Social Policy and Society, 19(4), 2020, pp.553-572.
Publisher:
Cambridge University Press
New demographic and epidemiological trends mean people are dying at older ages and over long periods of time, from multiple, chronic illnesses. There is a perception that these growing and changing needs will require novel community responses. One starting point is having ‘conversations’ about dying and death, and in this the phenomenon of ‘Death Cafe’ merits attention. In the first study of its kind, this paper reports on interviews with forty-nine Death Café organisers in thirty-four countries, exploring how this ‘cultural intervention’, first developed in the UK, has transferred elsewhere. Thematic analysis identified competing tensions between: local translation of Death Cafe and a desire for international alignment alongside instrumental use of the Death Cafe form and its incidental effects. The passion and commitment of Death Cafe organisers is compelling but may not lead to the behavioural change required to support a new public face of dying.
(Edited publisher abstract)
New demographic and epidemiological trends mean people are dying at older ages and over long periods of time, from multiple, chronic illnesses. There is a perception that these growing and changing needs will require novel community responses. One starting point is having ‘conversations’ about dying and death, and in this the phenomenon of ‘Death Cafe’ merits attention. In the first study of its kind, this paper reports on interviews with forty-nine Death Café organisers in thirty-four countries, exploring how this ‘cultural intervention’, first developed in the UK, has transferred elsewhere. Thematic analysis identified competing tensions between: local translation of Death Cafe and a desire for international alignment alongside instrumental use of the Death Cafe form and its incidental effects. The passion and commitment of Death Cafe organisers is compelling but may not lead to the behavioural change required to support a new public face of dying.
(Edited publisher abstract)
The experience of dying and death has changed considerably over the last century. At the beginning of the 20th century, children aged 0-4 were the age group with the highest proportion of deaths. Improvements in public health, including the prevention and treatment of infectious diseases, greatly reduced the proportion of deaths in childhood and early adulthood. By 1951 the position had changed to one in which people aged 75 years and over accounted for 39% of deaths. By 2004, 65% of all people who died were aged 75 and over. The causes of death have also changed. More people now die as a result of chronic illnesses such as heart disease, cerebrovascular disease (including stroke), respiratory disease and cancer.
The experience of dying and death has changed considerably over the last century. At the beginning of the 20th century, children aged 0-4 were the age group with the highest proportion of deaths. Improvements in public health, including the prevention and treatment of infectious diseases, greatly reduced the proportion of deaths in childhood and early adulthood. By 1951 the position had changed to one in which people aged 75 years and over accounted for 39% of deaths. By 2004, 65% of all people who died were aged 75 and over. The causes of death have also changed. More people now die as a result of chronic illnesses such as heart disease, cerebrovascular disease (including stroke), respiratory disease and cancer.
Social Science and Medicine, 62(2), January 2006, pp.329-336.
Publisher:
Elsevier
Several studies have investigated the cumulative influence of disadvantage acting from early to adult life. And they suggest that risk of death increases in a cumulative fashion. Few studies have investigated the life-course influences on social inequality in mortality in early old age. In this study we wanted to follow a cohort through their adult working age into retirement and investigate pathways that may give increased risk of mortality. A cohort of all inhabitants in the age range 68–72 who lived in the municipality of Oslo on 1st January 1990 was selected. Data were obtained by linking censuses from 1960, 1970 and 1980 with tax registry in 1990 and death registry 1990–1998. Independent variables were occupational class in 1960, 1970 and 1980 and household income in 1990. Occupational class was coded as manual and non-manual and household income as above or below median household income. A cumulative model was developed by adding times of disadvantage. Then a pathway model was developed which investigated the specific trajectories individuals followed. Most of the increased risk of death was explained by individuals’ social conditions in 1990. In the cumulative model, there was no clear gradient in the groups between the bottom and top categories. This suggests that the cumulative model is not important in the high mortality age and that the relative importance of a cumulative effect varies by stages of the life course.
