Age is not just a number: age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms among older adults

Associations between death anxiety and probable posttraumatic stress disorder and clinical depression and anxiety in older Israeli adults during wartime

The outbreak of the Israel-Hamas war on October 7, 2023, has presented unprecedented challenges to older adults' mental health, including increased posttraumatic stress, anxiety, and depression. The current study examined potential war- and age-related factors associated with probable posttraumatic stress disorder (PTSD), clinical depression (probable depression), and generalized anxiety disorder (probable anxiety) among older adults during the ongoing war. Moreover, due to the continued threat of death, we examined whether death anxiety is an additional contributing factor to older adults' probable PTSD, depression, and anxiety. Data were collected January-March 2024 from 554 community-dwelling older adults (Mage = 73.90 years, SD = 7.35, range: 61-96 years) who completed online scales assessing sociodemographic variables, war exposure (distance from the Gaza Strip, exposure to terror attacks/blasts), and age-related constructs (assistance in daily activities [ADL], cognitive decline, physical illnesses, death anxiety). Increased ADL was associated with probable depression, B = 0.62, OR = 1.87, and anxiety, B = 0.42, OR = 1.53, and cognitive decline was associated with probable depression, B = 1.52, OR = 4.56. Older adults with high levels of death anxiety were almost 3 times as likely to meet the criteria for probable PTSD, B = 1.05, OR = 2.85, and more than 1.5 as likely to meet the criteria for probable depression, B = 0.54, OR = 1.71, and anxiety, B = 0.50, OR = 1.65. The importance of death anxiety as a potential risk factor for negative psychological outcomes among older adults during war is discussed.

Death perceptions, grief, and distress in Ultra-Orthodox Jews who witnessed the 2021 Meron disaster

On April 29, 2021, during an Ultra-Orthodox annual communal event in Meron, a crowd rush resulted in the deaths of 45 individuals. Experiencing such events may intensify death proximity (subjective nearness to death, SNtD) and death anxiety, and increase distress. Furthermore, the experience of grief following the trauma may disrupt defense mechanisms that reduce death-related anxieties. Thus, we examined the mediating role of death anxiety on the association between SNtD and distress, and the possible moderating role of grief experiences on this model. Ultra-Orthodox Israeli Jews who experienced the Meron disaster (N = 168) responded to scales assessing demographics, SNtD, death anxiety, and psychological distress. Death anxiety mediated the SNtD-distress link and grief was a significant moderator. Specifically, for individuals low in grief, the association between high death anxiety and increased distress was nullified. Findings are discussed from the perspective of Terror Management Theory.

Multiple Trajectories and Predictors of Self-Esteem Change in Later Life: A Latent Growth Mixture Modeling Approach

Applying latent growth mixture modeling (GMM), this study delves into the examination of self-esteem trajectories in a sample of 5,597 older adults over a nine-year period. Four distinct patterns of self-esteem changes have emerged: low, decreasing, increasing, and high. Additionally, the study explores the relationships between each trajectory and various predictors encompassing demographic factors, socioeconomic status, health, and interpersonal relationships. The findings highlight the significance of these factors in predicting the likelihood of an individual following a specific self-esteem trajectory. Notably, maintaining employment, fostering satisfactory social relationships, and being free of frequent depressive feelings emerged as strong predictors for the stability and increase of high self-esteem. Intriguingly, an average or above-average income was unexpectedly associated with lower levels of self-esteem. The study emphasizes the contribution of GMM to advancing aging research.

Do Work-Related Factors Moderate the Association Between Subjective Nearness-to-Death and Psychological Distress?

The COVID-19 pandemic has been associated with increased existential concerns, as well as with significant changes in the work force. The current study examined the availability of meaning in work and belonging to a work group as personal resources which may mitigate psychological distress associated with feeling close to death. Data were collected from 450 working Israelis, and results indicated that the connection between feeling close to death and distress was not significant for individuals reporting high levels of belonging and meaning. Implications are discussed from the perspective of Terror Management Theory.

Subjective Nearness-to-Death and COVID-19 Worries Among Ultra-Orthodox Jews in Israel: The Moderating Role of Israeli Identity and Sense of Community

The Ultra-Orthodox community in Israel is characterized by close everyday contact and a strong sense of community. While the COVID-19 pandemic has resulted in global uncertainty, fear, and fatalities, this group was particularly affected by the pandemic. Accordingly, the current study examines whether subjective nearness-to-death was associated with increased COVID-19 concerns, and whether Israeli identity and sense of community moderate this association. Data were gathered from 255 Israeli Ultra-Orthodox Jews, and results yielded a significant link between subjective nearness-to-death and COVID-19 worries, moderated by both moderators. Results are discussed in line with terror management theory, and theoretical/practical implications are suggested.

