder of human demise and death, and research has demonstrated links between ageist attitudes and compromised abilities to seek and maintain close personal relationships, which ward off awareness of one's mortality. Accordingly, the current work examined whether reflective functioning, or the ability to comprehend one's own and others' mental states, mitigates the negative psychological manifestations of ageist attitudes in older adults. Data was collected from 686 participants aged 60-94 (Mage = 72.64, SD = 6.28), who completed scales assessing ageist attitudes, reflective functioning, and psychological distress, as well as relevant socio-demographic information. Results indicated that ageist attitudes were linked with low levels of reflective functioning and enhanced psychological distress. Moreover, reflective functioning moderated the ageist attitudes-distress link, which was not significant in individuals reporting high levels of reflective functioning. This study provides insight into how the ability to comprehend others' mental states mitigates the adverse psychological effects of ageist attitudes and highlights the importance of examining relationship-enhancing personal factors within the context of negative ageing perceptions and psychological distress.

Subjective Nearness-to-Death and COVID-19 Worries Among Ultra-Orthodox Jews in Israel: The Moderating Role of Israeli Identity and Sense of Community

The Ultra-Orthodox community in Israel is characterized by close everyday contact and a strong sense of community. While the COVID-19 pandemic has resulted in global uncertainty, fear, and fatalities, this group was particularly affected by the pandemic. Accordingly, the current study examines whether subjective nearness-to-death was associated with increased COVID-19 concerns, and whether Israeli identity and sense of community moderate this association. Data were gathered from 255 Israeli Ultra-Orthodox Jews, and results yielded a significant link between subjective nearness-to-death and COVID-19 worries, moderated by both moderators. Results are discussed in line with terror management theory, and theoretical/practical implications are suggested.

Reclaiming hope: Subjective nearness to death as a moderator between posttraumatic stress symptoms and hope among older adults

Perceiving one's remaining time until death, can serve as a source of resilience when faced with adversity in the second half of life. The current work is based on a prospective study and examines whether subjective nearness-to-death (SNtD) moderates the association between posttraumatic-stress symptoms (PTSS) and hope among adults in the second half of life. The first wave was conducted after the end of a military conflict in the south of Israel, and included 170 participants (M = 66.61, SD = 9.16; age range 51-91), 115 of whom also participated in Wave 2. Participants filled out self-reported questionnaires regarding background information, PTSS, SNtD and hope. A moderation effect was found, revealing that high levels of PTSS predicted lower levels of hope among those who felt close to their death, but not among those who felt far from their death. We suggest that one's evaluation of little time remaining to live, especially in old age, may be a significant factor exacerbating the negative consequences of PTSS on hope. The importance of the results to the research field is discussed.

Nurses' Perception of Using Cognitive Behavior Therapy for Death Anxiety and Ageism

Despite the effectiveness of cognitive behavior therapy (CBT) in relieving death anxiety and ageism among nurses, there is not a complete consensus on its acceptability, adherence, credibility, and expectancy in the literature. Therefore, this descriptive-comparative study aimed to examine Jordanian nurses' perception of using CBT in relieving death anxiety and ageism. Most participants perceived CBT as a credible and adherable treatment for death anxiety and ageism. Significant differences were found in the CBT credibility and expectancy between nurses grouped according to levels of perceived treatment adherence and acceptability of CBT. The findings provide a promising avenue for adopting CBT to target death anxiety and its associated ageism among nurses and for improving CBT adherence, acceptability, credibility, and expectancy. A better understanding of participants' perception of CBT is crucial for optimal clinical practice.

Informal caregivers' negative affect: The interplay of caregivers' resilience, aging anxiety and burden

OBJECTIVES

This study focused on the negative affect of informal caregivers of older adults. In a novel investigation, the interplay of aging anxiety, caregiving burden, and resilience as a protective factor was examined, suggesting that aging anxiety and caregiving burden are mediators for the link between resilience and negative affect.

METHODS

In a cross-sectional design, 191 Israeli informal caregivers of older adults (65+) participated in the study. They completed questionnaires that assessed demographic and caregiving characteristics, resilience, aging anxiety, caregiving burden, and negative affect.

RESULTS

The findings showed a serial mediation process in which higher resilience predicted lower caregiving burden, which subsequently predicted lower aging anxiety, which subsequently predicted lower negative affect. However, the indirect path from resilience to aging anxiety and negative affect was non-significant.

