Thinking about death in old age

Towards the end of his life Stephen Leacock  wrote that he and his ageing generation were like infantry plodding  through fog under heavy fire and sensing comrades slump silently about them one by one Perhaps this was because he was oppressed by the long Canadian casualty lists from WWII. It  must been  a very bad day because he was a remarkably funny and cheerful person.  His experience does not seem typical of all elderly humans.   We studied 6500 older people in Newcastle and Manchester for twenty years and  witnessed  one death, a heart attack in our Newcastle lab on a raw February afternoon.  We became aware of hundreds of others because our volunteers had agreed that we could arrange to be notified when they died and what had killed them.  Long grey sheets of printout from Her Majesty’s Registry Office in Southport were, indeed sad casualty lists evoking  memories and affection accumulated over many shared years. We needed these delightful peoples’ final  data points to tell us how fast and how much mental abilities change as death approaches 1 and to compare the effects of different terminal illnesses on rates of change – infections, very fast and dramatic, cancers rapid, heart-disease slower 2.  We also remembered them cheerful and lively in testing sessions when they never talked about inevitable death and decline. They did not even mention death when questioned about all of the things that worried or stressed them but often made jokes about it. A dour Manchester example:

Schoolmaster:  Why did you miss school yesterday Sally ?

Sally:                   My father was burned.

Schoolmaster:  I’m very sorry; was he badly burned?

Sally:                They don’t mess about at the Crem…….

Nowadays I think that I understand their taciturnity and notice it in my own age group. We never talk with each other about our own deaths, only those of acquaintances or public figures. We are apprehensive of the process of dying. Like Woody Allan we would prefer to be somewhere else when it happens. Some of my friends have obviously given their final transitions some thought because they have keen preferences as to how they might happen but none of us think that, after a brief fuss is over,  the state of being unalive will be more threatening or mysterious than what happens to a computer program if a machine on which it runs is switched off and scrapped.

 

As we age we come to realise that death is banal. Comforting dull numbers emphasise this. According to the World Health Organization the current global average is about 56 Million deaths a year, which is about 153,400 per day, or a little more than 100 per minute. We will each share our brief departure times with  many other people. Becoming accustomed to the banality of death is reason enough to  give up talking about it. We oldies continually talk to each other about the inconveniences of age and  endlessly compare our pathologies and prostheses, but this is just normal rummaging through shared topics to keep conversations going and no more important  or interesting than grumbling about bleak weather that we experience together. In contrast, talk about death would be very boring bad manners. None of us have anything new or interesting to say about it. I do not think that we consciously and deliberately avoid it, or flinch if we are accidentally reminded of it. It is just that we have all mulled  it over so very often over so many years that we have become fed up with it and need our normal routine of  trundling about finding things that amuse us and, possibly, each other.

