Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study

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Abstract

Background

Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China.

Methods

A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community.

Results

The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education.

Conclusions

Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13655-2.

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Most cited references 45

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The development and reform of public health in China from 1949 to 2019

Li WANG, Zhihao Wang, Qinglian Ma … (2019)

Background Public health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China. Methods The study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents. Results This study identified four key stages that public health experienced in China: the initial stage centering on prevention, the stage of deviation with more attention to treatment but little to prevention, the recovery stage after SARS(Severe Acute Respiratory Syndromes) Crisis, and the new stage to an equitable and people-centered system. In the latest stage, the National Basic Public Health Service Program (NBPHSP) is implemented to respond the threat of noncommunicable diseases (NCDs) and has achieved some initial results, while there are still many challenges including service quality, poor integration among service items and IT system, lack of quality professionals and insufficient intersectoral endeavor. Discussion There are unique Chinese wisdom and remarkable achievements as well as twists and turns on the development of China’s public health. Prevention-first, flexible structure of the system, multi-agency collaboration and mass mobilization and society participation are the main experience of public health in early stage. Despite twists and turns since 1980s, public health system in China shows substantial resilience which may be from the government’s continuous commitment to social development and people’s livelihoods and its flexible governance. In 2010s, in order to achieve the well-off society, Chinese government pays unprecedented attention to health sector, which bring a new wave of opportunities to public health such as remaining the NBPHSP for priority. The evolution and reform of China’s public health is based on its national condition, accumulates rich experience but also faces many common worldwide challenges. Getting this development and reform right is important to China’s social and economic development in future, and China’s experience in public health may provide many lessons for other countries. Conclusion Public health in China needs to focus on prevention, strengthen multi-agency coordination mechanism, improve the quality of public health services in the future.

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Death anxiety in older adults: a quantitative review.

B V Fortner, R Neimeyer (2016)

This literature review quantitatively summarized 49 published and unpublished research studies concerning the relationship between death anxiety and age, ego integrity, gender, institutionalization, physical and psychological problems, and religiosity in older adults. Results indicated that lower ego integrity, more physical problems, and more psychological problems are predictive of higher levels of death anxiety in elderly people. A suggestive but equivocal relationship was found for the predictor institutionalization. Furthermore, the review statistically demonstrated the importance of using sound methods for measuring death anxiety and sampling from the elderly population.

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Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator

Jiaxi Zhang, Jiaxi Peng, Pan Gao … (2019)

Background Death anxiety is a common phenomenon in all societies. Older adults may be more prone to death anxiety than their younger counterparts; however, death anxiety among older adults is not well understood. This study explores the relationship between meaning in life, self-esteem, and death anxiety in senior citizens in China. Methods A total of 283 older adults participated in this study; data were collected via the Meaning in Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Death Anxiety Scale. Results Results show that the dimensions of meaning in life, presence of meaning (r = − 0.43, p < 0.01), search for meaning (r = − 0.31, p < 0.01), and self-esteem (r = − 0.54, p < 0.01) were each negatively correlated with death anxiety. Regression analysis reveals that meaning in life significantly predicted self-esteem and death anxiety (F = 45.70, p < 0.01; R2 = 0.33). Path analysis indicated that self-esteem either completely or partially mediated the effects of meaning in life on death anxiety in older adults. Conclusions Overall, meaning in life appears to be significantly correlated with death anxiety in older adults, and self-esteem can mediate this effect.

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Author and article information

Contributors

Lei Lei:

ORCID: http://orcid.org/0000-0001-8766-7518

doublelei@tmmu.edu.cn

Hongyan Zhao: 745473845@qq.com

Lijuan Ran: rlj1984@swu.edu.cn

Lihua Wang: 773569612@qq.com

Yu Luo:

ORCID: http://orcid.org/0000-0002-3566-3766

luoyuhlgl@tmmu.edu.cn

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 23 June 2022

Publication date PMC-release: 23 June 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 1242

Affiliations

[1 ]GRID grid.410570.7, ISNI 0000 0004 1760 6682, School of Nursing, , Army Medical University / Third Military Medical University, ; No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 People’s Republic of China

[2 ]Xiaolongkan Community Health Service Center, No.4 Xiaolongkan Street, Shapingba District, Chongqing, 400030 People’s Republic of China

[3 ]GRID grid.263906.8, ISNI 0000 0001 0362 4044, Southwest University Hospital, ; No. 2 Tiansheng Road, Beibei District, Chongqing, 400715 People’s Republic of China

[4 ]GRID grid.410570.7, ISNI 0000 0004 1760 6682, The First Affiliated Hospital of Army Medical University, ; No. 29 Gaotanyan Street, Shapingba District, Chongqing, 400038 People’s Republic of China

Author information

Lei Lei http://orcid.org/0000-0001-8766-7518

Yu Luo http://orcid.org/0000-0002-3566-3766

Article

Publisher ID: 13655

DOI: 10.1186/s12889-022-13655-2

PMC ID: 9219144

PubMed ID: 35733112

SO-VID: f86d35fa-8712-4dcb-8866-ec45fbb761e6

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 February 2022

Date accepted : 17 June 2022

Custom metadata

ScienceOpen disciplines: Public health

Keywords: attitude to death,older adults,china,community-dwelling,cross-sectional study

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ScienceOpen disciplines: Public health

Keywords: attitude to death, older adults, china, community-dwelling, cross-sectional study

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Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Chinese Journal of School Health

Most cited references 45

The development and reform of public health in China from 1949 to 2019

Death anxiety in older adults: a quantitative review.

Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator

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Cited by 5

Most referenced authors 619