Bert Hayslip Jr & Robert O Hansson. Handbook of Death and Dying. Editor: Clifton D Bryant. Volume 1. Thousand Oaks, CA: Sage Reference, 2003.
For many of us, our own death seems distant. Indeed, it is comparatively rare for young adults to die, and when they do, their deaths are most often violent. For children and adolescents, death sometimes comes in the form of accidents or disease; it also touches young lives when parents and (more often) grandparents die. As young adults, most of us face the loss of important persons in our lives—our parents and grandparents—and these losses remind us that we too will not live forever. For those who are middle-aged, the physical realities of aging as well as the increased likelihood of losing parents or age peers due to cancer or heart disease bring death closer. For older persons, death is almost a fact of life. The reality of death is perhaps most evident when we lose loved ones, especially others with whom we have shared our lives (see de Vries, Bluck, and Birren 1993).
In this chapter, we explore the salience of death across the life span. We assume that both age-related and individual differences exist in people’s awareness of death. Such awareness is highly relevant to our individual lives and contributes to the meaning we assign to life. Indeed, idiosyncratic variations in the meanings we assign to death can either enhance or suppress our attention to death-related experiences, which may or may not covary with age. The meaning of death may also be rooted in historical events that shape the nature of death itself and our responses to it, and each of these events may have differential impacts on persons, varying by birth cohort (Hayslip and Peveto forthcoming). These distinctions parallel those made by Baltes (1987, 1997) in differentiating age-normative, history-normative, and nonnormative influences on developmental change across the life span.
Meanings of Death
What death means to us personally dictates how we live our lives as well as how we react to death. Death is often seen as the ultimate loss. As Kastenbaum (1998) has noted, death may involve losses of several kinds:
- The loss of our ability to have experiences
- The loss of our ability to predict subsequent events (after death)
- The loss of our bodies
- The loss of our ability to care for persons who are dependent on us
- The loss of a loving relationship with our family
- The loss of the opportunity to complete treasured plans and projects
- The loss of being in a relatively painless state
The Meaning of Life and Responses to Death
What individuals perceive as meaningful about life varies by age. For example, Reker, Peacock, and Wong (1987) found that, in general, older persons in their study sample reported more purpose in life than did the young; the older persons were also more death accepting. Yet the oldest-old (75+ years) and the young (16-29 years) experienced the most meaninglessness in life, had the fewest goals, and felt the most free-floating anxiety. One of our responses to death may be to use our time judiciously; that is, the awareness of death may help us to order our lives (Kastenbaum 1998). Without such orderliness, nothing would be any more important than anything else, and, indeed, it is often only when we nearly lose someone that we truly appreciate how special he or she is to us. However, it is important to point out that for some persons, simply living life on a day-to-day basis is more important than being preoccupied with future goals and plans. For example, Reker et al. found that older persons were less likely than younger persons to see life in terms of reaching goals and thinking about the future.The personal meaning that death has for an individual likely influences how he or she responds to death, and this response may or may not heighten the individual’s awareness of death-related experiences. In this respect, although fear and anxiety (see Hayslip 2003) are not the only ways in which we respond to death, they have received considerable research attention in the past 20 years (Neimeyer 1997-98). Whereas some might express anxiety over the variety of losses thought to accompany death, others may fear the loss of control over their everyday lives that may come about as a function of dying. People who are dying are often isolated from others in institutional settings, such as nursing homes or hospitals (Marshall and Levy 1990), and these settings can be depersonalizing.
Our feelings about death may determine the quality of the life we have left to live, and some evidence suggests that this response, too, covaries with age. In this context, one response to death or dying may be termed overcoming (Kastenbaum 1992). “Overcomers” see death as the enemy, as external, or as a personal failure, in contrast with others who have a participatory response to death. “Participators” see death as internal, as an opportunity to be reunited with a loved one, and as a natural consequence of having lived. As people age and approach death, they become more participatory in orientation (Kastenbaum and Aisenberg 1976), although some recent research has shown this relationship to be somewhat weaker than originally thought (Kastenbaum and Herman 1997).