CONCLUSION

Based on this study's findings, the aging anxiety of informal caregivers of older adults should be professionally addressed in the early stages of caregiving because it contributes to the caregiving burden and negative affect. Additionally, resilience should be enhanced by psycho-social interventions tailored to address informal caregiver challenges that often induce caregiving burden and negative affect.

"My life became more meaningful": confronting one's own end of life and its effects on well-being-a qualitative study

Background

The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress.

To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts.

Methods

Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach.

Results

While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted.

Conclusions

There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action.

Trial registration

www.germanctr.de, DRKS-ID: DRKS00020577.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00950-3.

COVID-19 and the Elderly's Mental Illness: The Role of Risk Perception, Social Isolation, Loneliness and Ageism

For almost two years, populations around the globe faced precariousness and uncertainty as a result of the COVID-19 pandemic. Older adults were highly affected by the virus, and the policies meant to protect them have often resulted in ageist stereotypes and discrimination. For example, the public discourse around older adults had a paternalistic tone framing all older adults as "vulnerable". This study aimed to measure the extent to which perceived age discrimination in the context of the COVID-19 pandemic, as well as the sense of loneliness and social isolation, fear and perception of COVID-19 risks, had a negative effect on older adults' mental illness. To do so, a self-report questionnaire was administered to 1301 participants (average age: 77.25 years old, SD = 5.46; 56.10% females, 43.90% males). Descriptive and correlational analyses were performed, along with structural equation modelling. Results showed that perceived age discrimination in the context of the COVID-19 pandemic positively predicts loneliness and also indirectly predicts mental illness. In addition, loneliness is the strongest predictor of mental illness together with fear of COVID-19 and social isolation. Such results highlight the importance of implementing public policies and discourses that are non-discriminating, and that favour the inclusion of older people.

Subjective Nearness-To-Death and Retirement Anxiety Among Older Workers: A Three-Way Interaction With Work Group Identification

Retirement anxiety represents a major challenge for older workers who hold negative expectations and concerns regarding the consequences of their future retirement. Although prior studies suggest that retirement is an age-related transition that may serve as a reminder that life is nearing its end, little is known about how subjective nearness-to-death is related to retirement anxiety, and the role of work group identification as a boundary condition. The current study draws on terror management and social identity theories to hypothesize and investigate these relationships. A three-way interaction model was tested on a sample of 327 Israeli older workers. We found a positive association between subjective nearness-to-death and retirement anxiety. Further, we demonstrated that the positive relationship between subjective nearness-to-death and retirement anxiety was more prominent for older workers whose work group self-definition and self-investment were both high or were both low. The theoretical and practical implications of these findings are discussed.

The subjective life course framework: Integrating life course sociology with gerontological perspectives on subjective aging

The expansion of life expectancy has precipitated a cultural transformation of the life course - altering the perceived temporal contours of middle and later life. However, our understanding of these perceptions is limited by the absence of a framework within which to examine them. This paper builds on the life course perspective - which emphasizes the objective patterning of lives - by focusing on the subjective side of the life course. Drawing on theoretically, methodologically, and substantively diverse studies, this paper develops the concept of the subjective life course - a term we use to denote individuals' perceptions of the life course, including its structure and timing and their advancing location in it. We outline two dimensions of the subjective life course - the target of the perception (i.e., generalized other versus self) and the temporal frame of reference (i.e., past, present, or future). Using the resulting framework as an organizational tool, we then discuss key constructs located at each intersection along these dimensions, providing examples, where possible, of empirical studies examining them. We close with a discussion of two broad directions for research: leveraging the framework to yield insight on the subjective life course and exploring links between objective and subjective dimensions of the life course.

Vaccination anxiety when vaccinations are available: The role of existential concerns

This study examined how existential fears are related to COVID-19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness-to-death (SNtD) and death anxiety, to COVID-19 vaccination anxiety during the first month of COVID-19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID-19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID-19 vaccination anxiety while controlling for demographics and for receiving COVID-19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID-19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID-19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID-19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID-19 vaccination anxiety more effectively.

Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer

OBJECTIVE

To explore ethical issues associated with older adults with cancer and the people who matter to them.

DATA SOURCES

A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics.

CONCLUSION

Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family.

IMPLICATIONS FOR NURSING PRACTICE

The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.

Subjective Age and Late-Life Functional Status: Mediating and Moderating Effects

OBJECTIVES

The present study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways.

METHODS

Older adults (average age 81.14 at T1) were interviewed once a year for three consecutive years (N=224 at T1, N=178 at T2, and N=164 at T3), Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status.

