Spirituality, Satisfaction with life and Death Anxiety among elderly people

INTRODUCTION

The purpose of this study is to explore the perceptions of elderly people surrounding

the topics of spirituality, life satisfaction and death anxiety. Thanatology (the study of

death and dying) is a multidisciplinary field, which over the last forty years has been a

field of inquiry that has had an increase in popularity.Contributions to the field come

from, but are not limited to professionals in philosophy, sociology, medicine, nursing,

psychology, anthropology, law, education, and theology (Neimeyer and Van Brunt,

1995). Likewise, the subject of spirituality has had an emergence of popularity as a

topic of importance. There is a wealth of literature relating to spirituality and spiritual

care. Carroll (2001) reports that “The need to understand the nature of spirituality and

to provide spiritual care has been widely acknowledged throughout the medical,

sociological, psychological, philosophical and theological literature””. Interestingly,

the rise in literature of these two topics occurs while “United States citizens have

sought increased control over their experience of dying”” (Silveira, DiPiero, Gerrity,

& Feudtner, 2000). Although satisfaction with current life circumstances is often

assessed in research studies, Diener, Suh, Lucas, & Smith (1999) also include the

following under life satisfaction: desire to change one’s life; satisfaction with past;

satisfaction with future; and significant other’s views of one’s life." (Beutell).

Subjective life satisfaction is a measure of an individual's perceived level of well-being

and happiness. It is frequently assessed in surveys, by asking individuals how satisfied

they are with their own lives. It is sometimes used as a synonym for subjective

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happiness and subjective well-being, however questions tapping life satisfaction and

happiness are slightly different, and well-being can be seen as a broader term.

Since the creation of mankind, death has been an inevitable reality and the last stage of

man’s life. Attitudes toward death are not completely positive or negative;rather, they

are on a continuum. At one end of the continuum is the perception of death as

humanity’s mortal enemy, while on the other end of the continuum, death is accepting

and even welcoming as a passage to a more blissful state (Aiken, 2001). Death also has

a subjective meaning that differs from person to person. Every individual has his or her

own interpretations of objects and events related to death. If these interpretations have

negative results, then the person suffers from high death anxiety. This sort of concept

of death depending upon death fears fits into the larger theoretical model of death

anxiety postulated by Tomer and Eliason (2000). Many dying patients feel seriously

depressed before their deaths, and a large number have suicidal feelings (Dacey &

Travis, 2004).Among the reasons for these depressions are the following:

 Medication-induced mood alterations.

 Awareness of how little time is left.

 Feelings of isolation from relatives and friends who are withdrawing.

 Feelings of grief for the losses that are close at hand.

 Feelings of disillusion and resentment over injustice.

Types of Death

Four commonly recognized and accepted types of death are: clinical death, brain death,

biological death, and social death.

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Clinical Death

This type of death refers to the cessation of respiration and the heart beat of an individual as the

evidence of death. However, there are many cases when patients’ ceased heart beat and breathing

has restarted as well as when many individuals whose lungs and heart had ceased to function

have been saved, due to the presence of cardiopulmonary resuscitation (CPR).

Brain Death

When the brain dose not acquires a minimum level of oxygen required for a specific period of

time, brain ceases its life. In this case, first the cortex stops, then the midbrain fails, and finally

the brain stem ceases to function. When the cortex and the midbrain stop operating, brain death

has occurred, and the person enters an irreversible coma. The body can remain alive in this

condition for a long time, because the autonomic processes are governed by the brain stem.

Consciousness and alertness, however, will never be regained (Brindle & Salancik, 1999).

Biological Death

The cells and the organs of the body can remain in a functioning condition long after the failure

of the heart and lungs. Since heart and lungs are involved in this type of death, cessation of their

functioning causes biological death (Dacey & Travers, 2004).

Social Death

When a person dies in the eyes of all his or her fellow human beings, he experiences social

death. Other people engage in behaviors that are carried out when a person is dead, even though

that person is biologically alive (Kastenbaum, 1995).