Individual Meaning Making
Many person-specific and contextual variables influence death awareness. One organizing principle for understanding the role of such variables is that each somehow shapes an individual’s perceived meaning of his or her own death or the death of a loved one. We want to emphasize, however, that understanding and assigning meaning to a death (one’s own or that of a loved one) is likely to be an active and complex process. In this section, we explore how this process unfolds for individuals but also as a collective effort on the part of families and communities.
Weiss (1988) has noted that the need to find a satisfactory explanation for the loss of a loved one (cognitive acceptance) is one of the fundamental processes involved in grief recovery. Thus bereavement researchers have focused considerable attention on the systematic examination of how people try to make sense of their losses to death and how such efforts relate to individuals’ eventual adjustment or recovery (Neimeyer 2001).
Davis and Nolen-Hoeksema (2001) have suggested that the process of meaning making can serve two important coping functions. They note, for example, that an unexpected, untimely, or traumatic death can threaten one’s basic assumptions about the world and about how life works. One may find old understandings and values challenged and thus less comforting than they previously were. A first coping function, then, is to find or reconstruct a personal meaning for the death that helps to reestablish predictability and one’s sense of security. To be satisfactory, such a meaning appears to require more than just a causal (medical) explanation for the death; instead, it demands a more philosophical, perhaps spiritual, explanation. Indeed, many people find satisfactory meanings with relative ease in the case of relatively “normative” deaths (e.g., “on time” deaths of the very old), and persons who possess helpful spiritual or religious beliefs often find satisfactory meanings in those beliefs. Not all bereaved, however, feel the need to search for meaning in a death. And those who do want a satisfactory explanation tend to find one fairly early on in their bereavement or not at all.
A second coping function of the meaning-making process is to help the bereaved individual to understand that in successfully dealing with a death, there is the possibility for personal growth or mastery, for an adaptive broadening of personal and philosophical perspectives, and for an increased appreciation of other important personal relationships. Davis and Nolen-Hoeksema (2001) report that in their research they have found that these perceived benefits of coping with a death are more consistently associated with eventual adjustment than is successfully finding a meaning in the death.
Family Meaning Making
In the above discussion of meaning making, we have assumed an individual’s frame of reference. Yet people’s understandings of important life events and their implications are social (collective) constructions as well. For example, a death usually results in consequences for an entire family, and most families have long-established patterns of behavior that precede their need to cope with a death, through which they work collectively to arrive at or negotiate shared understandings of any traumatic life event. For example, family members will often support one another as they try to think through a problem (Nadeau 1998, 2001).
The process and group dynamic involved in family meaning making when a death occurs is especially interesting, given that individual family members often enter this time with quite different feelings about the death and different perceptions regarding its cause and potential implications. A concerted family process then may have positive effects, helping family members to find an explanation that comforts, allowing naturally occurring coping and support processes within the family to proceed, and diffusing any members’ needs to blame someone or something. In this respect, a common strategy for family meaning making involves storytelling; that is, family members may share their personal understandings of the events or meanings surrounding the death. They search for commonalities, encourage shy or isolated members to participate, and help one another to recharacterize any troubling aspects of the event and to draw connections between co-occurring events or between perceptions of different family members (Nadeau 2001). Those who benefit the most from such a process are usually younger family members who lack the life experience, maturity, or resources necessary to cope with such events on their own.
Of course, families vary in the resources they bring to the meaning-making process. The members of some families may not be able to benefit from the perspectives of older and more experienced members because of limited family composition, for example. Some families are widely separated geographically, and members are not in frequent or meaningful contact. Some families lack a foundation of shared values or rituals, or lack cohesion or consensus regarding how they should try to adapt to change and stressful life events (Hansson et al. 1999; Nadeau 2001).
Community Meaning Making
The meanings and implications of death can of course also be examined on a larger scale. Some deaths, such as the death of a president (e.g., John F. Kennedy) or the deaths of disaster victims (e.g., those killed in the terrorist attacks on the World Trade Center and the Pentagon on September 11, 2001), can disquiet a community or a nation and result in a collective search for meaning. Such efforts often focus on healing the community as well as reaffirming purpose and a sense of future. There is often a need to memorialize the dead, but in a way that addresses the diverse needs found within the community.