RESULTS

Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA-T2 depressive symptoms-T3 functional status was mostly significant among those who felt closer to death.

DISCUSSION

The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults' earlier subjective views of aging.

Qualities of social relationships as mediators of the relationship between future perceptions and health

OBJECTIVES

Foreshortened future perceptions relate to higher mental and physical morbidity. However, socioemotional selectivity theory (SST) maintains that psychological well-being improves as future perceptions narrow due to growing tendency to prioritize meaningful goals and close relationships. The objective of this study was to reconcile this contradiction by examining a model in which the focus on close relationships suppresses the direct relationship between narrow future perceptions and physical/mental morbidity.

METHOD

Community-dwelling older adults (N = 249, mean age = 75.60, SD = 7.54) recruited through social clubs and day centers were interviewed at home. They filled self-report questionnaires measuring future time perspective, subjective nearness to death, positivity of relationships with others and inclusion of others in the self, while rating several physical/mental health indices. A structural equation modeling analysis tested direct and indirect effects.

RESULTS

Narrow future perceptions related to higher mental (|β| ranged .28 to .47, p < .001) and physical morbidity (|β| ranged .37 to .45, p < .001) and, surprisingly, also to lower positivity of close relationships (|β| ranged .24 to .31, p < .01) and less inclusion of others (|β| ranged .17 to .21, p < .01). Both social indices mediated the relationship with lower physical health, while positivity of close relationships also mediated the relationship with psychological distress.

CONCLUSION

The findings challenge SST assumptions by underscoring the negative effects of narrow future perceptions on social relationship, making the latter a mediator rather than suppressor in the link between future perceptions and physical/mental morbidity. The findings should be viewed in light of the study's limitations, including convenience sampling and cross-sectional design.

Death Anxiety and Loneliness among Older Adults: Role of Parental Self-Efficacy

Death anxiety and loneliness are major issues for older people. The present study aimed to broaden the understanding of factors that are linked with increased loneliness in old age by examining the association between death anxiety and loneliness, and the role of an unexplored variable among older adults, namely, parental self-efficacy. A convenience sample of 362 Israeli parents over the age of 65 was recruited through means of social media. Participants completed self-reported questionnaires, which included background characteristics, death anxiety, parental self-efficacy, and loneliness measures. The findings showed that death anxiety was positively associated with loneliness among older adults. The findings also confirmed that parental self-efficacy moderated this association in this population. We concluded that the combination of death anxiety and low parental self-efficacy identified a group of older adults that are at higher risk of developing increased loneliness levels. Mental health professionals should consider intergenerational relationships as a fundamental component of older adults' daily lives, focusing on parental self-efficacy in old age, as this appears to be a resilience resource.

Aging anxiety, loneliness, and depressive symptoms among middle-aged adults: The moderating role of ageism

BACKGROUND

Aging anxiety, or fears and concerns regarding one's future aging, have been shown to take a toll on older adults' health and well-being, including loneliness and depressive symptoms. However, little is known about the possible consequences that aging anxiety holds for middle-aged adults. The current study examines the relationship between aging anxiety and both loneliness and depressive symptoms in a sample of middle-aged adults. It further examines whether ageism, or negative attitudes toward older adults, which have been associated with increased aging anxiety, loneliness, and depressive symptoms, moderates the connections between these variables. It was hypothesized that for those with higher ageist perceptions, the psychological toll of aging anxiety will be greater.

METHODS

A convenience sample of 1038 participants (age range = 50-67, M=58.16, SD=5.22) was collected using online questionnaires assessing aging anxiety, ageism, loneliness, and depressive symptoms.

RESULTS

Aging anxiety was positively associated with loneliness and depressive symptoms. Furthermore, ageism moderated these relationships, such that they were stronger for those with a higher level of ageism.

LIMITATIONS

A cross-sectional design; an internet survey consisting of a non-clinical, healthy cohort.

CONCLUSIONS

The results point to the clinical importance of addressing aging anxiety and negative attitudes in middle-aged adults with regard to loneliness and depression. The study provides clinicians with additional information regarding the formation and psychological consequences of aging anxiety with regard to how individuals perceive older adults and the aging process.

Do Informal Caregivers Expect to Die Earlier? A Longitudinal Study with a Population-Based Sample on Subjective Life Expectancy of Informal Caregivers

INTRODUCTION

Subjective life expectancy is a good predictor of health and could therefore be a relevant factor in the informal caregiving context. However, no research has been conducted on the perception of life expectancy by informal caregivers. This is the first study that examines the association between transitioning into, and out of, informal caregiving, and subjective life expectancy, and the relevance of employment status and gender for these associations.

