Factors associated with attitudes toward death and dying in the second half of life: A scoping review

How we think and feel about death and dying affects how we live our lives and our opportunities for healthy aging. This scoping review, using the PRISMA guidelines and drawing on the World Health Organizations public health framework for healthy aging, examined the personal, health and environmental factors associated with attitudes toward death and dying in persons 50 years and older. Most of the 74 eligible studies focused only on negative attitudes to death and few studies investigated the comprehensive range of factors that influence attitudes to death and dying. In the context of population aging and the United Nations Decade of healthy aging (2021-2030) attention to death attitudes and the factors that influence them are imperative to enable current and future generations to age and die well.

From dread to disorder: A meta-analysis of the impact of death anxiety on mental illness symptoms

Growing research suggests that death anxiety may be transdiagnostic, playing a key role in the development and symptomology of psychopathology. This meta-analysis examined the relationship between death anxiety and mental illness symptoms. In total, 104 papers were included, representing cross-sectional data from 99 studies (ntotal = 24,434), and experimental data from 11 studies (ntotal = 1372). Meta-analyses of cross-sectional studies indicated a moderate correlation (r = 0.397) between death anxiety and overall mental illness symptoms. The clinical nature of the group emerged as a significant moderator of this effect. In addition, the relationship between death anxiety and mental illness symptoms was larger for clinical samples (r = 0.580), and for anxiety-related symptoms (r = 0.506) than for depression. Additional meta-analyses of 11 mortality salience studies revealed that death reminders had an overall moderate impact on clinical symptoms (Hedge's g = 0.481). The relevance of the sample to the symptom being measured significantly predicted this relationship; that is, the effect was moderate-to-large (Hedge's g = 0.671) when excluding comparison subgroups for which the effect was not predicted by the authors. The clinical nature of the sample did not significantly moderate the effect. The experimental studies were generally of higher quality and lower risk of publication bias compared to cross-sectional studies. These findings support the strong transdiagnostic role of death anxiety across numerous disorders. Clinical implications include the potential need to treat death anxiety directly, to maximise long-term therapy benefits.

Evaluation of a knowledge-attitude-practice model based narrative life education program for community-dwelling older adults: a mixed-methods feasibility study

BACKGROUND

The global aging population presents challenges that are particularly acute in China. Older Chinese adults' attitudes towards death significantly impact their quality of life. Death education is crucial for promoting positive perspectives on life and death. Narrative education offers a promising approach to facilitating death education. Integrating the Knowledge-Attitude-Practice (KAP) model into death education will enhance the feasibility and acceptability of death education programs.

METHODS

This mixed-methods feasibility study included a quasi-experimental trial and semi-structured interviews. Older adults in the intervention group (N = 27) received a 6-week KAP-based narrative life education program in addition to standard community health education; participants in the control group (N = 20) received only the normal community health education. In both groups, attitudes toward death and the meaning of life were assessed at baseline and immediately after the intervention. A post-intervention semi-structured interview and satisfaction survey were also conducted for the intervention group.

RESULTS

Forty out of 47 older adults completed the program for an 85.1% retention rate. All of the older adults in the experiment were very satisfied and satisfied with the life education program, and no adverse events were reported. Compared to the control group, participants in the intervention group had a significant decrease in the fear of death (P = 0.028), and substantial improvement in their value of life (P = 0.031), goal of life (P = 0.035), freedom of life (P = 0.003), and the total score for purpose in life (P = 0.017). The qualitative results yielded four themes: profound recognition of life and death, contradiction between thoughts and action, conflict between one's acceptance and others' avoidance, and evaluation of the life education program.

CONCLUSIONS

The KAP-based narrative life education program is feasible and acceptable for older Chinese community-dwelling adults. It is also potentially effective in improving attitudes toward death attitudes and the meaning of life in this cohort.

TRIAL REGISTRATION

This study was retrospectively registered at China Clinical Trial Registry as ChiCTR2300069551 on 2023-03-20. URL of registration: https://www.chictr.org.cn/showproj.html?proj=183176 .