In the case of a large disaster, there are likely to be progressive layers of victims in addition to those who died. These may include the immediate victims’ family members, responding emergency personnel, members of the community who were not directly affected, and persons who, but for chance, might also have become victims (Taylor 1991). It is no small feat, therefore, for members of a community who are so differently touched by a disaster to find common understandings and meanings on which to rebuild—but communities try. An excellent example can be taken from the experience of the people of Oklahoma City after the 1995 bombing of the Alfred P. Murrah Federal Building. This community organized to create a memorial to the dead that might accommodate the diverse needs of the many levels of victims of the event. The strategy of those who worked on creating the memorial was to involve community members in conceptualizing and planning the memorial, and they systematically queried the community regarding priorities. In particular, they asked, “When you are at the memorial, what feeling(s) do you want to have?” (the response options included “pride,” “anger,” “fear,” “hope,” “solemnity,” “courage,” “concern,” “inspiration,” “peace,” “healing,” and “spirituality”). They then asked, “What should the memorial do?” (suggestions included “provide the names of the lost,” “honor those who helped,” “be for the whole nation,” and “include something for the children”) (DelCour 1996; Thomas 1996).
The Oklahoma City experience illustrates how death can bring a community together. However, the meanings attached to death can also divide communities. A profound example of this is the worldwide “death with dignity” movement (Hillyard and Dombrink 2001). Many people believe that a terminally ill adult who is in extreme pain yet intellectually competent should be allowed to request and receive a physician-assisted death. They see such assistance as consistent with our culture’s values regarding personal autonomy and the alleviation of suffering, and they argue that issues of liberty and privacy rights have been extended to the individual’s physical being in other areas of the law. Others, however, view the notion of physician-assisted death as a contradiction of many of the fundamental values of our culture, including religious beliefs regarding the sacredness of life. In addition, physicians typically view their calling as a responsibility to protect life, and many worry that a confusion of this role with the role of facilitator of death could weaken the trust that is necessary between doctors and patients. Many people have also expressed concern about the potential for abuse of physician-assisted death, especially in regard to vulnerable populations.
In this case, then, it is not so much a matter of finding meaning in death as it is a debate over competing meanings and rights, the stuff of political turmoil. In this context, the death with dignity movement has made considerable progress in recent years. After failures to establish physician-assisted death laws in several western states, Oregon passed its Death With Dignity Act in 1994. Moreover, after several unsuccessful court challenges, taken all the way to the level of the U.S. Supreme Court, as well as the implementation of important procedural controls, Oregon deaths under this law are now being recorded. At the foundation of this movement, however, have been efforts on both sides to organize political and ideological allies and to frame for public consumption particular views and interpretations of the meanings of such deaths. It is unlikely that Americans will arrive at a comfortable, shared understanding of this aspect of the community’s experience with death within our generation, and the many other nations that have dealt with the issue have had similar experiences (Hillyard and Dombrink 2001).
Life-Span Issues In Collective Meaning Making
Each of the kinds of collective efforts to find meaning in death that we have discussed involves persons of many ages, and individual reactions reflect the age-related patterns described below. However, collective efforts also involve social processes and the framing of meanings by the older persons in the community, who have the most experience, authority, and wisdom. Where that process fosters community cohesion, survival, and prosperity, a pattern should stabilize. Where divides between meanings are too broad, however, the topic of death can be a potent and polarizing influence. Here we would expect the lines to be drawn not in terms of life-span-related competence, but more along ideological lines.
We turn now to a discussion of the many variables that influence individuals’ awareness of death across the life span and thus affect the meanings they assign to mortality. In this context it is important to note that such variables not only influence but are also influenced by the meaning(s) individuals attach to their own and others’ deaths.
Awareness of Death in Children and Adolescents
A given child’s awareness of death is largely a function of the interaction between that child’s development in the ability to think abstractly and his or her accumulation of death-related experiences. According to classic studies conducted by Nagy (1948) and by Speece and Brent (1996), children’s developmental changes include at least semiregular changes in their understanding of death. Nagy’s work suggests that children progress through three phases in their understanding of death. In the initial phase, death is not real to them—they believe the dead to have lifelike properties (e.g., death is like sleep). In the second phase, death is personalized and/or externalized, and in the third phase children reach a mature understanding of death as internal (to the person), universal, unavoidable, and irreversible. Speece and Brent’s perspective differs slightly from Nagy’s in that they identify a variety of aspects of an understanding of death (e.g., beginning with universality, inevitability, and unpredictability, followed by irreversibility, causality, nonfunctionality, or the loss of the body’s physical functions through death, and noncorporal continuation, or the ability to separate the ideas of life and death from the physical death of the body), which appear in a sequential, developmental, manner. Kastenbaum (2001) argues that children first understand the deaths of others before they comprehend their own deaths, but Speece and Brent do not agree. Despite the developmental shifts that all children go through, it is important to note that there are individual differences among children of given ages in their understanding and awareness of death (DeSpelder and Strickland 2002).
