Anxiety About Illness and Death: An Essay on How We Change as We Get Older

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    As friends and confidants across a lifetime begin to disappear, and one’s own health…is compromised, people still often seem to find creative and inspiring ways to accommodate the ‘new normal’ that multiple losses impose.

-Dr. Jason Holland, Lifespark

This essay on anxiety about illness and death as we get older was originally published in ‘Aging Wisely. Wisdom of Our Elders’ edited by Irving Silverman and Ellen Beth Siegel and is republished in Lifespark Weekly with permission from the editors.

Conscious anxiety about death and dying is a relatively common human experience.

From a developmental perspective, though, older adults tend to report less of it than others. Many indicate that they have simply accepted death, or have come to terms with it in some way. And that certainly makes a good deal of sense. Much more so than for other age groups, older individuals are likely to have experienced multiple losses. Particularly among those in senior living environments, the death of friends, neighbors, and family members can become a regular affair.

Thus, it’s certainly reasonable to speculate that seniors may simply get better at managing anxiety about death with the repeated exposure that comes with having lived a full life.

READ RELATED: Saying Goodbye: What Makes the Difference between Resiliency and Despair?

At the level of thoughts and emotions, however, the picture becomes a bit more complex. Here, we find that the threat of repeated losses, whether of the interpersonal or health-related kind, can bring about major adjustments in coping. Remarkably, as friends and confidants across a lifetime begin to disappear, and one’s own health condition and ability to perform daily tasks is compromised, people still often seem to find creative and inspiring ways to accommodate the ‘new normal’ that multiple losses impose. They may appropriately adjust their expectations or goals, as a way of developing a healthy acceptance of personal limitations. For many, there may also be a greater propensity to look for the silver lining in stressful life events or even find some paradoxical and bittersweet humor in them.

This phenomenon has been termed the positivity effectwhich refers to older adults’ tendency to favor positive over negative stimuli when processing information.

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Although the existence of the positivity effect has been confirmed in multiple studies, its origins are still a source of great debate. Is it primarily due to neurological changes associated with aging? Or is there more of a psychosocial process going on—a kind of learning that takes place leading one to conclude that life is short and we must look for the good in every moment? As a clinical psychologist, I am naturally biased toward the latter interpretation.

Working on an inpatient hospice unit, I witnessed countless individuals who, despite the apparent hopelessness of their situation, dug deep within themselves to somehow make the very most of their final moments on Earth.  

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Roger was among these men and women that I encountered in hospice . At age 67, he was diagnosed with lymphoma, and his health went steadily downhill from there. However, he still showed strong signs of life, even after learning that he likely had six months or less to live. I would find him outside gathered with other patients smoking cigarettes, absorbed in conversation. He became a very popular guy on the unit. Though eventually confined to a wheelchair, he remained a significant presence, whether he was joking around in the hallway or rounding up a group for a spontaneous ice cream social.

Still, Roger raised concerns among many of the staff. He seemed to completely ignore his impending death. His remaining family only came to visit sporadically, seemingly because he preferred not to tell them just how dire his situation had become. Even though doctors and nurses explained to him numerous times that his condition was terminal and likely to progress quickly, it wasn’t even entirely clear if Roger himself had fully digested that information. In fact, he was once overheard explaining on the phone that he was feeling much better now and likely to be released from the hospital soon.

It was my job to go in and talk to Roger about this.

He must have known it before I even walked through the door. Without breaking his gaze from the television hanging above his hospital bed, Roger cut to the chase. “I’m not going to talk about it,” he said to me in a matter-of-fact tone.

My first reaction was to do what many therapists probably would in that moment. Rolling with the resistance, as some might say, I nudged him to go just a few inches further. “That’s fair. I’m not going to make you talk about anything you don’t want to. What would it be like, though, to have an honest conversation with me about it—about what’s going on with your health? What do you think might happen?”

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He wasn’t taking the bait.

I had tried those therapist tricks on him before, and he saw it coming from a mile away. He looked me in the eyes and calmly but firmly asserted, “You can stay here and watch football with me in my room if you want, Doc. But if you keep pushing on this, I’m going to have to ask you to get out of here.” I hadn’t yet earned my Ph.D. and appreciated the vote of confidence. With little other choice, I opted for football.

As I sat down, I realized it actually wasn’t a live football game but instead one of those NFL documentaries showing all of the glorious highlights of Super Bowl past. A scene from Super Bowl XXXIV played on the screen. It was an epic matchup between the Tennessee Titans and St. Louis Rams that was played only 30 days into the new millennium. Befitting of the first Super Bowl of the 21st century, the game ended with a miraculous, game-winning play by the Rams’ defense that has since been labeled “The Tackle.” Watching it for the first time in nearly ten years, I instinctively winced. Surprised by my reaction, Roger leaned over and asked, “Are you a football fan, Doc?”