Factors related to advance directives completion among cancer patients: a systematic review

INTRODUCTION

Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person's future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients.

METHODS

A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior.

RESULTS

Out of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients' age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: "Lack of knowledge of the ADs concept" and "Previous experience of the disease", the subjective norm category includes three subcategories: "Social support and interaction with family", "Respecting the patient's wishes" and "EOL care choices". Also, the category of perceived control behavior was categorized into two sub-categories: "Decision-making" and "Access to the healthcare system", as well as external factors affecting the model, including "socio-demographic characteristics".

CONCLUSION

The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.

Investigating the Relationship Between Spiritual Health, Meaning in Life, and Death Attitudes among COVID-19 Patients Discharged from ICUs: A Cross-Sectional Study in Iran

The COVID-19 pandemic has been shown to affect both physical and mental health. Because of this mental health burden, it is important to pay attention to issues such as the relationship between spiritual health, death attitudes and meaning in life - all issues made more prominent during the pandemic. This study was conducted to determine the correlation between these three factors - spiritual health, meaning in life, and death attitudes, among patients with COVID-19 discharged from the intensive care units of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran.This cross-sectional, descriptive-analytical study was conducted between April 2020 and August 2021 with 260 participants. The data collection instruments were a demographic characteristics questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, The Meaning in Life Questionnaire (MLQ), and Death Attitude Profile-Revised (DAP-R).The correlation between meaning in life, spiritual health, and death attitudes was determined by Spearman's correlation coefficient. The research results showed that there is an inverse and significant correlation between spiritual health and death attitudes (p = 0.01); an inverse, but insignificant correlation between existential health and subscales of death attitudes, except for the subscales of approach acceptance and neutral acceptance (p > 0.05); and an inverse, but insignificant, correlation between spiritual health and death attitudes, (p > 0.05). In addition, there was an inverse and significant correlation between the presence of meaning in life and escape acceptance (p = 0.002); an inverse and significant correlation between the search for meaning in life and neutral acceptance (p = 0.007); and an inverse and significant correlation between the meaning in life and death attitudes (p = 0.04). Besides, the findings showed an inverse but insignificant correlation between all spiritual health subscales and the meaning in life subscales (p > 0.05). Spiritual health has an inverse correlation with death attitudes.Also, there is an inverse correlation between the total score of spiritual health and death attitudes. Regarding the subscales of spiritual health, there is an inverse correlation between existential health and death attitudes subscales, except for approach acceptance and neutral acceptance. Also, the results showed an inverse and significant correlation between meaning in life and death acceptance and avoidance subscales, and there was an inverse and significant correlation between the meaning in life and death attitudes. Finally, the increase in spiritual health reduces patients' risks of thinking about death. The research results double the significance of the role of nurses, especially those dealing with critically ill patients and those who have experienced severe disease conditions.

The indirect effect of generativity on fear of death through ego-integrity holds when controlling for spirituality

In previous research on the indirect effect of generativity on fear of death through ego-integrity, intrinsic religiosity was controlled for. This paper tests the same indirect effect, but controls for spirituality instead of religiosity. German adults (N = 154) were administered self-report questionnaires on generativity, ego-integrity, fear of death, spirituality, and physical health. Spirituality correlated negatively with fear of death. A mediation analysis yielded the hypothesized indirect effect without spirituality significantly predicting fear of death. The present results indicate that the indirect effect of generativity on fear of death through ego-integrity holds when spirituality is considered beyond the religious domain.

Psychological support and demand for death education among Chinese college students during the COVID-19 pandemic: The mediating role of neutral death attitude

AIM

This study aimed to explore the mediating role of neutral death attitude between psychological support and demand for death education among college students during COVID-19.

DESIGN

A cross-sectional survey was conducted with 1800 college students selected by convenience and snowball sampling from 20 provinces and municipalities.