In addition to developmental differences among children, which often covary with their level of (Piagetian) cognitive development, death-related experiences also help to account for differences in children’s understanding of death, as do individual differences in personality and the extent to which particular families communicate openly about death(Kastenbaum 2001). Additionally, children’s awareness of death is affected by several other factors, including their patterns of play, their use of death-related humor and games (e.g., peekaboo, hide-and-seek), their exposure to death via the media, their experiences with the loss of family pets, and their parents’ and teachers’ use of “teachable moments” (Kastenbaum 2001).
Experiences with the deaths of grandparents, friends, heroes (sports figures, rock stars), and parents are particularly powerful influences on children’s awareness of death, as are culturally relevant experiences such as the Columbine High School shootings in 1999, the Oklahoma City bombing in 1995, the space shuttle Challenger disaster in 1986, the terrorist attack on the World Trade Center in 2001, and the deaths of such public figures as Kurt Cobain, Dale Earnhardt, Sr., Selena, Princess Diana, John F. Kennedy, Robert Kennedy, Martin Luther King, Jr., and John F. Kennedy, Jr.
It is clear that the death of a parent has a profound impact on children and adolescents (e.g., Fristad et al. 2000-2001; Servaty and Hayslip 2001; Thompson et al. 1998), and Oltjenbruns (2001) notes that children often reexperience grief related to parental death as they mature. For example, for a young child a parent’s death may signal the loss of safety, but during his or her adolescence, that same child may experience struggles with identity that are influenced by the parent’s death. To the extent this occurs, it appears to be helpful for the child, in concert with the surviving parent, to attempt to “reconstruct” the deceased parent (Oltjenbruns 2001; Silverman, Nickman and Worden 1992).
When an adolescent experiences the loss of a parent, impaired school performance and disrupted, conflictual relationships with peers are often two results (Worden 1996). For some children and adolescents, the impact of a parent’s death can be far-reaching (see Balk and Corr 2001; Kastenbaum 2001; Oltjenbruns 2001). Some may display a hypersensitivity to death, and especially to the loss of other family members (see Zall 1994).
Similar negative outcomes have been observed in children who have lost siblings to death (see Oltjenbruns 2001). Nevertheless, it should be noted that the impacts on children of either a parent’s or a sibling’s death covary with a number of factors, such as quality of the relationship and the nature of the death (e.g., through cancer, AIDS, suicide, murder). Moreover, as Kastenbaum (2001) notes, death has specific connotations for children depending on who dies (e.g., a pet, a parent, a friend, a grandparent). Likewise, some children may be unable or unwilling to let others know how they may be thinking about their own death or the deaths of others (Kastenbaum 2001).
For adolescents, awareness of death is often tied to the deaths of friends (see Balk and Corr 2001), parents, or grandparents and is intimately bound to their efforts to define themselves as unique individuals and to establish intimate relationships with others (Corr, Nabe, and Corr 2003). Of special significance are the deaths of age peers via suicide; such deaths may be especially difficult for adolescents who feel emotionally and interpersonally isolated from otherwise available sources of support. They may feel guilty for having failed to prevent the suicide or feel that they should have died instead, or they may feel they are being rejected by their friends who hold them responsible for the death (see also Corr et al. 2003). Balk and Corr (2001) note that family patterns of communication are often disrupted when a child dies; the impact of a sibling’s death on an adolescent varies depending on whether the one who died was younger or an older adolescent (Balmer 1992).