METHODS

A longitudinal study was conducted with data from the German Ageing Survey (waves 2008, 2011, 2014, and 2017). Up to 20,774 observations pooled over all waves were included in the main models. In total, 1,219 transitions into and 1,198 transitions out of informal caregiving were observed. Fixed effects (FE) regression analysis was used. Moderator and stratified analyses were conducted with gender and employment status used as moderator variables and to stratify the sample. Sociodemographic information, health, and lifestyle factors were controlled for.

RESULTS

Results of adjusted FE regression analyses indicated a significant reduction of subjective life expectancy when transitioning into informal caregiving. No significant change was found when transitioning out of informal caregiving. Subjective life expectancy was significantly decreased when employed individuals transitioned into informal caregiving and significantly increased when they transitioned out of caregiving. Findings for women transitioning into informal caregiving indicated a significant decrease in subjective life expectancy, while no significant change was found among men.

CONCLUSION

The study's findings indicate that informal caregivers, female and employed caregivers in particular, perceive informal care provision as dangerous for their longevity and expect to die earlier when transitioning into informal caregiving. Thus, supportive interventions for informal caregivers, particularly employed and female informal caregivers, are recommended.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial

Background

Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses.

Methods

A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393).

Results

Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group.

Conclusions

CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Electronic supplementary material

The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.

Age is not just a number: age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms among older adults

Objectives: Humans often hold structured generalizations about themselves, which include attributes of qualities or characteristics they consider as important to their personal self-definitions. In this regard, holding one's age as an important defining personal category (high age awareness) was demonstrated to be connected with increased distress in older adults. However, little is known about the manner by which this connection is affected by individuals' perceptions regarding how close they are to their death on the one hand, and their personal resources on the other hand. Accordingly, the current research examined whether the connection between age awareness and depressive symptoms is mediated by subjective nearness-to-death, and whether this mediation is moderated by self-esteem.Method: A convenience sample of 386 older adults was collected using an online panel survey (age range 60-97, M = 71.62, SD = 6.88). Participants were requested to fill out scales assessing age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms, as well as various sociodemographic scales.Results: Age awareness was associated with increased subjective nearness-to-death and depressive symptoms. In line with the hypotheses, subjective nearness-to-death mediated the age awareness-depressive symptoms connection, and this mediation was moderated by self-esteem.Conclusion: Age awareness is an important concept in old age, and is connected with increased depressive symptoms. We discuss this issue in line with Terror Management Theory, and emphasize the relevance of personal resources, such as feeling far from death and holding a positive view of oneself, in this regard.

Subjective nearness-to-Death, filial obligations, and depressive symptoms: the case of Jews and Arabs in Israel

Objectives: Research has examined the link between subjective perceptions of life and death and psychological well-being. However, while cultural values were shown to provide a defense against death-related thoughts, little is known about specific cultural expectations with regard to this issue. Accordingly, the current study focused on two sub-cultures within the Israeli society, and examined whether filial obligations moderate the connection between subjective nearness-to-death and depressive symptoms. Moreover, the study also examined whether this moderating effect is culture-dependent, by examining differences between Jewish and Arab citizens of Israel.Method: Data were collected from 337 participants, two-thirds of which were Jewish. Age ranged from 45 to 65 (M = 52.32, SD =4.49). All participants filled out scales examining subjective nearness-to-death, filial piety, and depressive symptoms.Results: Filial piety did not moderate the connection between subjective nearness-to-death and depressive symptoms for the entire cohort. However, a significant three-way interaction of cultural group × filial piety × subjective nearness-to-death was found, and further analyses demonstrated that filial piety served as a significant moderator among Jews, but not among Arabs.Conclusions: This study highlights the importance of examining subjective perceptions of mortality in a cultural context, as culture was shown to affect how such perceptions are connected with depressive symptoms. These effects are discussed from the framework of terror management theory within the context of the Israeli society, and future directions are suggested.

Retirement anxiety and depressive symptoms among middle-aged adults: An indirect effect through death anxiety

Basing our argument on Terror Management Theory, we posit that retirement is an age-related transition, which could result in greater death saliency and anxiety, leading to increased depressive symptoms. An indirect-effect model was tested on a convenience sample of 574 Israeli Jewish older workers (mean age = 57), finding that the link between retirement anxiety and depressive symptoms is mediated through death anxiety. Anxious anticipation of retirement could imply that the individual perceives it as an "end," resulting in greater death saliency and death anxiety, which are related to poorer mental health. Theoretical and practical implications are discussed.