METHODS

A questionnaire survey (The Psychological Support Scale, Demand for Death Education Scale and Neutral Death Attitude Scale) was distributed to 1800 college students.

RESULTS

Psychological support had a significant positive predictive effect on demand for death education and neutral death attitude, with neutral death attitude partially regulating the demand for death education of college students after receiving psychological support.

Religious Afterlife Beliefs Decrease Behavioral Avoidance of Symbols of Mortality

An astonishing cultural phenomenon is where, far away from or close to a city center, people in different societies localize cemeteries that function as both sites of memory of lost ones and symbols of mortality. Yet a psychological account of such differences in behavioral responses to symbols of mortality is lacking. Across five studies (N = 1,590), we tested a psychological model that religious afterlife beliefs decrease behavioral avoidance of symbols of mortality (BASM) by developing and validating a word-position task for quantifying BASM. We showed evidence that religious believers, including Christians, Muslims, Hindus, and Buddhists, exhibited decreased BASM relative to nonbelievers. We also provide evidence for a causal relationship between religious afterlife beliefs and reduced BASM. Our findings provide new insight into the functional role of religious afterlife beliefs in modulating human avoidance behavior in response to symbols of mortality.

Nostalgia and Spirituality

Abstract. We investigated the relation between nostalgia and spirituality. We hypothesized that nostalgia is linked to greater spirituality through self-continuity and, in turn, meaning in life. In Study 1, we measured nostalgia and spirituality. Nostalgia predicted greater spirituality. In Study 2, we tested this relation in a nationally representative sample. Nostalgia again predicted greater spirituality, and this relation remained significant after controlling for key demographic variables and core personality traits. In Study 3, we manipulated nostalgia and measured self-continuity, meaning in life, and spirituality. Nostalgia predicted spirituality serially via self-continuity and meaning in life.

Death anxiety among older adults with chronic illnesses during Covid-19: A qualitative approach

In the current study, we have investigated death anxiety during the Covid-19 pandemic among older people with chronic illnesses with qualitative approach. Eighteen older people (10 female, 8 male) participated in the study. Phenomenological research design was used. A semi-structured interview technique was used with interviews conducted online to collect the data. To analyse the data, both thematic and content analysis were used. The following seven themes were examined: meaning of death before and during Covid-19; meaning of death during Covid-19; awareness of life; anxiety toward family members during Covid-19; effects of Covid-19 on daily life; future anxiety after Covid-19; and coping strategies for death anxiety. The participants were mostly afraid of losing their significant others rather than dying. During the pandemic, they have had fears about the manner of death associated with Covid-19. They were mostly hopeful for the future and spirituality was generally recommended.

Self-Management in Older Pakistanis Living With Multimorbidity in East London

In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of "managing" in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.

Uncertainty in Faith, Fear of Death? Transitions in Religious Doubt and Death Anxiety in Later Life

While religiosity is usually associated with lower death anxiety, holding doubts about one's faith are associated with higher death anxiety. Using longitudinal data from the Religion, Aging, and Health Study (2001-2004), this study examines within-individual changes in religious doubt and death anxiety. Results from lagged dependent variable models suggest that compared to older adults who did not experience any doubt about their faith, those holding consistently high doubt or increasing or decreasing doubt reported greater death anxiety. Lingering religious doubt was associated with higher death anxiety among weekly religious attenders. Taken together, our findings suggest that being more assured in one's faith and spiritual understanding may lead to a more peaceful experience when confronting thoughts about one's own mortality, especially for older adults holding a stronger religious identity. We situate our findings within the literature on the "dark side" of religion and well-being in later life.

Death attitudes among older Asian and Pacific Islander Americans: The role of religiosity, spirituality, and psychosocial health factors

With the growth of older minorities in the United States, more attention is needed on what the experience of dying means in this population. Previous research has overlooked older Asians and Pacific Islanders. This study examined death attitudes among 69 diverse nursing home residents in Hawai'i. Results from correlational and regression analyses showed religiosity and spirituality had significantly distinct impacts on death attitudes and psychosocial health. Ethnicity and religious/spiritual affiliation had significant effects on study outcomes, even between minority subgroups. These findings highlight the importance of exploring the differential impact of religious/spiritual and cultural factors on death attitudes among older minorities.