I was (and remain) a football fan and remembered that Super Bowl very clearly. I grew up in Tennessee and had only recently moved to the West Coast to finish up my schooling. Like most Tennesseans on January 30th of 2000, I was at home with my family watching the game. Our eyes were glued to the television set, as the Tennessee Titan’s quarterback, Steve McNair, took the final snap and completed a pass to Kevin Dyson only two yards away from the goal line and a Super Bowl win.

As I recounted the story to Roger, I could see his eyes lighting up.

Suddenly, I found myself on my feet acting the scene out in front of his hospital bed as though it were a private stage. Using the curtain as a makeshift goal line, I reenacted Kevin Dyson’s valiant but failed effort to reach the end zone and stretched my arms forward, holding an imaginary football that fell just inches short of its target. “It was absolute pandemonium in my house,” I explained. Contorting my face to convey the “weeping and gnashing of teeth” that took over my family that night, we burst into a spontaneous fit of laughter. And for a brief moment, I wasn’t a therapist and he wasn’t a terminally-ill patient. We connected as human beings in a way that seemed to transcend the bleached walls of the hospital room.

Only days later, Roger’s condition worsened, and it was determined that he could no longer make medical decisions for himself.

His designated guardian was notified that death was imminent. As friends and family gathered around his bedside, there were tearful remembrances of Roger, intermixed with expressions of surprise and confusion about his choice to minimize his condition for so long. If only he knew our thoughts and could feel what we feel now, surely he would have made a different decision and been more forthcoming. At least, that was the assumption at the time.

But, that is an assumption of the living and the healthy. Although I imagine myself approaching my own death in a different way, I’m also hyper-aware of the fact that a ‘good death’ is highly subjective, not too unlike a ‘good life.’ What Roger knew, that no one else seemed to fully appreciate, is that he had made up his mind a long time ago about what he wanted to stand for and value in his life as well as in his death. He couldn’t be burdened with more bad news about his health. He was too busy connecting with other people and bringing out the best of them, just as he did with me that day in his hospital room.

READ RELATED: Talk to Your Future Self and Learn How to Discover Your Core Values

When I catch myself contemplating death and a wave of terror comes upon me, my mind sometimes turns to Roger.

Thinking about his friends and family holding hands and singing songs around his bedside, I wonder, “What would I want people to say about me on my deathbed?” Or put another way, what do I really want to stand for in this world? The answer is always a moving target. I never quite get there, falling inches short of the goal no matter how far I stretch my arms forward. Still, somewhere deep inside, I find a voice that tells me to keep pushing forward anyway, no matter how much the odds seem to be stacked against me.  


Further Reading:














Addis, D. R., Leclerc, C. M., Muscatell, K. A., & Kensinger, E. A. (2010). There are age-related changes in neural connectivity during the encoding of positive, but not negative, information. Cortex, 46, 425-433.

Brandtstädter, J., & Renner, G. (1990). Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychology and Aging, 5, 58-67.

Carstensen, L. L., & Mikels, J. A. (2005). At the intersection of emotion and cognition: Aging and the positivity effect. Current Directions in Psychological Science, 14, 117-121.

Kennedy, Q., Mather, M., & Carstensen, L. L. (2004). The role of motivation in the age-related positivity effect in autobiographical memory. Psychological Science, 15, 208-214.

Mather, M., & Carstensen, L. L. (2005). Aging and motivated cognition: The positivity effect in attention and memory. Trends in Cognitive Sciences, 9, 496-502.

Rasmussen, C. A., & Brems, C. (1996). The relationship of death anxiety with age and psychosocial maturity. The Journal of Psychology, 130, 141-144.

Reed, A. E., & Carstensen, L. L. (2012). The theory behind the age-related positivity effect. Frontiers in Psychology, 3, 339.

Reed, A. E., Chan, L., & Mikels, J. A. (2014). Meta-analysis of the age-related positivity effect: age differences in preferences for positive over negative information. Psychology and Aging, 29, 1-15.

Rehmert, A. E., & Kisley, M. A. (2013). Can older adults resist the positivity effect in neural responding? The impact of verbal framing on event-related brain potentials elicited by emotional images. Emotion, 13, 949-959.

Thorson, J. A., & Powell, F. C. (2000). Death anxiety in younger and older adults. In A. Tomer (Ed.), Death attitudes and the older adult: Theories, concepts, and applications (pp. 123-136). New York, NY, US: Brunner-Routledge.

Sneed, J. R., & Whitbourne, S. K. (2001). Identity processing styles and the need for self-esteem in middle-aged and older adults. The International Journal of Aging and Human Development, 52, 311-321.


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