Reclaiming hope: Subjective nearness to death as a moderator between posttraumatic stress symptoms and hope among older adults

Perceiving one's remaining time until death, can serve as a source of resilience when faced with adversity in the second half of life. The current work is based on a prospective study and examines whether subjective nearness-to-death (SNtD) moderates the association between posttraumatic-stress symptoms (PTSS) and hope among adults in the second half of life. The first wave was conducted after the end of a military conflict in the south of Israel, and included 170 participants (M = 66.61, SD = 9.16; age range 51-91), 115 of whom also participated in Wave 2. Participants filled out self-reported questionnaires regarding background information, PTSS, SNtD and hope. A moderation effect was found, revealing that high levels of PTSS predicted lower levels of hope among those who felt close to their death, but not among those who felt far from their death. We suggest that one's evaluation of little time remaining to live, especially in old age, may be a significant factor exacerbating the negative consequences of PTSS on hope. The importance of the results to the research field is discussed.

Self and Perceived Others' Views of Aging and Their Association with Mental Health in the Second Half of Life

This study focuses on the concepts of subjective age and subjective nearness-to-death (views-of-aging) and examines the association between individuals' chronological age, self, and others' perceptions of these variables and mental health. A total of 267 participants aged 40-95 M = 64.33 provided sociodemographic information and filled out scales assessing self and others' views-of-aging, depressive symptoms, and their well-being. After controlling for covariates, age was not related to the dependent variables, whereas young/far from death self, and perceived others' views-of-aging was related to better mental health. The interaction between young age and young/far from death perceived others', but not self, views-of-aging was associated with lower depressive symptoms and higher well-being. Finally, the interaction between young/far from death self and perceived others' views-of-aging was associated with lower depressive symptoms but not with well-being. These findings provide an initial glance at the complex relations between two types of personal views-of-aging and emphasize the importance of how individuals appraise others' perceptions of their own aging process and life expectancy.

Existential ageing and dying: A scoping review

BACKGROUND

After significant early interest in aging and dying, recent empirical studies have been few and theoretically fragmented.

OBJECTIVE

The aims of this review were to map what is empirically known about the intersections between existential aging (a sense of passing years that evoke a sense of nearness-to-death) and dying identity and to describe the available evidence.

METHOD

Articles were reviewed employing PRISMA guidelines. Seven data bases were searched resulted in 165 records. Of these 165 records a final selection of 24 studies that met the criteria were examined.

RESULTS

Evidence from the review found that the formation of the identity of dying alongside existential aging was associated with personal changes related to self/gerotranscendence, self-concerns about the inevitability of death (mortality salience), self-concerns about the prospect of death (death anxiety), attitudes toward the older self as a moderator of attitudes to death (aging attitudes), or simply anticipating the death of self (the future). Collectively, these studies found that death and dying were threats or challenges to life as an increasingly aging identity and that this seems to require compensation or accommodation.

CONCLUSION

These studies confirm the importance of nearness-to-death on identity formation and psychological change in older populations. However, most of the studies were quantitative and tested for pre-existing ideas and concepts. There is a need for more qualitative studies to search for wider or parallel meanings about identity change in the face of aging and death, more longitudinal designs, and greater attention to mixed methods approaches, especially for populations for whom talk or writing may be restrictive.

Adjustment and maladjustment to later life: Evidence about early experiences in the family

Introduction

Previous parenting studies with European-American families have identified optimal parenting as being based on warmth combined with strictness (i.e., authoritative parenting). The present study analyzes, in adolescents and adults, their adjustment and maladjustment related to age and their early experiences in the family.

Methods

The sample consisted of 2,158 Spanish people (58.29% women): 624 adolescents, 630 young adults, 504 middle-aged adults, and 400 older adults. The families were classified into one of the four parental typologies (authoritative, indulgent, authoritarian, and neglectful) based on their scores in the two main dimensions (warmth and strictness). Child functioning was measured as components of adjustment (self-esteem, emotional self-concept, and empathy) and maladjustment (aggression and hostile sexism).