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The presence of many different types of death has made it quite difficult to propose a single

standard definition of death. However, different practitioners throughout the world have tried to

present a legal definition of death, of which the Harvard Criteria is a very standard one. The

legal definition of death involves a condition, in which the person cannot sense anything

including any sort of pain, cannot even breathe, all his or her senses and movements are ceased

and the electroencephalogram does not show any reading at all ( Aiken, 2001).

Stage Theory of Death

The Stage Theory of death is a very important and well known theory that represents different

stages involved in the process of dying.Elizabeth Kubler-Ross in 1969 gave this theory (Dacey,

& Travers, 2004). She has given five stages that operate in the dying process and according to

her these stages began working right after the awareness of any terminal illness and are steps to

cope with the harsh miseries associated with death. Five stages of this theory are;

1. Denial is basically a state of shock after learning about having a fatal disease.

2. Anger follows denial and the patient becomes irritated in this stage and starts thinking in a

negative way that “Why me?” Mostly the feelings of jealousy towards healthy people also occur

in this stage. Cursing, reproaching, shouting, showing aggression, and resentment are also

common. These all emotions help the individual to go through this phase of anger successfully.

The patient seems to have reached the ego integrity described by Erikson (1963): “acceptance of

one’s one and only life cycle as something that had to be”.

3. Bargaining is a middle stage in which the dying person tries to bargain with his fate. This

bargaining may proceed between the patient and family, friends, and with God. Bargaining with

God through prayers or exchanges with a religious representative is common (Freiberg, 1992).

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4. Depression occurs as the patient gradually becomes aware of his not getting better. Fear of

death is the strongest at this stage of dying and the patient’s feelings are totally lost.

5. Acceptance is the last stage when the dying person finally accepts his upcoming death and

ends his struggles.The patient seems to have reached the ego integrity described by Erikson

(1963): “acceptance of one’s one and only life cycle as something that had to be and permitted

of no substitutions”. The fear of death is removed (Freiberg, 1992). There are many individual

differences in passing through these stages and coping with the problems of each of these stages.

Another important theory about the dying process is that of Saunders (1989). Her theory’s main

stages are shock, awareness of loss, withdrawal, healing, and renewal.

Death anxiety

Different definitions of anxiety have been given by different psychologists in different ways.

According to Macmillan’s Dictionary (1973) New York, “Anxiety is feeling of fearful

uneasiness or apprehension as over some in pending or anticipated event; worry”.

The concept of death anxiety can be defined as” a negative arousing response motivated by the

hope of a state in which the self does not survive”(Tomer, 2000).

Death Anxiety Model

The death anxiety model (Tomer, 2000) gives three points that tell us about death anxiety and

that are as follows: Past-related regret, future-related regret, and meaningfulness of death. The

past-related regrets are defined as the feelings of dissatisfaction due to the unfulfillment of

indispensable needs. Future-related lament is the supposed incapability of achieving the futuristic

aims. Meaningfulness of death can be regarded as the person’s concepts about death. All these

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things work together to enhance to decrease the death anxiety that each of us experiences.

According to the death anxiety model, one will suffer from higher death anxiety when both the

regrets are felt and life is considered meaningless. If one believes that this world is a just place

and whatever we shall do here, we shall be asked about it after death, and then death becomes a

meaningful phenomenon for that person (Tomer, 2000).

Psychological Theories about Death Anxiety

Different psychological theorists have also given their full attempts in order to define death

anxiety, some of which are as follows:

Self-Realization Theories:

The word self-realization brings two very prominent names in mind, Maslow and Rogers. Both

emphasized on the realization of inborn potentials that every individual have. The self

actualizing person given by Maslow (1970) is the one who fears lesser about being dead and has

high realization of his being. In the view of Roger (1959), every person has a need for positive

regard and that comes in relation to his own self experiences and leads to conditions of worth.

After that, the person begins to avoid the experiences that do not fit into his state of worth. This

can occur either by distorted perceptions of experiences or by completes denial of the

experiences. A fully functioning person, according to Rogers, has a balance between the self

experiences and self regard and he has no need for a state of worth. The concept of death anxiety

can be understood under the light of this fully functioning individual’s concept of Rogers. But at

the same time, Rogers’ concept of a perfect individual changes the notion of death. According to

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Rogers (1980), death may be a fascinating incident for a person having balance amid self

experiences and self regard.