Several studies have investigated the cumulative influence of disadvantage acting from early to adult life. And they suggest that risk of death increases in a cumulative fashion. Few studies have investigated the life-course influences on social inequality in mortality in early old age. In this study we wanted to follow a cohort through their adult working age into retirement and investigate pathways that may give increased risk of mortality. A cohort of all inhabitants in the age range 68–72 who lived in the municipality of Oslo on 1st January 1990 was selected. Data were obtained by linking censuses from 1960, 1970 and 1980 with tax registry in 1990 and death registry 1990–1998. Independent variables were occupational class in 1960, 1970 and 1980 and household income in 1990. Occupational class was coded as manual and non-manual and household income as above or below median household income. A cumulative model was developed by adding times of disadvantage. Then a pathway model was developed which investigated the specific trajectories individuals followed. Most of the increased risk of death was explained by individuals’ social conditions in 1990. In the cumulative model, there was no clear gradient in the groups between the bottom and top categories. This suggests that the cumulative model is not important in the high mortality age and that the relative importance of a cumulative effect varies by stages of the life course.
... epidemiological data, the narrative stories on the ageing experience of a sub-sample of 20 respondents (10 men and 10 women) were tape-recorded. A five-year follow-up was carried out with the same cohort in 1995, when 17 of the original sub-sample of 20 were still alive. Unlike five years previously, most of the narrators said they had now crossed the line into old age. At the ten-year follow-up in 2000, six
This paper presents, analyses and interprets expressions of the experience of advanced old age based upon the concepts of the French phenomenologist, Maurice Merleau-Ponty, and the German philosopher, Martin Heidegger. During 1990, 262 older residents of the city of Jyväskylä in central Finland were interviewed. They were born in 1910 and aged 80 years at the time. In addition to collecting epidemiological data, the narrative stories on the ageing experience of a sub-sample of 20 respondents (10 men and 10 women) were tape-recorded. A five-year follow-up was carried out with the same cohort in 1995, when 17 of the original sub-sample of 20 were still alive. Unlike five years previously, most of the narrators said they had now crossed the line into old age. At the ten-year follow-up in 2000, six women and four men were still alive to describe their experience at 90 years of age. Collective history and objective structures had provided a common foundation for my narrators' notions of the world – of right and wrong and of good and bad. Over their lifetime, this socio-cultural background had gradually changed, and they perceived the changes. Moreover, in the earlier stages of the study, they voiced criticisms of these changes. At age 90 years, however, they no longer criticised society or its people. By this time, it seems they felt they had completed the mission of living a life.
Subject terms:
life story books, self-concept, ageing, death, emotions;
Ageing and Society, 18(6), November 1998, pp.673-689.
Publisher:
Cambridge University Press
This article draws on interviews with people over the age of 75 to explore the nature of attitudes to death in old age. It focuses on the issues raised by elderly people themselves when given the opportunity to talk about death and dying. In so doing, attitudes to death and dying are separated into 'death of self' and 'death of other'. each of these categories is then divided thematically according to the issues raised by respondents.
This article draws on interviews with people over the age of 75 to explore the nature of attitudes to death in old age. It focuses on the issues raised by elderly people themselves when given the opportunity to talk about death and dying. In so doing, attitudes to death and dying are separated into 'death of self' and 'death of other'. each of these categories is then divided thematically according to the issues raised by respondents.
Subject terms:
older people, quality of life, ageing, attitudes, death;
FINKELSTEIN Adi, TENENBAUM Ariel, BACHNER Yaacov G.
Journal article citation:
Ageing and Society, 40(8), 2020, pp.1788-1807.