Not only unreliable impressions gained while ambling around Oxford but also objective research  suggests that our attitudes to death do change as we grow old.  In 2007 304 people aged from 18 to 87 filled in the “Colbert Leiter Fear of Death” questionnaire. 3 The youngest were the most aware and fearful of their eventual deaths. Men’s anxiety about death declined after  30 and throughout middle-age to a lifetime low in old age. Women also experienced  easing of death-worry between 30 and 50 but then had a second peak of death anxiety. This also  faded within a decade. Intrigued by this sex difference the same authors questioned a second sample of 113 women aged from 18 through 85 and, once again, found   a gradual decline in death-anxiety as age increased interrupted by a second peak in the 50’s and then a further relaxation. They suggest that this late female peak is associated with menopause that brings into focus losses of life potential and the inevitability of further, undesired changes. Apart from  evoking unwelcome existential insights menopause is accompanied by marked changes in hormonal and neurotransmitter balance that cause anxiety, depression, a variety of discomforts, feelings of being unable to cope and loss of morale. Many other studies from  different countries and cultures all report the same gradual reduction in fear and anxiety about death as age advances and also find that, in general, women of any age are more anxious about death than men are. A likely explanation why the young fear death more is that the longer we live the more accumulating losses of family and friends and deaths of public figures accustom us to what my most sententious colleagues call  “a sense of finitude”. Other studies of the effects of life-threatening illnesses find that young patients are the most, and elderly patients are the least upset and depressed by them. This seems another example of how older poets, like Edmund Blunden, can be sharper on the ball than designers of psychological surveys: “Life after all is nothing much to lose, but young men think it is and they were very young”. This speaks to a different discomforting possibility:  for many of us, if life becomes less rewarding death seems less important.  It is hard to generalise. Studies of patients with cardiovascular problems 4and cancer 5 find that depression is a common companion to serious illness, but this does not seem to be  brought about by the fear of impending death; rather by what life has become. A sage aphorism is that people think very seldom about death until about the age of 40 but, after this remember it every day. This does not discount the different idea that whenever they think of death the young worry more about it than the old do.  My few impertinent interrogations of my contemporaries suggest that they do think about death more often, but not more anxiously than they used to when they were young. This may be true – at least for those who gave me any polite response. Perhaps our increasing awareness of death also suggests that becoming accustomed to this inevitability removes most of our apprehension, leaving only reasonable practical concerns about planning for dependents and the best use of remaining time. Most of my more tolerant and forthcoming friends agree with this and add that, in their 70’s, they no longer entice themselves with plans or ambitions that can only mature two years or further ahead. Those who seem the most contented seem to choose to live within tighter boundaries of present time.

A different possibility is that gradual neurochemical changes make the luckier of us less prone to worry about anything at all. We regret that we do not have the energy and the focus to work as effectively as we once did but we also simply cannot worry as strenuously about anything, including  impending absence.

Most studies suggest that any increases in sadness depression and anxiety in old age are mainly due to inevitable objective difficulties such as bereavement and poverty and severe illnesses. A good side to this news is that we are not doomed to inevitable sadness in old age by neurochemical changes we cannot avoid or control. We are mainly distressed by objective predicaments that we can understand, and that may be resolved by advances in medicine, social engineering and economic equality, or by self-training in techniques such as mindful meditation.  Throughout our lives we have to confront many things that we would rather not experience but cannot do anything about. In old age we must continue to deal with these with what grace and dignity we can manage. The approach of death is one of these unpleasant inevitabilities but being aware of continually closer approach of this  final stress does not seem to be a particularly powerful downer. One strategy to keep our spirit level as we grow old is to develop a relentless curiosity about what is happening to us and to explore, with all of the intelligence and humour that we can manage, the fascinating changes we experience.  Another is to become ever more fecklessly cheerful, stumbling through the kindly fog of old age not, like Leacock, anticipating a bullet at any moment but, just as we have done all our lives,  simply looking gently about us for any fun that is to be had.

  1. Rabbitt, P., Lunn, M., & Wong, D. (2008). Death, dropout, and longitudinal measurements of cognitive change in old age. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(5), P271-P278.
  2. Rabbitt, P., Lunn, M., Pendleton, N., & Yardefagar, G. (2011). Terminal pathologies affect rates of decline to different extents and age accelerates the effects of terminal pathology on cognitive decline. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(3), 325-334.
  3. Russac, R.J. , Gatliffe, C., Reece, M. & Spottswood, D. (2007). Death Anxiety across the Adult Years: An Examination of Age and Gender effects. Death Studies, 31, 549-561.
  4. Pinquart, M. & Duberstein, P.R. (2010). Depression and Cancer Mortality, a Meta-analysis. Psychological Medicine 40, 1797-1810.
  5. Schultz, R., Beach, S.R., Ives, D.G. Martire, L.M. et al.  (2000). Association Between Depression and Mortality in Older Adults. The Cardiovascular Health Study  Arch Intern Me ;160. :1761-1768.
  6. Yong, H-H., Gibson, S.J., Home, D,J, deL., Helme, R. D. (2001) Development of a Pain Attitudes Questionnaire to Assess Stoicism and Cautiousness for Possible Age Differences Journal of Gerontology, B., 56, 279-284.

About Gray Rabbitt

Grumpy gerontologist
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