The relationship between physical health and fear of death in rural residents: The mediation effect of meaning in life and mental health

The current research used questionnaire data to examine the direct and indirect paths between physical health and fear of death. For 386 rural residents, physical health, meaning in life, and mental health were negatively related to fear of death. Physical health affected fear of death through three paths: one was the independent mediation of meaning in life, the other was the independent mediation of mental health, and the third was the serial mediation of meaning in life and mental health. To reduce the fear of death and improve the quality of life among rural residents, educational interventions of meaning in life and mental health are imperative.

In a Pandemic Are We More Religious? Traditional Practices of Catholics and the COVID-19 in Southwestern Colombia

The relationship between times of crisis (natural disasters, pandemics) and religious behaviour has been the subject of long debate. Theoretical models of religious coping propose that adversity caused by adverse and unexpected events instigates people to use religion more intensively. This research explores this hypothesis, comparing the effects of religious practices among people who declare themselves Catholics in the Department of Nariño, Colombia, during the coronavirus pandemic. I found that gender, the type of religious practices and the frequency of pre-pandemic participation are significant predictors of religious intensification. These findings, as well as the description of the ideas and reactions that the people of Nariño have about COVID-19, contribute to a more nuanced understanding of religious behaviours and the significant implications for the future of Catholicism in this region.

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.

Elderly People's Acceptance of Death: A Study of a Polish Cohort

Introduction: Old age is usually the natural time for people to prepare for death, which may evoke various emotions ranging from acceptance to hostility. Aim of the work: The study aimed at specifying various degrees to which elderly people accept death. Material and method: The study employed the diagnostic poll method and an Inventory of the Attitude towards Death (IAD) poll questionnaire. The investigation was administered in a cohort of 150 people over 65 years of age living in Poland. Results: The highest results were noted both for males and females on the “Value” scale (M = 4.94 and M = 4.96) and on the “Necessity” scale (M = 4.79 and M = 4.95). These two scales also had the highest values in the cohorts of city dwellers and country dwellers. A statistically significant difference (Z = 2.339, p = 0.019) was found in the “Necessity” dimension between investigated people with higher education and others. Furthermore, statistically significant differences were found in the following dimensions: “Mysteriousness”, “Value”, “Dread”, “Tragedy”, and “Absurdity”. Comparing death dimensions in people with chronic illnesses and in those without such illnesses, meaningful statistical differences were noted in the “Necessity” dimension (t = 1.983, p = 0.049). However, analysing death dimensions in people who suffered because of a severe illness in a family member and respondents whose families were healthy, statistically significant differences were noted in the “Absurdity” dimension (t = 2.057, p = 0.041). Conclusions: Sex, the place of residence, and death of a close person did not affect elderly people’s acceptance of death. On the other hand, those suffering from chronic diseases were more aware of the inevitability of death. People without higher education were also more aware of the inevitability of death. Suffering of a serious disease of a close one considerably affected acceptance of death in the elderly.

Wisdom as the mediator in the relationships between religious meaning system and attitude toward death among older adults

The objective of the present research was to investigate whether wisdom is a mediator in the association between the religious meaning system and the attitude toward death in the period of late adulthood. The study included 315 persons aged 60-75. Three measures were used: Religious Meaning System Scale (RMSS), Three-Dimensional Wisdom Scale (3D-WS), Death Attitude Profile-Revised (DAP-R). The analyses allowed for a partial verification of the hypothesis that wisdom is a mediator in the relationship between the explicit religious meaning system and the multidimensional attitude toward death in late adulthood. It was confirmed that the relationship of the religious meaning system with fear of death, death avoidance, neutral acceptance, escape acceptance and approach acceptance is mediated by at least one (cognitive, reflective and/or affective) of the dimensions considered in the study.