Publisher:
Cambridge University Press
The life expectancy of people with Down syndrome (DS) has increased significantly over the last few decades. Consequently, they and their families face new ageing-related challenges, the first signs of which appear in people with DS around the age of 30. The goal of this study was to explore the perceptions of adults with DS regarding their own and their parents’ ageing and end of life, and to examine the views and concerns of the parents regarding the ageing of their children with DS. The unique approach used in this study was to convene not only the ageing people with DS but also their parents, to discuss the subject together. A total of 33 people with DS participated in the study. Most of them were interviewed with one or two parents. Participants with DS found it difficult to talk about their own old age and addressed the issue mainly through the decline in the functioning of an older person they knew. The parents emphasised the changes needed in terms of the official regulations, so as to ensure that their children with DS age with dignity and quality of life. The study identifies the increasingly pressing need to prepare adults with DS for their own and their parents’ ageing and end
(Edited publisher abstract)
The life expectancy of people with Down syndrome (DS) has increased significantly over the last few decades. Consequently, they and their families face new ageing-related challenges, the first signs of which appear in people with DS around the age of 30. The goal of this study was to explore the perceptions of adults with DS regarding their own and their parents’ ageing and end of life, and to examine the views and concerns of the parents regarding the ageing of their children with DS. The unique approach used in this study was to convene not only the ageing people with DS but also their parents, to discuss the subject together. A total of 33 people with DS participated in the study. Most of them were interviewed with one or two parents. Participants with DS found it difficult to talk about their own old age and addressed the issue mainly through the decline in the functioning of an older person they knew. The parents emphasised the changes needed in terms of the official regulations, so as to ensure that their children with DS age with dignity and quality of life. The study identifies the increasingly pressing need to prepare adults with DS for their own and their parents’ ageing and end of life in a timely manner.
(Edited publisher abstract)
Subject terms:
Downs syndrome, parent-child relations, life expectancy, ageing, attitudes, death;
Objective: Clinicians may question whether thoughts of being better off dead are normal consequences of aging or symptoms of depression. This study examines whether thoughts of suicide are as strongly linked to depression severity in older adults as they are in other age groups. Methods: Cross-sectional cohort study. Participants included 509,945 outpatients >18 years old from four large integrated healthcare systems in the Mental Health Research Network who completed 1.2 million Patient Health Questionnaires (PHQ) and had data to calculate Charlson Comorbidity Index scores from 2010 through 2012. The PHQ8 estimated depression severity, while suicidal ideation was measured using the 9th item of the PHQ. Data were abstracted from a Virtual Data Warehouse. Results: In older adult patients, suicidal ideation was strongly associated with depression severity. Older adults who had at least moderately-severe depression (PHQ8 ≥15) were 48 times more likely (95% CI: 42.8–53.8) to report suicidal ideation than those with minimal or mild symptoms of depression (PHQ8 <10) after adjustment for all other variables in the model, including medical comorbidity burden. Conclusions: Depression severity was by far the strongest predictor of suicidal ideation in older adult patients. Older patients with suicidal ideation should be screened for depression.
(Edited publisher abstract)
Objective: Clinicians may question whether thoughts of being better off dead are normal consequences of aging or symptoms of depression. This study examines whether thoughts of suicide are as strongly linked to depression severity in older adults as they are in other age groups. Methods: Cross-sectional cohort study. Participants included 509,945 outpatients >18 years old from four large integrated healthcare systems in the Mental Health Research Network who completed 1.2 million Patient Health Questionnaires (PHQ) and had data to calculate Charlson Comorbidity Index scores from 2010 through 2012. The PHQ8 estimated depression severity, while suicidal ideation was measured using the 9th item of the PHQ. Data were abstracted from a Virtual Data Warehouse. Results: In older adult patients, suicidal ideation was strongly associated with depression severity. Older adults who had at least moderately-severe depression (PHQ8 ≥15) were 48 times more likely (95% CI: 42.8–53.8) to report suicidal ideation than those with minimal or mild symptoms of depression (PHQ8 <10) after adjustment for all other variables in the model, including medical comorbidity burden. Conclusions: Depression severity was by far the strongest predictor of suicidal ideation in older adult patients. Older patients with suicidal ideation should be screened for depression.
(Edited publisher abstract)
Working with Older People, 19(3), 2015, pp.140-149.
Publisher:
Emerald
Purpose: The purpose of this paper is to report a pilot study that evaluated an innovative practice in a faith community context designed to help older people live well at the end of life and prepare for death.
Design/methodology/approach: A simple audit of the intervention using a contemporaneous journal kept by the author, and a follow up questionnaire completed by participants.
Findings: Rich findings on the process are reported. These indicate a high degree of engagement by participants, the establishment of a high degree of group intimacy and trust, a high level of articulation of wisdom, the emergence of significant anxiety in some isolated cases, and the use made of tea and cake to manage the transition between the existentially demanding nature of the discussions and normal life. The outcome indicated very high levels of appreciation and increased confidence in relation to issues of death and dying.
