Exploring Death Anxiety Among Older Adults: An Integrative Review of Associated Factors and Interventions.

With the aging of the population and the substantial surge of individuals above the age of 60, psychological concerns particular to this population have come to hold more weight on the healthcare and social levels. One of the concerns of older adults, which can significantly influence their psychological well-being, is the fear of inevitable mortality or death anxiety. This integrative review tackles the subject of death anxiety among older adults by providing a comprehensive synthesis of the factors associated with death anxiety and the effective interventions to mitigate it. A systematic screening of relevant articles was conducted using the PRISMA guidelines. Content and thematic analysis of 46 selected articles were performed, from which five key themes emerged: demographic factors, psychological and psychosocial factors, spiritual and religious factors, death reminders, and effective interventions. The review contributes to the field of thanatology and offers clinical insights into the care of older adults.

Some Personal Reflections on the History and Current Status of Textbooks in the Field of Death, Dying, and Bereavement.

This article is a contribution to recording one dimension of the history of education in the field of death, dying, and bereavement. It offers some personal reflections on the history and current status of textbooks in our field that have been or are currently published in North America. The scope of this reflection looks back on the earliest textbooks in this field published in the 1960s and 1970s and extends to textbooks published in the early 2020s. Critical comments are offered on general trends or on textbooks that are no longer in print, but not on individual titles that are currently available for adoption and instructional use. Because I am the lead author of one such textbook, I do not choose to engage in invidious comparisons. Instead, this article includes descriptions of contemporary textbooks taken from the Amazon website.

Necrophilic behaviour in wild stump-tailed macaques (Macaca arctoides).

Necrophilic behavior (attempted copulation with corpses) has been scarcely reported in non-human primates, especially in the wild. Here is the first case of necrophilic behavior observed in wild stump-tailed macaques in Thailand. Six groups of total N > 460 individuals have been identified and habituated. The corpse of an adult female was found and directly observed for 2 days and by camera trap for 3 days. The cause of death could not be identified, but no prominent physical injury was detected. Within 3 days of the observation, three different males attempted copulation with the corpse. Noteworthy for this observation was that not only males in the group of the dead female but also males from different groups interacted with the corpse. Taken together, these observations suggest that some cues emanating from the corpse coupled with a nonresistant/passive orientation may have triggered these responses in the males. Given that necrophiliac responses have been scarcely reported in non-human primates, our findings provide new insight into these behaviors and to comparative thanatology in general.

Some Reflections On The History And Current Status of Education in the Field of Death, Dying, and Bereavement at the College and University Level In North America.

This article is a contribution to recording one dimension of the field of death, dying, and bereavement. It offers some personal reflections on the history and current status of formal education in this field at the college and university level in North America. The scope of this reflection looks back on the earliest known examples of formal education in this field that took place in the 1960s and 1970s, provides examples of some of the early pedagogical resources that were created to support and foster those initiatives, and sketches more recent developments as regards introductory or undergraduate survey courses in this field, other death-related courses, programs in thanatology, and efforts to offer certificates or certification for educators and other professionals in this field. The article concludes with some thoughts about what we have learned from and about education in the field of death, dying, and bereavement.

Processo de morte e morrer e cuidados paliativos: um pleito necessário para graduação em enfermagem / Death and dying process and palliative care: a necessary claim for nursing undergraduation / Proceso de muerte y el morir y cuidados paliativos: un reclamo necesario para la carrera de enfermería

Objetivo: analisar a percepção dos estudantes de graduação em enfermagem sobre a temática "o processo de morte e morrer" e sua abordagem durante sua formação. Método: estudo descritivo, exploratório, com abordagem qualitativa, desenvolvido com alunos do último ano de graduação em Enfermagem de uma universidade pública do Rio de Janeiro. Resultados: Participaram do estudo 57 estudantes e, após a organização dos dados emergiram as classes: "Sentimentos frente à morte"; "A necessidade da abordagem do conteúdo de morte na graduação"; "A vivência da morte do paciente" e "Atitude de cuidado diante do processo de morte". Considerações finais: uma formação que contemple o estudo da tanatologia e a filosofia dos cuidados paliativos é de suma importância, dado ao fato de que a morte é consequência inexorável da vida. O estudo reafirma a necessidade constante desta discussão durante a formação e o exercício da enfermagem(AU)

