Aging with Attitude: Better than Dying with Dignity

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Table of contents

A total of 2, middle-aged adults participated in the survey. The average age of respondents was The majority were employed Table 1 presents the demographic characteristics of respondents. In this sample, the internal consistency of the scale was. Knowledge about EOL care planning was measured using a scale developed for the original survey. The five components include advance directives, death with dignity, hospice, last will, and organ donation.

Although euthanasia is not legalized in South Korea, cancer patients at the final stage and their family have been often asked if they prefer to die with dignity, which means no more treatment. Considering such circumstances, death with dignity has been actively discussed in South Korea and often examined in health-care research. After developing the scale, an experienced social work researcher reviewed and confirmed the scale, establishing content validity of the items.

The possible range of scores is from5 to 35 with higher scores indicating higher satisfaction with life. Descriptive statistics and correlation tests between continuous variables were performed to assess the characteristics of the study sample and the bivariate association between study variables, respectively. An interaction term was created by multiplying two centered variables, knowledge on EOL care planning and death experience of family or friends. The average death attitude score was Approximately 3 in 10 respondents experienced the death of family or friends in the previous year.

The average score for knowledge of EOL care planning was Respondents who were older, had a higher level of education, and had greater life satisfaction were more likely to have positive attitudes toward death. Main effects and an interaction effect of knowledge of EOL care planning and death experiences of family or friends on death attitudes were found.

Elderly people have the right to live and die with dignity

Knowledge of EOL care and death experiences of family or friends in the previous year were associated with death attitudes see Table 3. Middle-aged Koreans with better perceived knowledge of EOL care planning and who had experienced the death of family or friends in the previous year were more likely to have positive attitudes toward death.

However, the interaction effect suggests that the effects of knowledge of EOL care planning were stronger for those who have not experienced the death of family or friends. Figure 1 displays the interaction effect between knowledge of EOL care planning and death experiences on death attitudes.

With all of the factors in the equation, the final model accounted for 9. To fill the gap in the literature about death attitudes among middle-aged adults in Eastern society, we examined factors associated with death attitudes among middle-aged Koreans. Furthermore, we explored the main effects and the interaction effect of death experiences and knowledge of EOL care planning on death attitudes. We found significant main effects as well as an interaction effect of death experiences and knowledge about EOL care planning on death attitudes. In addition, age and life satisfaction were also positively related to death attitudes.

Our descriptive analyses showed highly positive attitudes toward death among middle-aged Korans, which might reflect a traditional cultural perspective toward death originating in Buddhism. In Buddhism, birth, aging, illness, and death are essential parts of life and it is believed that there is life after death Yeun, Because Buddhists view death as moving to the next life as crossing the river of death Shin et al.

Consistent with our findings, Shin et al. Their participants viewed death as the end of suffering in life and a turning point to move to the next life or return to the original place. Interestingly, age and death attitudes were significantly related even though the range of age was not substantial in this sample.

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Russac, Gatliff, Reece, and Spottswood found that fear of death peaks around the 50s and then decreases, which is consistent with our findings. Given the age range of 46 to 64 years in our sample, participants aged more than 50 years might have undergone their peak of death fear and experience decreasing fears toward death and resulting in more positive death attitudes.

This study also found a main effect of death experiences of family or friends on death attitudes. As a result, they may have more positive attitudes toward death. Among all predictors included in our study, knowledge about EOL care planning was the strongest factor associated with death attitudes. This finding is consistent with empirical evidence that showed the effectiveness of EOL care educational programs on death perceptions among health-care professionals e.


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The concept of self-efficacy may explain this crucial effect of knowledge on death attitudes. In contrast, lack of knowledge about EOL care planning may elevate fear of death because people may not know what to expect when they die or how to deal with it. Awareness about possible EOL care options and benefits of each option can empower individuals and help them embrace their own impending death.


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Furthermore, the interaction analysis revealed an interaction effect between death experiences and knowledge about EOL planning, indicating the moderating role of knowledge about the EOL planning on the relationships between death experiences and death attitudes. Regardless of the experience of death, greater knowledge about EOL care planning was associated with positive death attitudes.