Thinking About the End of Life When It Is Near: A Comparison of German and Portuguese Centenarians

This study examined how common thinking of and planning for the end of life (EOL) is among German and Portuguese centenarians, and whether patterns of EOL views are shaped by cultural and individual characteristics. A significant portion of centenarians in both countries reported not thinking about the EOL, not believing in the afterlife, and not having made EOL arrangements. Latent class analysis identified three EOL patterns: Class 1 (EOL thoughts with EOL arrangements and afterlife beliefs), Class 2 (EOL arrangements and afterlife beliefs without EOL thoughts), and Class 3 (Overall low endorsement of EOL items). The proportion of Portuguese centenarians was higher in Class 1 and of German centenarians higher in Classes 2 and 3. Centenarians' demographic, social, and health characteristics were significantly different across EOL patterns. As lack of EOL planning can result in poor EOL quality, enhancing communication among centenarians, family, and health-care professionals seems imperative.

Attachment to God and Death Anxiety in Later Life: Does Race Matter?

Research suggests that religion plays a critical role in individuals' attitudes toward death in later life. The purpose of this study is to investigate whether a previously unexamined aspect of religion-secure attachment to God-is associated with death anxiety among U.S. older adults and whether this association varies across race. Using longitudinal data from a representative sample of adults aged 65 and older ( N = 936), the analyses reveal that secure attachment to God is associated with a decrease in death anxiety over time. Furthermore, the negative association between secure attachment to God and change in death anxiety is greater for older Blacks than their White counterparts. These results indicate that religion serves a protective function against death anxiety in later life. Moreover, religion provides greater psychological benefits for older Blacks than older Whites, reinforcing a long-standing claim that religion is particularly valuable for individuals from marginalized backgrounds.

Neural responses to one's own name under mortality threat

Recent behavioral research has shown evidence for greater inclination to avoid symbolic cues of mortality threats in nonbelievers than Christians. However, the neurocognitive mechanisms underlying religious influences on behavioral tendency to avoid mortality threats remain unknown. We tested the hypothesis of distinct arousal/attention-related brain responses to self-related information under mortality in nonbelievers and Christians. We recorded event-related brain potentials (ERPs) from Christians and nonbelievers while they viewed their own names and a stranger's name (i.e., Zuma) that flashed around a cue word (i.e., death, pain or life) located at the center of a screen. While own name vs. a stranger's name induced faster responses and larger P3 amplitudes, the P3 amplitudes to own name showed distinct patterns of modulations by the cue words in nonbelievers and Christians. Specifically, own name elicited larger P3 amplitudes in the death than pain/life cue conditions in nonbelievers but not in Christians. Moreover, the differential P3 amplitude to own names in the death vs. life cue conditions predicted greater inclination to avoid mortality threats in nonbelievers but not in Christians. Our findings provide a neurocognitive account of increased behavioral tendency to avoid mortality threats in nonbelievers than in Christians.

5-HTTLPR moderates the association between interdependence and brain responses to mortality threats

While behavioral research suggests an association between cultural worldview and decreased anxiety of death, the underlying neurobiological mechanisms remain unclear. Using functional MRI, we investigated whether and how the serotonin transporter promoter polymorphism (5-HTTLPR), which has been associated with mental disorders such as anxiety and depression, moderates the associations between a cultural trait (i.e., interdependence) and self-report of death anxiety/depression and between interdependence and brain responses to mortality threats. Long/long and short/short allele carriers of the 5-HTTLPR were scanned using fMRI while they performed a one-back task on death-related, death-unrelated negative, and neutral words. Participants' interdependence and death anxiety/depression were assessed using questionnaires after scanning. We found that participants who assessed themselves with greater interdependence reported lower death anxiety/depression and showed decreased neural response to death-related words in emotion-related brain regions including the anterior cingulate, putamen, and thalamus. However, these results were evident in long/long allele carriers of the 5-HTTLPR but not in short/short allele carriers who even showed positive associations between interdependence and neural activities in the anterior cingulate, putamen and thalamus in response to death-related words. Our findings suggest candidate mechanisms for explaining the complex relationship between genotype, cultural traits, and mental/neural responses to mortality threats. Hum Brain Mapp 38:6157-6171, 2017. © 2017 Wiley Periodicals, Inc.