Practical implications: The findings of the pilot have been used to inform training of clergy in the principles of working in this area (e.g. in ways of managing group dynamics and anxiety, pacing, tuning in to archetypes and the natural symbols that people use to talk about death and dying, self-care and supervision of the programme leader/facilitator).
Originality/value: The paper adds to knowledge in terms of an in depth description of processes at work in a group of older people working on spiritual and practical issues in relation to death, and offers ideas for supporting older people in this process, some of which are specific to the Christian tradition, and some of which are more widely applicable to people of all faiths and none. It gives a specific worked example of what “spiritual care” in this area might look like.
(Publisher abstract)
Purpose: The purpose of this paper is to report a pilot study that evaluated an innovative practice in a faith community context designed to help older people live well at the end of life and prepare for death.
Design/methodology/approach: A simple audit of the intervention using a contemporaneous journal kept by the author, and a follow up questionnaire completed by participants.
Findings: Rich findings on the process are reported. These indicate a high degree of engagement by participants, the establishment of a high degree of group intimacy and trust, a high level of articulation of wisdom, the emergence of significant anxiety in some isolated cases, and the use made of tea and cake to manage the transition between the existentially demanding nature of the discussions and normal life. The outcome indicated very high levels of appreciation and increased confidence in relation to issues of death and dying.
Practical implications: The findings of the pilot have been used to inform training of clergy in the principles of working in this area (e.g. in ways of managing group dynamics and anxiety, pacing, tuning in to archetypes and the natural symbols that people use to talk about death and dying, self-care and supervision of the programme leader/facilitator).
Originality/value: The paper adds to knowledge in terms of an in depth description of processes at work in a group of older people working on spiritual and practical issues in relation to death, and offers ideas for supporting older people in this process, some of which are specific to the Christian tradition, and some of which are more widely applicable to people of all faiths and none. It gives a specific worked example of what “spiritual care” in this area might look like.
(Publisher abstract)
Subject terms:
older people, religions, end of life care, death, dying, ageing;
International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.923-929.
Publisher:
Wiley
Using a cross-national longitudinal design, this study evaluated regional variations (South, Centre and North of Europe) in passive death wishes (wish to die) and predictors of passive death wishes. It used data from wave 1 (2004) and wave 2 (2006-2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE), a survey of individuals aged over 50 years and their spouse of any age.
Using a cross-national longitudinal design, this study evaluated regional variations (South, Centre and North of Europe) in passive death wishes (wish to die) and predictors of passive death wishes. It used data from wave 1 (2004) and wave 2 (2006-2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE), a survey of individuals aged over 50 years and their spouse of any age. The statistical analysis found that the rate of passive death wishes was significantly lower in Northern (4.6%) than in Southern (8.5%) and Central (7%) Europe. The article reports that older adults, women, and those reporting more depressive symptoms, more medical conditions and lower levels of hope in wave 1 were more likely to report passive death wishes in wave 2, that passive death wishes were associated with increased mortality risk, and that most predictors of passive death wishes functioned similarly across geographic regions.
Subject terms:
life expectancy, longitudinal studies, mortality, older people, ageing, death;
Using widow(er) statistics and four successive sets of census data (1971-2001) on married couples from the Office for National Statistics Longitudinal Study, this study examines changes in couples’ living arrangements and households and shows how these differ by age and gender on the death of a spouse or partner. The findings are discussed in the following sections: age on death of spouse (independently, with extended family, or in communal/residential care); residential mobility before and after death of spouse; numbers of couples separated by death. Residential independence and mobility in older age and the policy directions chosen in the future for long-term care provision for older people are also briefly discussed.
Using widow(er) statistics and four successive sets of census data (1971-2001) on married couples from the Office for National Statistics Longitudinal Study, this study examines changes in couples’ living arrangements and households and shows how these differ by age and gender on the death of a spouse or partner. The findings are discussed in the following sections: age on death of spouse (independently, with extended family, or in communal/residential care); residential mobility before and after death of spouse; numbers of couples separated by death. Residential independence and mobility in older age and the policy directions chosen in the future for long-term care provision for older people are also briefly discussed.