Erickson’s Psychosocial Theory:

In relation to the concept of fear of being dead, the most important stage of this theory (Erikson,

1982) is the final step that compares honor with hopelessness. During this stage if a person views

his whole past life as a significant life, he can easily resolve the crisis of this stage. Opposite to

that, if the whole life is seen as a waste, then the crisis cannot be solved and the person

experiences a greater fright of death. A healthy solution for the conflict in this phase will be

associated with a minor fright of demise (Neimeyer, 1994).

Personal Construct Theory:

In accordance with this theory (Kelly, 1955) in order to predict events having same themes,

people construct events themselves. These constructs form a hierarchy leading to the production

of a belief system that people follow strictly. Some of these concepts are present at a lower rank

and these can easily be mold without changing the whole system while some of them are very

rigid and to be changed, they require the whole system to be revised. Kelly uses death as a model

for risk, which is the attentiveness about forthcoming alteration in one’s basic concepts

(Neimeyer, 1994). The Threat Index (TI) has been made on the basis of this theory (Krieger &

Epting, 1974).

Search-for-Meaning Theories:

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These theories emphasize that by looking for meaning in one’s relation with one’s past can allow

one to re-establish a sense of reason in life. In the context of death anxiety, these theories

suggests that first of all the perception of death should be changed i.e. it should not be seen as an

evil, rather a considerable event that gives meaning to life. The theory also says that a complete

self was certainly associated with low fright of fatality (Westman & Canter, 1985).

The Two-Factor Model of Death Anxiety

This model (Gilliland & Templer, 1985-86) shows that there are two factors for the

determination of death anxiety. The first factor is concerned largely with mental fitness as

depicted by death unease while the second factor revolves around experiences about the topic of

death i.e. the clear cut fear of death.

Terror Management Theory

Terror management theory given by Rosenblatt, Greenberg, Solomon, Pyszczynski, and Lyon

(1989) says that different cultural systems support the concepts of individuals about the world

via identification with these systems, but this is valuable only when people live their lives in

accordance with their own specific cultural systems. All these theories about death and death

anxiety have many overlaps among them. Resultantly, more than one of these theories can be

used to give the same hypotheses.

Factors Affecting Death Anxiety

Death anxiety and Age

One variable that is associated to the fear of dying of a human being is age. Nevertheless, the

relationship amid views about dying and age is not completely understandable (Tomer &

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Eliason, 1996). A very common view about death anxiety is that an increase in age leads to

greater fear of death because the distance between us and death becomes short. However,

different researches have proved this idea wrong. A research conducted by Gesser, Wong, and

Reker (1988) on 50 individuals belonging to three age units: the adolescent (18-26), the adult

(35-50), and the old (60 and elder) showed that even though demise concern was elevated in

adolescents, but it was elevated in adults also and lesser in the old people. A current combination

of results of different studies about fear of dying in the old people proves that death anxiety

becomes stable through the last years of existence (Fortner & Neimeyer, 1999).

Approaches of the Elderly to Death

A common view about old people is that they always have some degree of preparation to face

their own death as they have witnessed a large number of deaths and funerals throughout their

entire lives. Butler (1975) pointed out that many older people show a perseveration in

reminiscing about their lives. Moreover, as they do not have careers to pursue or families to rise,

therefore they have generally less death anxiety (Freiberg, 1992).

Literature Review

Death anxiety has been a topic of interest for researchers since a long time. A lot of

researches have been carried out on different aspects of death anxiety. Different factors

affecting death anxiety like spirituality and life satisfaction have also been studied by

researchers both in same cultures and among different cultures.