Awareness of Death in Young Adulthood
For young adults, death comes, for the most part, unexpectedly. Rather than dying because of disease, young adults die often by accident or through violence (Corr et al. 2003). Although it is the rare younger person who dies of cancer or heart disease, potentially fatal illnesses such as AIDS are increasing among young adults (Cook and Oltjenbruns 1998). In most cases, however, deaths among young adults are due to homicides, auto or motorcycle accidents, and, in some cases, war (Cook and Oltjenbruns 1998).
Regardless of the cause of death, the process of dying disrupts the young adult’s relationships with parents, children, and spouse, interferes with future goals and plans, and often undermines the individual’s sense of attractiveness and sexuality (Corr et al. 2003). Understandably, a terminal illness or a sudden death leaves family members and friends feeling frustrated, angry, and lonely. Because death in young adulthood is nonnormative, young adults in the process of dying often feel angry and cheated because they are never going to reach the personal or career goals they have set for themselves. If they have children, they experience the sadness of knowing they will not see their children grow up, marry, and raise their own children (Rando 1984).
Loss of a Child
A young adult who loses a child through death, particularly if the child dies at a relatively young age, may experience great personal distress for as long as 5 years after the death (Murphy et al. 1999). When a child dies in a hospital, the parents are sometimes physically separated from their dead child by hospital staff, especially if the child has died in childbirth or shortly thereafter; a funeral may not be held for such a child because it is assumed that it would be too upsetting, further interfering with the parents’ healthy expression of feelings.
When a child dies, the parents may assume that they are responsible, that they should have done something to prevent their child’s death. The parents often feel alone, angry, and resentful toward others, and each spouse may feel disappointed in the another. Ultimately, a child’s death challenges feelings of “parental omnipotence”—the parents’ feeling that, because they are parents, they should be able to “fix” everything in their child’s life. The greatest fear of a young parent is that his or her child may die suddenly and that the parent will be powerless to prevent it. The death of a very young child can have serious consequences for the family as a whole, leading to divorce, physical or mental illness, and school difficulties (Cook and Oltjenbruns 1998).
Research has shown that among couples who have lost children to death, wives become less angry over time, but husbands’ anger increases; husbands are also more likely to use denial as a coping mechanism (Bohannon 1990-91). Indeed, a father who loses a child does grieve, but it may take him longer to admit his grief to himself and to others (DeFrain et al. 1990-91). Families in which an atmosphere of open communication exists between husband and wife and between parents and children are most successful in accomplishing the grief work that follows the death of a child. Parents who lose a child need to make sense of the death; coming to an understanding of why the child died and accepting that the death was not their fault can help them do so (Kotch and Cohen 1985-86). Some families seek professional help in working through their grief, and community support is also very important. One wellknown support organization is the Compassionate Friends, which brings parents who have lost children together to share their feelings as well as to help one another cope with the death of their loved sons or daughters.
Rubin and Malkinson (2001) argue that parents who have lost children to death grieve along two dynamic dimensions: personal functioning (e.g., well-being, quality of the marriage) and relationship to the dead child (e.g., idealizing the child after death). According to these researchers, the age of the child and the parent’s age interact to dictate the impact of child loss, and the death of a child requires a parent’s “lifelong accommodation” (p. 233) to the varying meaning of the loss and his or her relationship to the child who died.
Awareness of Death in Middle Adulthood
For adults who are in their 40s and 50s, the possibility of their own death or the death of a spouse becomes real. Cancer, heart disease, stroke, heart attack, and rarer diseases such as amyotrophic lateral sclerosis and multiple sclerosis are the major killers of middle-aged adults (see Hayslip and Panek 2002). For men, lung, colorectal, and prostate cancers become major concerns, and for women, lung, breast, and colorectal cancers are prominent concerns (American Cancer Society 1998).
When individuals in middle adulthood face terminal illness, they are likely to reevaluate life and its meaning (see DeSpelder and Strickland 2002). They often assess the quality of their relationships as well as their achievements and goals with a finality that was never present before—because they can never achieve those goals or fulfill the potential of their relationships. For these reasons, they may place importance on continuing to carry out their life roles (as father, mother, spouse, mentor, friend, worker). Ultimately, they must make plans for the future and settle “unfinished business” (Kübler-Ross 1969). They must put their legal affairs in order—insuring the security of a business, for example, or making arrangements to ensure that a child’s education is paid for. It is critical that they take steps to be sure their obligations and responsibilities to loved ones do not go unmet after they die.