However, the effect of knowledge about EOL care planning on death attitudes was greater among those without death experiences than among those with death experiences. A possible explanation is that as death experiences led to more exposure to EOL-related issues that may influence their death attitudes, the effect of EOL care planning knowledge itself might be attenuated.

For example, individuals who lost their loved one are likely to have multiple contacts with health-care professionals to consult about the severe illness of their loved one or discuss EOL treatments, influencing their attitudes toward death, and possibly weakening the influence of EOL care knowledge on death attitudes.

On the contrary, given the possibly limited experiences with EOL care issues, knowledge about EOL care planning can play a critical role in death attitudes for those without death experiences, underlining the importance of EOL planning knowledge to reduce fear or anxiety of death.

Due to the cross-sectional design, we cannot draw any causal relationship among the factors examined in the study. For example, individuals who have positive attitudes toward death may seek more information on EOL care planning and become knowledgeable about such planning rather than vice-versa.

Furthermore, nonprobability sampling of the original survey limits the generalizability of our findings. Third, use of dichotomous variables such as religion or death experiences may limit further understanding about the influence of such factors on death attitudes. For example, due to the dichotomous measure of death experience yes or no , the potential difference between those who experience the death of a loved one and those with multiple death experiences in the previous year could not be detected.

Lastly, our regression model explained a small amount of variability in death attitudes i. Statistically significant relationships between predictors and a dependent variable can provide critical implications even if R 2 is small. Despite the limitations stated earlier, this study offers crucial implications for health-care practitioners and future research.

First, our study sheds light on the necessity of EOL care education programs for middle-aged adults. Fear of death is widely considered a psychological barrier to EOL care preparation Carr, However, our findings imply that lack of knowledge about EOL care plans may lead to negative attitudes toward death, indicating the necessity of educational interventions about EOL care planning. Furthermore, our finding about the interaction effects between death experience and knowledge of EOL care planning on death attitudes underscores potentially greater benefits of such education for those without death experiences.

Given the extensive focus on palliative or hospice care in the EOL care literature, emphasis on death or EOL care education tends to be limited to dying individuals and their families. Beyond this existing discussion, our study suggests that EOL care education can contribute to building and improving positive death attitudes for middle-aged adults.

In this regard, educational intervention programs about EOL care may be successfully implemented for middle-aged Koreans as they tend to prefer to exercise autonomy in the last stage of life. In addition, our finding of the positive association between life satisfaction and death attitudes suggests the potential benefits of reminiscence programs on death attitudes. A well-designed counseling or life reflection program could provide older adults with opportunities to look back over their lives and to focus on accomplishments rather than failures and hence ease fear toward death.

Lastly, our findings provide a possible target intervention group to improve death attitudes: If EOL care education or counseling services targeted individuals in their 50s when fear of death peaks, it may effectively address negative attitudes toward death and prepare middle-aged adults to enter late life with healthier attitudes toward death. Further examination of potentially crucial variables related to death attitudes can enhance our understanding about how middle-aged adults perceive and prepare for their own death in the Korean context. Moreover, research with middle-aged adults in other societies including Western countries is needed to understand death attitudes across cultures.

Death is a certain life event for everyone, and positive attitudes toward death are a critical factor that can help individuals prepare for their own death. With the growing number of older adults and increasing life expectancy, there is increasing attention to the quality of the last stage of life. The findings of this study provide practical insights to promote positive death attitudes among middle-aged Koreans.

Health-care professionals need to be aware of the necessity of EOL education for middle-aged adults to help them prepare for and embrace the final stage of life.

Death Attitudes Among Middle-Aged Koreans: Role of End-of-Life Care Planning and Death Experiences

Her areas of research focus on long-term care for older adults including family caregiving and end-of-life care. She is also interested in health disparities among ethnic minority older adults and their caregivers. She is interested in investigating if and how social structural, relational, and cultural contexts are associated with health and mental health outcomes among racial and ethnic minorities.

