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THE FEAR OF DEATH AND DYING IN OLDER ADULTHOOD
Diana Green
OLDER ADULTS IN THE UNITED STATES• Population aging due to baby boomers and
increase in life expectancy1
• Increasingly racially diverse population1
• Increased strain on healthcare systems due
to chronic conditions common in older
adulthood2
• Increased strain on social security and
welfare programs3
1. Center for Disease Control, National Center for Chronic Disease Prevention and Health Promotion. (2013). The state of aging and health in America 2013. Retrieved from http://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf
2. National Council on Aging. (2011). Center for Health Aging. Retrieved from http://www.ncoa.org/improve-health/center-for-healthy-aging/chronic-disease/
3. Ortman, J. M., Velkoff, V. A., & Hogan, H. An aging nation: The older population in the United States. U. S. Census Bureau. Retrieved from http://www.census.gov/prod/2014pubs/p25-1140.pdf | Graph retrieved from U.S. Census at http://www.census.gov/prod/2014pubs/p25-1140.pdf
THE FEAR OF DEATH AND DYING
• Death anxiety is having a negative emotional reaction to
the idea of not existing or of self-disappearance1
• Death anxiety trends: high for young people, higher in
middle adulthood, lowest in older adulthood2
• Older adults think about death more, but worry about it
less2
• Top concerns: fear of prolonged dying process & fear of
abandonment3
1. Tomer, A. & Eliason, G. (1996). Toward a comprehensive model of death anxiety. Death Studies, 20(4), 343-365.
2. Depaola, S. J., Griffin, M., & Young, J. R. (2003). Death anxiety and attitudes toward the elderly among older adults: The role of gender and ethnicity. Death Studies, 27, 335-354. doi:10.1080/07481180390199091
3. Fry, P. S. (2003). Perceived self-efficacy domains as predictors of fear of the unknown and fear of dying among older adults. Psychology and Aging, 18(3), 474-486. doi:10.1037/0882- 7974.18.3.474
THEORETICAL PERSPECTIVES
Terror Management
Theory1
Self-preservation instinct v.
knowledge of mortality
1. Bozo, O., Tunca, A., & Simsek, Y. The effect of death anxiety and age on health-promoting behaviors: A terror-management theory perspective. The Journal of Psychology: Interdisciplinary and Applied, 143(4), 377-389.
doi:10.3200/JRLP.143.4.377-389
2. Cicirelli, V. G. (2003). Older adults' fear and acceptance of death: A transition model. Ageing International, 28(1), 66-81. doi:http://dx.doi.org/10.1007/s12126-003-1016-6
3. Tomer, A. & Eliason, G. (1996). Toward a comprehensive model of death anxiety. Death Studies, 20(4), 343-365.
Transition Model2
Specific to older adults
Different components of
fear
Different coping mechanisms
Death Anxiety Model3
Three factors that
determine death anxiety
Death salience
1.
2. 3.
COGNITIVE BEHAVIORAL THERAPY FOR ANXIETY
1. Roth, N. (1978). Fear of death in the aging. American Journal of Psychotherapy, 32(4). Retrieved from ww.ajp.org
2. Cully, J. A. & Teten, A. L. (2008). A therapist’s guide to brief cognitive behavioral therapy. Retrieved from http://www.mirecc.va.gov/visn16/docs/therapists_guide_to_brief_cbtmanual.pdf
3. Image retrieved from http://www.guelphtherapist.ca/blog/
• Anxiety about dying does not necessarily lead to a
clinically significant anxiety disorder1
• If therapy is needed, CBT has proven very effective for
treating anxiety2
CBT2
Emotions, thoughts, and
behaviors are all interconnected
12-20 sessions
Homework assignments &
skill acquisition
COGNITIVE BEHAVIORAL THERAPY WITH OLDER ADULTS
1. Barrowclough, C., King, P., Colville, J., Russell, E., Burns, A., & Tarrier, N. (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal
of Consulting and Clinical Psychology, 69(5), 756-762. doi:10.1037/0022-006X.69.5.756
2. Photos retrieved from www.mymcpl.org, www. monarcaresblog.com, www.teamsters355.com
• Prevalence of anxiety disorders in older adults: 4% to 6%1
• Use of medication may present increased risk of negative drug interactions2
LITERATURE
• Consistent evidence that CBT is effective when treating older adults with generalized anxiety disorder or
similar illnesses
• Wetherell, Gatz, and Craske (2003) compared CBT to discussion group and to waiting list
• Barrowclough et al. (2001) pre- and post-test model; 71% met criteria for successful treatment
outcomes
• Limitations: small sample sizes, predominately high-functioning,
well-educated, young old (65-74 years old), White women
1. Wetherell, J. L., Gatz, M. & Craske, M. G. (2003). Treatment of generalized anxiety disorder in older adults. Journal of Consulting and Clinical Psychology, 71(1), 31-40. doi:10.1037/0022-006X.71.1.31.
2. Barrowclough, C., King, P., Colville, J., Russell, E., Burns, A., & Tarrier, N. (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal
of Consulting and Clinical Psychology, 69(5), 756-762. doi:10.1037/0022-006X.69.5.756
ADAPTIONS FOR OLDER ADULTS
• Use learning
accommodations such as
white boards and
binders1
• Different priorities and
symptoms of older versus
younger clients2
• Awareness of cohort
differences3
1. Bhar, S. S. & Brown, G. K. (2012). Treatment of depression and suicide in older adults. Cognitive and Behavioral Practice, 19(1), 116-125. doi:10.1016/j.cbpra.2010.12.005.
2. Mohlman, J. (2004). Psychosocial treatment of late-life generalized anxiety disorder: Current status and future directions. Clinical Psychology Review, 24(2), 149-169. doi:10.1016/j.cpr.2004.01.001
3. Knight, B. G. & Satre, D. D. (1999). Cognitive behavioral psychotherapy with older adults. Clinical Psychology: Science and Practice, 6(2), 188-203. doi:10.1093/clipsy.6.2.188
POLICY
Macro:
• Pennsylvania: 2012 best
practices for older adults
• Arizona: 2011 practice
protocol for older adults
Micro:
• CBT focused practices
and clinicians
Photo from www.minddisorders.com
ETHICS: COGNITIVE IMPAIRMENT
• 12% to 20% of older adults experience
cognitive disorder1
• During treatment, may be difficult to ascertain
when client is unable to participate/give consent2
• Safety concerns2
1. McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics and Behavior, 19(2), 112-129. doi:10.1080/10508420902772702.
2. Schwiebert, V. L., Myers, J. E., & Dice, C. (2000). Ethical guidelines for counselors working with older adults. Journal of Counseling and Development, 78(2), 123-129. Retrieved from
http://search.proquest.com/docview/218965321?accountid=14605
3. Knight, B. G. & Satre, D. D. (1999). Cognitive behavioral psychotherapy with older adults. Clinical Psychology: Science and Practice, 6(2), 188-203. doi:10.1093/clipsy.6.2.188
4. Picture retrieved from healthyblackmen.org
ETHICS: TERMINAL DIAGNOSIS• Legal aspects of physician assisted suicide
• Suicidal ideation assessments
Schwiebert, V. L., Myers, J. E., & Dice, C. (2000). Ethical guidelines for counselors working with older adults. Journal of Counseling and Development, 78(2), 123-129. Retrieved from
http://search.proquest.com/docview/218965321?accountid=14605
Picture retrieved from www.sodahead.com and senior-care-resources.com