Ghufran, and Ansari (2008) studied the effect of being a widow or a widower on religiosity and

fear of death in old age. 120 old people, with age ranging from 60 to 75 years. Bhushan’s

religiosity scale and Thakur’s death anxiety scale were used. It was found that religiosity was

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same for the subjects whose spouses were dead and subjects whose spouses were alive. however,

on the other hand, participants with their spouses dead showed greater death anxiety as compared

to those whose spouses were alive. Widows suffered more from fear of demise as compared to

the widowers.

Suhail, and Akram (2002) conducted a research on the effects of different correlates of fear of

death, including age, gender, and religiosity. Templer Death Anxiety Scale and Collett-Lester

Fear of Death Scale were given to a sample of 132 individuals. Results showed that people of

older age, people of low religiosity and women were more fearful about being dead afraid of

death and that they viewed demise as a negative experience than the men, younger people and

highly religious people.

Anwar, Javadpour, and Zadeh (2012) conducted a study on medically ill patients to assess their

death anxiety and its correlates among sever medically ill in-patients. The aim of this study is to

investigate relation of death anxiety with variable such as severity of illness, depression and

religious belief. The study is a cross-sectional, descriptive study. Data were collected using

demographic questionnaire, templar death anxiety scale, beck depression questionnaire,

cumulative illness rating scale and religious attitude questionnaire. The co relational and

regression analysis were conducted to identify the factors that correlate and predict the level of

death anxiety respectively. A group of hundred and fifty persons including 50 severely ill

patients, 50 relative caregivers and 50 normal healthy controls completed the questionnaires.

Death anxiety score was 7.2 relatives, 5.3 in patients and 4.4 in control group. Depression and

severity of illness had positive correlation with death anxiety in medical patients (P < 0.05).In

addition to that religious belief had negative correlation with death anxiety (P < 0.05) and was

the strongest protective factor for death anxiety in patients group. In relatives and controls

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depression predicted more death anxiety. Individuals suffering from Sever medical illnesses do

not inevitably experience more death anxiety. Discussing to the relative the fact, the low death

anxiety in their relative patients, will preserve the right of patients to make rational decision

about their treatment and life. In presence of death anxiety early detection and management of

depression could reduce death anxiety.

Joseph, and Leelamma (2005) conducted a study on institutionalized and non-institutionalized

aged. The aim of the present study was to compare the general well-being and death anxiety

among institutionalized and non-institutionalized aged. 200 aged people were selected for the

study: 100 elderly populations drawn from four old age homes around Ernakulam District in

Kerala and 100 elderly living with family members at home were drawn from the same

community. PGI- General Well-being measure and Death Anxiety scale was administered. Z-

Test was used for interpreting the data. The results indicate that Non-institutionalized aged

reported better General Well-being compared to Institutionalized aged. There is no significant

difference in Death Anxiety among the two groups.

Wu, Tang, and Kwok (2002) conducted a research to find out the death anxiety among the

Chinese elderly people and also about the other correlates of death anxiety. 237 individuals (62

men and 165 women) with ages ranging between 60 and 91 years were interviewed for this

purpose and it was found that greater fear of death was present in young age anxiety, during

presence of a stressor or any mental suffering. On the other hand, death fretfulness was not

controlled by sex, income, religiosity, and other variables.

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Falkenhain, and Handal (2003) administered Hoge’s Intrinsic Religious Motivation Scale,

Osarchuck and Tatz’s Belief in Afterlife Scale, Klug Death Acceptance Scale and Templer’s

Death Anxiety Scale to a sample of seventy-one elderly people with age ranging between 65 and

87. Results showed that all the variables were considerably connected except for faith in life after

death and death anxiety.

Ya-Hui Wen, (2012) conducted a study on religiosity and death anxiety. This study explored the

relationship between religiosity and death anxiety. One hundred sixty-five church participants

filled out the Intrinsic Religious Motivation Scale, the Revised Death Anxiety Scale, and a

personal questionnaire. Factor analyses, Pearson correlation, and linear and quadric regression

analyses were conducted. The results found a positive relationship between intrinsic religious

motivation and frequency of religious service attendance and strength of belief. Findings showed

a linear and a quadratic relationship between death anxiety and intrinsic religious motivation

Duff and Hong (1995) studied six communities of people who were retired for the relation of age

concentration, religiosity and fear of death using a death anxiety scale developed by Nelson and

Nelson. One community named Pious consisted of religious retired people. Findings indicated

that age has no impact on death anxiety of retirement community in five communities, other than

Pious. Pious community exhibited lowest death anxiety in each age category.