Like young adults who deal with terminal cancer, middle-aged persons who face the disease must make a series of adjustments—seeking appropriate treatment, coping with its side effects, dealing with remissions and relapses, and accepting the end of life (Cook and Oltjenbruns 1998). When an individual’s cancer is incurable, he or she goes through the process described above.
Death also affects middle-aged individuals through the loss of one or both parents (see also Moss, Moss, and Hansson 2001). Because such deaths are often anticipated—that is, the loss of an elderly parent is viewed as “normal”—adult children’s grief may be disenfranchised. The life circumstances of the middle-aged child and the older parent who has died (e.g., quality of life, living arrangement) also mediate the impact of a parent’s death in adulthood (Moss et al. 2001).
When one loses a parent to death, one’s awareness of one’s own mortality increases. The fact that a parent is still alive serves as a “psychological buffer” against death (Moss and Moss 1983). As long as one of one’s parents is alive, one can still feel protected, cared for, approved, and even scolded. Stripped of this “protection,” one must acknowledge that one is now a senior member of the family and that death is a certainty. Although adult children certainly mourn and grieve over the loss of their fathers, their mothers may represent the last evidence of their families of origin, as women typically outlive men.
The death of a parent may also have special significance for men versus women. For an adult male, a father’s death may represent the loss of a trusted friend, a role model, and a valued presence in the role of grandparent, especially if the son has male children of his own, as his identity is in part tied to his father’s identity. An important part of raising his own son may be telling stories about his own father and encouraging his son to feel closer to his grandfather. For an adult female, a mother’s death may heighten her own feelings as a mother, particularly if she and her mother have remained close over the years and have shared child-raising experiences. A parent’s death thus symbolizes many things—the adult child’s own mortality, independence from authority, attachment, and love. For many middle-aged persons, the deaths of their parents may coincide with other personal, marital, or work crises; in some cases, the loss of a parent can intensify a couple’s marital difficulties (Douglas 1990-91).
Awareness of Death in Late Adulthood
Late adulthood is often a period during which individuals come to think in terms of loss—loss of good health, loss of relationships with others, and loss of status in the community as independent and productive persons (Kastenbaum 1998). Perhaps the most important losses that accompany getting older are the loss of a spouse and, ultimately, the loss of one’s own life. Older people are likely to have had more death experiences (losses of parents, siblings, and friends) than younger people. This can have several consequences: First, for older people the future seems finite rather than infinite; second, older people may see themselves as less worthy than younger people because their futures are limited; third, older people may find that desirable roles are closed off to them; and fourth, not knowing what to do with their “bonus time” on earth, older people may think that they have already “used up” the years available to them. In addition, as more of their friends and relatives die, older persons become increasingly attuned to sadness and loneliness, as well as to signals from their bodies that say that death is near.
Death is further normalized in later life through its association with integrity (Erikson 1963), in terms of its being a developmental task of later life (see Hayslip and Panek 2002), and as a stimulus for life review (Butler, Lewis, and Sunderland 1998). It is in this context that an awareness of death may affect the quality of an individual’s life and relationships with others. For example, women may be anticipatorily socialized into the role of widow prior to their husbands’ deaths (Lopata 1996). Likewise, grandparents who are raising their grandchildren (due to various family circumstances) may have fears about their grandchildren’s welfare in view of their own perceived imminent death (Hayslip et al. 1998).
Kastenbaum (1998) suggests that for some persons, the principle of compensation may preserve a sense of continuity and fairness about life and death. This principle suggests that, just as we may have been compensated by the “Tooth Fairy” for each lost tooth as children, older persons and terminally ill persons are compensated for the loss of health and ultimately the loss of life itself by the promise of eternity. We assume that persons who are near to death acquire a kind of spiritual wisdom that lets them view death more positively. The principle of compensation reinforces the practice of regressive intervention—that is, the stance that there is nothing more we can do for an old person. It is important to note, however, that older persons who are dying rarely say that they view the afterlife as a compensation for death (Kastenbaum 1998).
