262 Grief and Loss Across the Lifespan
because of the professional and societal “ambivalence about whether to fight
or accept death” (Hooyman & Kiyak, 2008, p. 540). Gawande (2014, p. 232)
puts it differently in his recent book Being Mortal; the conflict is “between one’s
fears and one’s hopes” and decisions about trade-offs one is willing to make to
stay alive become a key to defining what quality of life is hoped for or feared.
Multiple factors influence attitudes and fears about death and dying, such
as age, gender, and previous experiences with the death of loved ones. There is
general agreement (Cicirelli, 2002; Corr, Nabe, & Corr, 2006) that older adults
fear death less than do younger adults. While older women are more likely to
report fear and anxiety about dying, they are less fearful of the unknown than
older men. However, as Hooyman and Kiyak (2008) report, this difference
may emanate from gender differences in socialization, specifically women’s
greater ability to express emotions. The oldest of older adults seem to talk and
think more about death and seem less afraid of their own death compared to
younger older adults and midlife adults (Hooyman & Kiyak, 2008). However,
Cicirelli (2002, 2006) reports that adults over 75 who are aware of their limited
lifespan still seem to desire more time. A nearly universal fear, regardless of
age, is the pain of dying; this is followed closely by concerns about whether
there is an afterlife (Cicirelli, 2006). Psychological health seems predicated on
resolving some of these issues during older adulthood.
Some research (Oktay & Walter, 1991) indicates that older adults who
have coped with previous loss are better prepared to cope with death. Among
hospice volunteers, death anxiety is found to be lower when the volunteer has
had more experience of death; the novices felt more death anxiety (Bluck, Dirk,
Mackay, & Hux, 2008). In comparing their analysis with others’ findings, Bluck
et al. suggest that experiencing others’ deaths within the supportive hospice
environment may explain why experienced hospice volunteers felt less death
anxiety or avoidance. In explorations of death anxiety (generalized anxiety
about death) and fear of dying (fear of the dying process), bereaved Israeli
parents were found to have higher levels of fear of dying (particularly true
for mothers) than nonbereaved parents, yet their death anxiety levels were
about the same (Azaiza, Ron, & Tinsky-Roimi, 2011). Further, there was no
significant relationship between religiosity and death or dying anxiety. What
people seem to fear most about death is their inability to predict the future and
the process of dying—not surprisingly, most are particularly concerned about
dying a painful death (Hooyman & Kiyak, 2008).Social Development
There is much variation among older adults and is significant correspon-
dence between the well-being of older adults and the richness of the social
relationships they maintain. The ability to maintain social relationships often
corresponds to older adults’ housing situations and their continued activity
(or not) in the community (Greenfield & Russell, 2011). In considering two
living arrangements specifically designed to allow older adults to “age in
place,” Greenfield, Scharlach, Lehning, and Davitt (2012) found that success-
ful programs attend to assuring that older adults have access to civic engage-
ment and empowerment activities, opportunities to pursue and build social