Race and Gender Differences in Correlates of Death Anxiety Among Elderly in the United States

BACKGROUND

Death anxiety among elderly is a major public health concern. Few studies, however, have been conducted on factors associated with death anxiety.

OBJECTIVES

This study investigated race and gender differences in psychosocial correlates of death anxiety among elderly in the US.

MATERIALS AND METHODS

With a cross-sectional design, we used data of the Religion, Aging, and Health survey. 1,074 White and Black elderly (age > 65 years, 615 women, 359 men) were entered to this study. Demographic (age, gender, and race), socio-economic (family income, perceived financial difficulty), health (number of chronic medical conditions and self-rated health), and psychological (perceived control over life) factors were measured. Death anxiety was measured using four items. We used linear regressions to determine factors associated with death anxiety based on race and gender.

RESULTS

Although race and gender did not have main effects on death anxiety (P > 0.05), they altered correlates of death anxiety. Age was a predictor of death anxiety among women (B = 0.165, P = 0.002) but not men (B = 0.082, P = 0.196). Self-rated health was associated with death anxiety among Whites (B = - 0.120, P = 0.050) but not Blacks (B = - 0.077, P = 0.268). Total family income was only associated with death anxiety among White men.

CONCLUSIONS

Demographic, socio-economic, health, and psychological determinants of death anxiety in United States differ based on race, gender, and their intersection. Findings advocate that geriatric psychiatrists and gerontologists who wish to reduce death anxiety among elderly people may need to tailor their interventions to race and gender.

Are religiousness and death attitudes associated with the wish to die in older people?

BACKGROUND

A wish to die is common in older persons and is associated with increased mortality. Several risk factors have been identified, but the association between religiousness and a wish to die in older adults has been underexplored, and the association between death attitudes and the presence of a wish to die has not been investigated yet. The aim of this study is to explore the relationship between religiousness and death attitudes on the one hand and wish to die on the other hand, adjusting for clinical factors such as the presence of depression or somatic disorder.

METHODS

The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the Structured Clinical Interview for DSM-IV Disorders, and logistic regression analyses estimated the unique contribution of religiousness and death attitudes to the wish to die, controlling for socio-demographic variables, depressive disorder, and somatic symptoms.

RESULTS

Both religiousness and death attitudes were associated with a wish to die in univariate models. Adding these variables in a multivariate logistic hierarchical model, death attitudes remained significant predictors but religiousness did not; 55% of the pseudovariance of the wish to die was explained by these variables, with an effective size of 0.89. Major depressive episode, somatic symptoms, Fear of Death, and Escape Acceptance were the most important predictors of the wish to die.

CONCLUSIONS

This study suggests that how older adults perceive death partly determines whether they have a wish to die. There may be a clinical, patient-oriented benefit in discussing with older patients about how they perceive death, as this can play a role in the early detection (and prevention) of death or suicide ideation and associated behaviors in older adults.

Religion in the lives of older women serving life in prison

This exploratory qualitative study examined the roles of religiousness in the lives of 21 older women (mean age = 63) serving life sentences in one southern state. Based on survey and focus group methodology, several themes emerged as important focal points, including early religious experiences prior to incarceration, imprisonment and religious doubt, participation in formal and informal religious activities, and use of religion in coping with stressors such as interpersonal relationships, trauma, and health statuses. Irrespective of their religious upbringing, all participants agreed that religiosity/spirituality played a key role in their ability to cope with their prison experience as well as for maintaining hope and the opportunity for release.