Simington (1996) used a convenient sample of an entire population of nursing students to find

personal views of people for old aged individuals, death anxiety and religious welfare. Kogan’s

Old People Scale, Death Anxiety Scale, Death Depression Scale, and Spiritual Well-Being Scale

were used. Results showed the presence of an opposite relationship between personal views of

people for old aged individuals and fear of death and death despair, also that there was a direct

relation between personal views of people for old aged individuals and religious welfare.

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Russac , Gatliff , Reece, and Spottswood (2007) conducted two studies to examine death anxiety

across the adult years,304 men and women between 18 and 87 years completed the Collett-

Lester Fear of Death scale. Death anxiety peaked in both men and women during their 20s and

declined significantly thereafter. However, women displayed a secondary spike during their 50s

not seen in men. In the second study, 113 women between 18 and 85 years completed the

Templer Death Anxiety Scale. Death anxiety displayed the same bimodal distribution and

significant decline with age seen in Study 1. The results suggest that more emphasis should be

placed on the cause of increased death anxiety among 20-year-olds and on why women, but not

men, experience a second anxiety spike during their 50s.

Rationale

I want to know that how two of the variables namely spirituality and life satisfaction

are related to death anxiety in our cultural frame work. Different researches have been

conducted in west regarding these variables and their effect on individuals. Cultural

differences found to be of great importance in determining the effect of variables like

age, gender, spirituality, religiosity and life satisfaction.

The two factors chosen by me are spirituality and life satisfaction, both of which are

very important with regard to death anxiety. People differ greatly in their levels of

spirituality, and belief in afterlife is a very crucial aspect of spirituality. It influences

people’s attitude towards death and its fear in very important ways. In the same way,

life satisfaction is closely related to death anxiety. If an individual’s level of

satisfaction is high with his life, he will suffer less death anxiety in old age, but if he

has low satisfaction with his life, the result will be higher death anxiety.

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So, through this study, I intend to explore the effects of these factors on death anxiety. I

also want to provide benefits to society by suggesting some ways in which the problem

of death anxiety can be better managed, reduced and fought against.

Objectives of the study

1- To investigate whether death anxiety differs significantly across males and

females

2- To investigate whether females experience more death anxiety than males.

3- To measure and assess whether higher level of spirituality influence death

anxiety in a more positive way as compare to low level of spirituality

Hypothesis

1- There is a significant effect from correlation to life satisfaction.

2- There is a significance correlation between spirituality and life satisfaction.

3- People having low level of spirituality will be high on death anxiety as compared to

those having high level of spirituality

Method

Research Design

Correlational design will be used

Sample

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Sample of the study will be consisted on 50 males and 50 females living in old age

homes.

Sampling Strategy

Purposive sampling technique will be used to collect data.

Inclusion Criteria

Old males and females of 60 and above living in old age homes are included in the

sample.

Exclusion Criteria

Participants with any history of psychological and psychiatric illness will be excluded

from the study

Measurement

Demographic information form will be filled by each participant in the beginning of

the study.

Death Anxiety Scale

Collet-Lester Fear of Death and Dying scale will be used to measure the death anxiety

of the elderly people.

Life Satisfaction Scale

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Satisfaction With Life Scale (SWLS) will be used to assess the overall life satisfaction

of the elderly people.

Procedure

Permission

Permission will be taken from the Social welfare Officer of the Old Age Homes to

collect data from the elderly people.

Consent Form

Consent taking form will be filled by the participants to participate in study

Demographic Form

Demographic form will be filled by the participants to obtain general information in the

beginning of study.

Statistical Analysis

SPSS version 17 will be used for data analysis.

Descriptive Analysis will be done for demographic variables

Further analysis will be conducted according to the hypothesis of the study

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