"I´m the one who has written this": reciprocity in writing courses for older adults in Norway

Purpose: The aim of this article is to explore, theoretically and empirically, the reciprocity of care afforded by writing courses as community interventions for older adults.

Methods: We narratively analyzed 209 excerpts of the anthology “I´m the one who has written this” written by teachers and participants of courses organized by the Church City Mission in Norway.

Results: The reciprocity that appeared in the writing courses is grounded in the sense of vulnerability that both teachers and participants embraced, and that is experienced in three main relational movements that these writing courses convey: self-exploration, otherness and togetherness. In addition, the data suggests that these courses promote affective processing and existential meaning-making, motivation, as well as improvements of memory and attention. However, more research is needed to confirm these preliminary findings, and their possible effects in older adults with and without symptoms of dementia.

Conclusion: Even though these writing courses for older adults are not explicitly therapeutic, they can have therapeutic effects, given the reciprocity afforded in these cultural community interventions. A theoretical exploration upon reciprocity in eldercare is hereby provided. These findings could shape improvements in aging and health care policies that are person-centered and focus on reciprocity.

The Utility of a Positive Body Image Among Community-Dwelling Older Adults Who Perceive Death to Be Near and Fear It

Physical changes are an inevitable part of the aging process. However, research has demonstrated inconclusive findings with regard to body image among older adults. This study attempts to clarify the utility of body image among this age-group, by adopting the framework of terror management theory. It is suggested that a positive body image may moderate the connection between two types of death concerns and psychological distress: subjective nearness-to-death and death anxiety. A convenience sample of 386 community-dwelling older adults, aged 60-97, filled scales measuring subjective nearness-to-death, positive body image, psychological distress, and death anxiety. A significant negative association was found between a positive body image and distress. Moreover, positive body image moderated the connection between distress and both subjective nearness-to-death and death anxiety. Thus, holding a positive image of the body seems to be an important resource for older adults when death is perceived to be near.

Subjective nearness-to-death and negative attitudes toward persons with disability: Attachment patterns moderate

We examined whether subjective nearness-to-death is associated with negative attitudes toward people with disabilities, and whether attachment patterns moderate this connection. A total of 462 Israeli adults, average age 57 years, completed scales measuring subjective nearness-to-death, negative attitudes toward people with disability, and attachment patterns. High levels of subjective nearness-to-death were associated with negative attitudes toward people with disability, and attachment patterns were significant moderators. Findings point to the theoretical importance of both perceptions of death and personal resources for coping with subjective nearness-to-death in relation to attitudes toward individuals with disabilities.

Future time perspective, loneliness, and depressive symptoms among middle-aged adults: A mediation model

BACKGROUND

Recent studies have demonstrated the relevance of subjective time perceptions with regard to depressive symptoms among aging and older adults. Moreover, loneliness was found to bear a strong connection to such symptoms. However, little is known about the connection between the three constructs. Accordingly, the current research examines whether the connection between future time perspective and depressive symptoms is mediated by loneliness.

METHODS

Data was collected from 1021 participants aged 50-67 (mean age = 57.89), who completed the Future Time Perspective Scale, a scale measuring loneliness, and the Center for Epidemiological Studies Depression Scale (CES-D), and provided relevant socio-demographic information.

RESULTS

Future time perspective was negatively linked with both loneliness and depressive symptoms. Moreover, loneliness was a significant mediator for the connection between future time perspective and depressive symptoms.

LIMITATIONS

The study focused on a specific age range, and employed a cross-sectional design.

CONCLUSIONS

This study provides a view into the manner by which subjective perceptions of time are linked with depressive symptoms during the aging process, and highlights the clinical importance of such perceptions to depressive symptoms.

Palliative Sedation for the Terminally Ill Patient

Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with. Active consensus from the patient and advanced care planning is recommended for PS. The decision-making process concerning the continuation or withdrawal of other treatments is not the same as that used for PS. The practice differs totally from euthanasia in its intentions, procedures, and results. The most widely used drugs are midazolam and haloperidol for refractory delirium, but chlorpromazine and other neuroleptics are also effective. In conclusion, some patients experience refractory symptoms during the last hours or days of life and PS is a medical intervention aimed at managing this unbearable suffering. It does not have a detrimental effect on survival.