Awareness and completion of advance directives in older Korean-American adults

There has been growing concern about racial and ethnic disparities in completion rates of advance directives (ADs) in community-dwelling older populations. Although differences in AD completion rates between non-Hispanic whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community-dwelling Korean-American older adults (n=675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, education), need (chronic conditions, functional disability), and enabling (health insurance, acculturation) variables were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who were more acculturated were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion in Korean-American older adults and provides recommendations for possible AD educational interventions for this older adult minority population.

The moderating effect of the negative impact of recent life events on the relation between intrinsic religiosity and death ideation in older adults

Researchers tested the hypothesis that the negative impact of recent life events would moderate the relationship between intrinsic religiosity and death ideation in older adults. Participants (n = 272) completed assessments of death ideation, intrinsic religiosity, and negative impact of recent life events. We confirmed the presence of concurrent moderation and found that older adults with greater negative impact of recent life events and high intrinsic religiosity reported greater death ideation. These relatively surprising findings may be due to reduced fear of death in intrinsically religious older adults, an explanation consistent with previous research.

Moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well-being among elderly Malays

BACKGROUND

Research has found that physical health decline in later life is associated with poor psychological well-being. This study aimed to examine the possible moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well-being.

METHODS

The sample for this study consisted of 1415 elderly Malay Muslims. It was obtained from a cross-sectional survey entitled 'Patterns of Social Relationship and Psychological Well-Being among Older Persons in Peninsular Malaysia', which conducted from 2007 to 2009, using a multistage stratified sampling procedure. Data collection was performed through face-to-face interviews. A four-step moderated hierarchical regression analysis using SPSS software for Windows and the 'ModGraph-2' software program was used to test the hypothesis.

RESULTS

Results of bivariate analysis showed, at certain levels of chronic medical conditions, older persons with a high level of religiosity reported significantly higher levels of psychological well-being compared to their counterparts with a low level of religiosity. Four-step moderated hierarchical regression analysis revealed that the negative effect of chronic medical conditions on psychological well-being is reduced by both personal and social religiosity (β = 0.07, P ≤ 0.01), after controlling for selected sociodemographic factors.

CONCLUSION

Taken together, these findings indicate that the depressogenic effect of physical illness is decreased by religiosity in chronically ill elderly people. The implications and limitations of the current study are discussed and recommendations for future research are proposed.

Afterlife Beliefs and Ego Integrity as Two Mediators of the Relationship Between Intrinsic Religiosity and Personal Death Anxiety Among Older Adult British Christians

The aim of this study was to investigate the efficacy of afterlife beliefs and ego integrity as two mediators of the negative relationship between intrinsic religiosity and personal death anxiety in later life. One hundred forty-three older adult British Christians responded to both initial and follow-up postal surveys containing questions on their religious and death attitudes. Structural equation modeling analysis showed that intrinsic religiosity predicted lower personal death anxiety via fostering more benign afterlife beliefs and ego integrity. This study demonstrated that intrinsic religiosity had a negative indirect effect on personal death anxiety through the joint agency of more benign afterlife beliefs and greater ego integrity. It also provided empirical evidence in support of the role of intrinsic religiosity in promoting psychosocial well-being in later life.

Religiosity and Death Attitudes and Engagement of Advance Care Planning Among Chronically Ill Older Adults

The aim of this study was to examine the association of religiosity and death attitudes with self-reported advance care planning (ACP) in chronically ill older adults. Survey data were collected in person for a sample of 157 chronically ill older adults drawn from primary care clinics in North Carolina. Logistic regression was used to examine associations of religiosity and death attitudes in the likelihood of engagement in three ACP outcomes: (a) ACP discussions with the doctor, (b) ACP discussions with family, and (c) the completion of a living will. Greater reported religiosity ( b = 1.67, p < .01) was significantly associated with reported ACP discussions with the doctor ( R2 = .29, model significance p < .01). Less fear of death was significantly associated ( b = −0.41, p < .01) with self-reported completion of a living will ( R2 = .21, model significance p < .01). Religiosity and fears of death should be considered in future ACP studies.