Results

Overall, only adolescents and adult children raised in indulgent families reported the highest self-esteem, emotional self-concept, and empathy, and the lowest aggression and hostile sexism. Authoritative parenting (warmth with strictness) was related to a lower emotional self-concept and greater aggression and hostile sexism than indulgent parenting (warmth without strictness). The worst scores corresponded to authoritarian and neglectful parenting.

Discussion

The present findings provide new evidence about early experiences in the family, even after parental socialization has ended. Interestingly, contrary to the main findings from classic studies with European-American families, only high parental warmth combined with low parental strictness (i.e., indulgent parenting) is always positive for greater adjustment and less maladjustment in all age groups.

Subjective Nearness-To-Death and Retirement Anxiety Among Older Workers: A Three-Way Interaction With Work Group Identification

Retirement anxiety represents a major challenge for older workers who hold negative expectations and concerns regarding the consequences of their future retirement. Although prior studies suggest that retirement is an age-related transition that may serve as a reminder that life is nearing its end, little is known about how subjective nearness-to-death is related to retirement anxiety, and the role of work group identification as a boundary condition. The current study draws on terror management and social identity theories to hypothesize and investigate these relationships. A three-way interaction model was tested on a sample of 327 Israeli older workers. We found a positive association between subjective nearness-to-death and retirement anxiety. Further, we demonstrated that the positive relationship between subjective nearness-to-death and retirement anxiety was more prominent for older workers whose work group self-definition and self-investment were both high or were both low. The theoretical and practical implications of these findings are discussed.

Can Music Therapy Improve the Quality of Life of Institutionalized Elderly People?

INTRODUCTION

The current population has new characteristics that require changes to be made in the public health system. In the case of the elderly, the concrete aspects of their health must be known to improve the system, in search of a better quality of life and as much independence as possible.

METHOD

The aim of this study was to verify the efficiency of a music therapy program with institutionalized elderly participants to avoid depressive symptoms and improve social interaction and creativity. This is a group case study that uses a pretest-post-test descriptive design. The program was divided into sixteen sessions, two sessions each week. As inclusion and exclusion criteria, physical dependency and cognitive state were used.

RESULTS

The results present an improvement in the physical dimensions of quality of life and an increase in creativity and social interaction. It is recommended that the sessions in the program, aiming to achieve a greater efficiency, are extended because the elderly have very ingrained habits and routines that are very hard to eliminate.

DISCUSSION AND CONCLUSIONS

Music therapy, a non-pharmacological and worthwhile treatment, is a therapeutic option with proven benefits. Music therapy has the potential to improve health and quality of life in the elderly and also foster the amelioration of various chronic illnesses, such as depression.

Vaccination anxiety when vaccinations are available: The role of existential concerns

This study examined how existential fears are related to COVID-19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness-to-death (SNtD) and death anxiety, to COVID-19 vaccination anxiety during the first month of COVID-19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID-19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID-19 vaccination anxiety while controlling for demographics and for receiving COVID-19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID-19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID-19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID-19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID-19 vaccination anxiety more effectively.

The effects of confronting one's own end of life on older individuals and those with a life-threatening disease: A systematic literature review

BACKGROUND

Awareness of the impending end of one's life can pose profound existential challenges, thereby impairing well-being. Confronting one's own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches).

AIM

To synthesize the existing knowledge on the effects of different approaches of confronting one's own end of life on older individuals and those with a life-threatening disease.

DESIGN

A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso.

DATA SOURCES

Medline, PsycINFO, and Web of Science were searched from inception to 12/2020.

RESULTS

N = 49 studies reported on different approaches of confronting one's own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being).

CONCLUSION

Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.

Ageism and Psychological Distress in Older Adults: The Moderating Role of Self-Esteem and Body Image

Ageist attitudes have been associated with negative physical consequences and psychological distress among older adults. Although holding a positive self-image and body image contributes to well-being among older adults, their combined effect on the consequences of ageism has not been examined. Accordingly, the current study examines the moderating role of both variables on the connection between ageism and psychological distress among older adults. Data were collected from 383 older adults (age range = 60-90; M = 71.44; SD = 6.62), who filled out scales assessing ageism, self-esteem, body image, and psychological distress. Psychological distress was associated with reduced self-esteem and body image. In line with the moderation hypothesis, the ageism-distress link remained significant only for individuals with low levels of both self-esteem and body image. The discussion highlights the relevance of both self-esteem and body image as important personal resources which may buffer the connection between ageism and psychological distress among older adults.