Indeed, many ideas about aging tend to reinforce the association between older persons and death, leading to the conclusion that death and dying are “more natural” or “more appropriate” for older persons than for the young. For example, integrity (a sense of completeness) and disengagement (withdrawal from others) have both been described as attributes of later life (Cumming 1963; Erikson 1963). Instead of seeing disengagement or integrity/life review as characteristic of all elderly persons, we might instead view these as being characteristic of some persons more than others irrespective of age, consistent with personality traits or specific life experiences. In contrast to this negative outlook regarding older persons and death, Cicirelli (1997) found that despite a low quality of life, older persons stated their preference to maintain life at all costs if they were to have a terminal illness. Only a minority of the older persons in Cicirelli’s sample said that they would wish to end their lives through suicide, euthanasia, or physician-assisted suicide. Wong (2000) argues that persons who age “successfully” (Rowe and Kahn 1995) approach death more adaptively if they hold either neutral acceptance (using what time is left to accomplish something worthwhile and significant) or positive acceptance (self-actualization, the promise of a rewarding afterlife).
Generativity and Death
An awareness of limited time left in life also appears to be related to a shift in priorities regarding personal and social goals for that remaining time. Lang and Carstensen (2002) found that persons (typically older adults) who view their remaining time in this world as limited tend to place greater importance on two forms of goals. The first of these is generativity (implying a wish to help others, to share one’s life experience with others, to leave one’s mark on the world). An increased desire to contribute to future generations, then, may provide a comforting sense of “immortality” (McAdams, Hart, and Maruna 1998). The second goal that becomes more important involves emotion regulation (a need to understand one’s own feelings more fully and to have some control over them).
Grief in Late Adulthood
In general, several factors seem to put a bereaved person at risk for both psychological and health-related difficulties: The death that caused the bereavement was sudden or especially violent, the bereaved person has feelings of ambivalence toward and was dependent on the person who died, the health of the bereaved person was poor prior to the death, there are other coexisting crises in the bereaved person’s life, the person who died was the bereaved person’s parent or child, and there is a lack of social support for the bereaved person (Stroebe and Schut 2001). Lund et al. (1986-87) found that, compared with other elderly persons in their study sample, those who were poor copers expressed lower self-esteem prior to bereavement and shortly after the death they had more confusion, expressed a greater desire to die, cried more, and were less able to keep busy.
Whether older persons and younger persons “grieve” in different ways in the process of adjusting to loss is a matter of some disagreement. Some scholars discuss “stages” of grief, such as a first phase of initial shock/disbelief, a second phase of working through one’s feelings and reviewing one’s relationship with the deceased, and a restructuring phase, when “life moves on,” which may last for varying periods of time (Cook and Oltjenbruns 1998; Corr et al. 2003; DeSpelder and Strickland 2002). However, reactions to losses through death are highly variable; an older person’s loss of a spouse, for example, must be understood in light of the interpersonal context in which older widows and widowers function (Moss et al. 2001).
Loss of a Spouse in Later Life
Clearly, older people are much more likely than younger people to have to deal with the loss of a spouse to death. Indeed, widowhood is a normative experience in later life. Between ages 65 and 75, 35% of women are widowed, versus 9% of men. For those ages 75-84, the figures are 60% and 19%, respectively. Among those age 85 and older, 80% of women are widowed, versus 39% of men (U.S. Bureau of the Census 1993). It is not surprising, then, that older widows outnumber older widowers by a ratio of six to one (U.S. Bureau of the Census 2000).
Relative to our knowledge about widows, we know comparatively little about how men cope with the loss of a spouse (see Lund 2000). Given the above-noted imbalance in the numbers of widowers versus widows, it would appear that support for widowers from other men who have lost their wives is likely to be scarce (Lund 2000). However, in a 2-year longitudinal study, Lund, Caserta, and Dimond (1986) found that widows and widowers tended to face common problems in bereavement, suggesting that the loss of a spouse represents a similar adjustment for men and women.
Given the many losses that older persons may face, it is important to note here that anyone who has to deal with several closely spaced deaths might not have the opportunity to do the grief work necessary to “work through” one loss before being confronted by another; this situation has been called bereavement overload. A person experiencing such overload may appear depressed or apathetic, or may suffer from physical problems (Kastenbaum 1978). In addition, when a person experiences a loss through sudden death, he or she may suffer from acute grief and thus may have particular difficulty coping with the loss (Cook and Oltjenbruns 1998).
