Still You: End-of-Life Anxiety and Coming to Terms with Death as a Part of Life

A cancer diagnosis five years before had left Iris caught up in an imminent fear of death. Even though she’d since gone into remission, thoughts of death haunted her — at 65 years old, she didn’t know how to move through them. Her doctor recommended a psychologist in her area, and after the first few sessions, Iris began feeling a deep sense of relief. Finally opening up to another person about her fears and anxieties was both healing and freeing. Talking with a professional also gave Iris the courage to take concrete steps forward, like creating an advance directive, speaking candidly with family members, and focusing on mindful practices. These efforts, in turn, helped her feel more in control and eventually come to terms with her own mortality.

Facing Mortality as an Older Adult
When Cornell professor Karl A. Pillemer conducted a study of more than 1200 aging Americans, he found it surprising how many seemed comfortable talking about their own mortality. Yet a number of older adults in the US still battle a serious fear of death that hinders them from living their remaining days in peace.
Other studies explore the multiple factors that can influence someone’s relationship with death. These include a person’s level of self-esteem, physical health, and perceived amount of social support. Other influencers are one’s religious and spiritual beliefs, their cultural values, and how they deal with uncertainty and fear of the unknown. And relationships come into play, too: the health of our children, our connection with immediate family, and the loss of a spouse all factor into how we deal with our own mortality.
Of course, cultures around the world have very different approaches to death. Many Asian and African cultures see death as something to be wholly embraced and as an integral part of life. Some Western cultures, on the other hand, promote fear instead of acceptance. We teach people that being young is better than being old; our answer to old age is often to ignore or deny its existence. As professor Michael Friedman points out, “Death is morbid, but coming to terms with it is a key developmental challenge of old age and a major challenge for our health and mental health systems.”
As caregivers, it’s important to talk with our aging loved ones about their thoughts and feelings on death. The consequences of fearing one’s own mortality are significant: your loved one might be struggling with unnecessary fear, anxiety, and confusion that could be avoided with a few carefully chosen proactive steps. After all, our aging loved ones deserve to live out their remaining years with as much peace and resolve as possible.
Ways for Your Loved One to Cope with End-of-Life Anxiety
There are certain coping strategies that can make a big difference in helping your loved one explore and accept their own mortality:

  • Seek information. When it comes to sensitive topics like palliative care and end-of-life choices, being well-informed can help reduce the amount of anxiety your loved one feels. You can start by having a gentle conversation about these issues to see what your loved one wants to know more about. By doing online research, you can discover how organizations, such as IOA, can help support your inquiries about dying and death.
  • Create an advance directive. Going through the process of getting an advance directive will guide your loved one to learn more about their options and confront difficult scenarios like the possibility of terminal illness. It also means speaking with family members and getting everyone on the same page to support your aging loved one. While this can be challenging at times, it’s well worth the effort: many older adults feel very relieved when they know they have a plan in place for the worst case scenarios and the support of both their family and doctors.
  • Join a support group. Being able to talk with other people in their age group can give your loved one the social support they need. Many community centers and aging organizations offer senior support groups where older adults can share their feelings in a safe environment. This type of setting also encourages participants to offer emotional support to each other, which can be really healing. If you’re having trouble finding a support group in your loved one’s area, consider asking local therapists for recommendations. Keep in mind that services like the Friendship Line—where your loved one can share their feelings with a trained compassionate volunteer or staff professional anytime—can be equally beneficial.
  • Keep a journal. If your loved one enjoys writing, keeping a journal of their thoughts is a great way to explore their feelings and fears. Journaling is known to help people cope with their fear of death. To get started, you might check in to see whether your loved one is keen on the idea — if they are, offer suggestions for topics to write about such as their anxieties and fears. Together you can talk about what your loved one writes down.
  • Mend relationships. Repairing broken relationships can help your loved one to face their own mortality. Healing unresolved issues with partners, parents, siblings, or children can offer your loved one the resolution they need to step into this final phase of life peacefully. Patching up important connections before it’s too late can support your loved one in learning and growing during this transitory time.
  • Speak with a professional. If your loved one is struggling to come to terms with their own mortality after attempting the ideas above—or if they’re having a hard time moving forward on them—then it might be time to consult a professional. As older adults are aware of the passage of time, it’s likely that talking with a therapist, psychologist, or counselor will be helpful because older people are more motivated to explore death and dying issues. An experienced professional will offer guidance to your loved one on how to move forward.

Other Benefits of Speaking to a Professional

Aside from general guidance, talking with a professional about end-of-life challenges can offer a range of mental health benefits to older adults. A good, professional therapist knows the right questions to uncover any deep-seated issues, is trained to listen compassionately, and can offer  steps for coping in healthier ways. Your aging loved one might even feel more comfortable seeking emotional support from a professional than family members: some older adults don’t want to burden their families with their anxieties and fears, and so they choose to repress these thoughts. A professional, meanwhile, provides a neutral and confidential space for your loved one to share whatever they need to discuss. Professional counselors might also be able to facilitate resolutions, like acting as a mediator for family conflict or providing family counseling if your loved one needs support in mending relationships.
Encouraging your loved one to openly communicate about their own mortality, whether with family members or a professional, can help them come to terms with this final phase. And as your loved one works to reframe their perspective on mortality, it might even provide you and your family encouragement to do the same. Seeing our own mortality as no more than a continuation of our journey as human beings, and embracing life for all that it is—pain, love, life, and death—can help us all to make the most of our lives in the present moment.
For families and caregivers wanting to offer their aging loved ones the best support possible, Institute on Aging provides an array of services and resources to help you do just that. Get in touch with us today to learn more.

Picture of Dr. Patrick Arbore

Dr. Patrick Arbore

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