As a member of the first cohort of Hartford Geriatric Social Work Faculty Scholars, she conducted a study focusing on depression among long term care residents. Her research interests center around mental health issues of older adults, particularly elder suicide. She has published 87 articles about the issues about the wellbeing of older adults in Korea. Her research areas include social welfare policy for older adults, long-term care, home in home services and retirement. Declaration of Conflicting Interests. National Center for Biotechnology Information , U. Int J Aging Hum Dev.

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Author manuscript; available in PMC Jan 1. Adamek , 1 and Mee Hye Kim 3.

Dying with dignity.

Abstract The purpose of this study was to examine factors affecting death attitudes among middle-aged Koreans. Review of Previous Studies Most existing studies about death attitudes in Western society were conducted with older adults, focusing solely on death anxiety or fear.


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    7. Death Experiences As individuals get older, there can be the increasing possibility of losing loved ones such as family or friends. Open in a separate window.

    Death Attitudes Among Middle-Aged Koreans: Role of End-of-Life Care Planning and Death Experiences

    Data Analysis Descriptive statistics and correlation tests between continuous variables were performed to assess the characteristics of the study sample and the bivariate association between study variables, respectively. Results Descriptive Statistics The average death attitude score was Knowledge about EOL planning.

    Interaction of death experience and end-of-life knowledge on death attitudes. Step 1 Step 2 Step 3 Interaction term: Discussion To fill the gap in the literature about death attitudes among middle-aged adults in Eastern society, we examined factors associated with death attitudes among middle-aged Koreans. Implications for Practice and Research Despite the limitations stated earlier, this study offers crucial implications for health-care practitioners and future research.

    Conclusion Death is a certain life event for everyone, and positive attitudes toward death are a critical factor that can help individuals prepare for their own death. Exposure to death is associated with positive attitudes and higher knowledge about end-of life care in graduating medical students. Journal of Palliative Medicine. Journal of Religious Gerontology. Death and dying anxiety among elderly Arab Muslims in Israel.

    Self-efficacy conception of anxiety. Life experience with death: Relation to death attitudes and to the use of death-related memories. The will to live: Gender differences among elderly persons. Racial differences in end-of life planning: The relationship between death related factors and death preparation: A comparison of pre-elderly and baby-boomers. Korean Journal of Population Studies. Death anxiety and death competency: The impact of a palliative care volunteer training program. Colton J, Bower K. Some misconceptions about R 2. Aging and attentional bias for death-related and general threat-related information: The latter is justified since it is no longer an individual problem but a pressing social issue.

    While society should put more money into old peoples' home to enable those living there a more comfortable and dignified life, but more than that, perhaps society should have a more open discussion of life and death for people of advanced age and perhaps see the cycle of life and death with a more open mind - particularly mindful not only of an individual's sacred right to life, but to death with dignity as well.

    What is society's attitude to those who want to die as a result of infirmity in general, and great stress and pain in particular? This question must also be asked if society has the right to prolong a person's acute suffering in such circumstances. Euthanasia is not the answer as it is akin to murder, where the dying person has no choice. But what about assisted suicide, where the person, in full command of his mental faculties, has expressed a wish to die but can't do it himself? To date, I think Switzerland is the only country that has legalized assisted suicide, and the latest study shows more and more foreigners are going to that country for that reason - as their home countries do not allow it.

    As a first step, that concept could be made more generally known and legislation enacted to ensure its legality.

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    In laymen term, it is a document that allows you to provide a clear statement that in the event you are seriously ill and become unconscious whether you would like to be given all the life supporting system to prolong your survival. You can also choose to request relief from pain even if doing so hastens death. Singapore has allowed AHCD for many years already. The concept of assisted suicide should therefore be discussed in the context of providing the most ideal medical service, and not looked upon as a taboo topic. Death is very much part of the cycle of life.

    We should all live and die with dignity. The author, a practising haematologist, migrated to Singapore from Hong Kong in He is also a principal mediator with the Singapore Mediation Centre.