It is commonly believed that younger persons who lose spouses through death have a more difficult time adjusting than do older individuals. For a young person, one consequence of a spouse’s death may be increased child-care or work responsibilities for which the widowed spouse is unprepared. Also, as widowhood in young adulthood is relatively uncommon, the newly widowed person may not be able to look to others of his or her own age as models for how to survive alone. Although some researchers have found evidence that younger persons who are widowed make poorer adjustments than do older persons, others have not. For example, Thompson et al. (1991) discovered that although older bereaved spouses were initially more distressed than older nonbereaved spouses, 2 years later there were few differences between the groups. Sable (1991) found that older women’s grief over losing their spouses subsided within 3 years. Yet, although many older widows eventually move on with their lives, others do not seem to be able to do so, perhaps because of lack of emotional support from others or the presence of other stressors. In Sable’s study of bereaved women, 78% said that they thought they would never get over their loss; they simply learned to live it. Moreover, older women adjusted to loss more negatively than did younger women. This is contrary to many people’s assumptions that because older women are more prepared for their husbands’ eventual deaths they can adjust more quickly and completely when they are widowed.
When an older spouse dies, both the surviving spouse and the couple’s adult children suffer a loss. Bass et al. (1990) found that the spouses in their study sample were more negatively affected by the death of an aged relative (spouse) than were the adult children, yet the spouses tended to become more socially active after the death than did their children, perhaps in an effort to rebuild support from others that was lacking prior to the spouse’s death. Although the adult children reported trying to prepare themselves emotionally for the parent’s death, this seemed to make adjustment more difficult. Findings such as these should alert us to our own biases about anticipatory grief (i.e., that one can be prepared emotionally for a death and thus make things easier). They should also help us to recognize the tremendous psychological burden a spouse carries in caring for a dying husband or wife.
The Loss of an Adult Child
Approximately 10% of adults over the age of 60 experience the death of a grown child (Moss, Lesher, and Moss 1986-87). Not only is the death of an adult child untimely, but it severs forever a lifelong parent-child bond (Blank 1997). Because this kind of loss is comparatively rare, those who experience such losses are unlikely to find others who have had similar losses available to provide needed emotional support (Moss et al. 1986-87). When an adult child dies, the relationships among all family members are affected. Each surviving sibling must deal with his or her own loss, and this influences the relationships of all the siblings with one another as well as with their older parents. Guilt, anger, and depression may cloud amily relationships, impede communication, and disrupt family helping patterns and family rituals (see Rubin and Malkinson 2001). For the surviving parents, hope for the future may be eroded. When one’s child dies, one’s own mortality (and immortality) is shaken; one can no longer share in the joy of the child’s life. Indeed, grandparents also experience significant grief over the death of a grandchild (Reed 2000).
When elderly parents and grandparents experience the death of an adult child/grandchild, their grief reactions are often very intense and prolonged (Cook and Oltjenbruns 1998; Murphy et al. 1999). Older persons who lose adult children through death experience a special sense of failure that many find difficult to deal with. Very few adults expect to bury their own children. Moss et al. (2001) provide a review of the comparatively scarce literature substantiating the negative impact of sibling death on older persons (relative to those whose spouses have died), as well as the impacts on elderly parents of the loss of an adult child, which can be quite variable. This is similarly true for grandparents who grieve for their dead grandchildren (see Fry 1997; Reed 2000).
In view of the above discussion of the factors that influence death awareness across the life span, we would be prudent to remind ourselves of the idiosyncratic meanings death has for children and adults, as well as to recognize the variability in how persons respond to such meanings as they experience both similar and different developmental transitions. Deathawareness is at once an individual, familial, community, and cultural phenomenon, and its various elements interact dynamically. Thus death awareness might be best thought of as something individuals construct and reconstruct based on the interaction of developmentally significant life experiences (e.g., the death of a parent), cultural shifts in mortality rates, changes in funeral rituals (Irion 1990-91; Hayslip, Sewell, Riddle 2003), and cultural shifts in causes of and beliefs about death (Ariès 1981). Given such factors, we must recognize that each individual has a personal understanding of what death means and that a person’s awareness of this meaning influences his or her responses to mortality—both his or her own and that of others.