Objective: to analyze the perception of undergraduate nursing students about the theme, "the process of death and dying" and its approach during their training. Method: descriptive, exploratory study, with a qualitative approach developed with students of the last year of undergraduate nursing in a public university in Rio de Janeiro. Results: 57 students participated in the study and, after organizing the data, the following classes emerged: "Feelings about death"; "The need to approach the content of death in training education"; "The patient's death experience" and "Care attitude towards the process of death. Final considerations: nursing undergraduation education must have included the study of thanatology and the philosophy of palliative care, due to the importance given that death is an inexorable consequence of life. The study reaffirms the importance of this discussion happening during the nursing education training and over nursing work(AU)

Objetivo: analizar la percepción de los estudiantes de enfermería sobre el tema "El proceso de la muerte y el morir" y su enfoque durante los estudios de formación. Método: Investigación descriptiva, exploratoria, con enfoque cualitativo desarrollado junto a estudiantes del último año de pregrado en enfermería en una universidad pública de Rio de Janeiro. Resultados: En el estudio participaron 57 alumnos y, tras organizar los datos, surgieron las siguientes clases:"Sentimientos ante la muerte"; "La necesidad de abordar el contenido de muerte en el pregrado"; "La experiencia de la muerte del paciente" y "Actitud de cuidado ante el proceso de muerte". Consideraciones finales: una formación que incluya el estudio de la tanatología y la filosofía de los cuidados paliativos es de suma importancia dado que la muerte es una consecuencia inexorable de la vida. El estudio reafirma la necesidad de que esta discusión sea constante durante la formación y el ejercicio de la enfermería(AU)

Death Preparedness: Development and Initial Validation of the Advance Planning Preparedness Scale.

Delayed advance planning and costs of life sustaining treatments at end of life significantly contribute to the economic burden of healthcare. Clinician barriers include perceptions of inappropriate timing, lack of skills in end-of-life communication and viewing readiness as a behavior rather than a death attitude. This study developed and validated a measurement of psychological preparedness for advance directive completion. Confirmatory factor analysis (N = 543) of a 35 item pool (Cronbach α = .96) supported five sub-scales; psychological comfort (α = .87), desire to know (α = .88), thinking (α = .84), willingness (α = .82) and existential reflection (α = .79) with a possible common factor (α = .84). Results suggested significant predictors of completing directives in 30 days included discussion (OR .08, p < .001), preparedness (OR 4.08, p = .03) and uncertainty (OR 4.37, p = .02). APP = 35 is a reliable and valid measure with utility to assess readiness for completion of EOL documents.

A report of stillbirth and subsequent maternal cannibalism observed in a free-ranging group of Japanese macaques at Awajishima, Japan.

How primate mothers interact with their dead infants has attracted much attention from primatologists. In particular, the care given to infant corpses has been well documented, and some researchers have employed quantitative analyses to explore the underlying mechanisms of this behavior. In contrast, instances of maternal cannibalism, another striking response to dead infants, are relatively uncommon and the factors contributing to this phenomenon remain unclear among primates. Here, we report a new case of stillbirth and subsequent maternal cannibalism that occurred in a free-ranging group of Japanese macaques residing on Awajishima Island, Japan. In the observed case, a multiparous female gave a stillbirth in the winter of 2022. The newborn appeared premature due to the lack of hair and unformed limbs, and the unseasonal birth. Initially, the mother cared for the newborn by licking and holding the body, but she suddenly began consuming the entire corpse, except for the parts around the head. This is the first case of maternal cannibalism by a multiparous mother of free-ranging Japanese macaque. We compared this case with those previously reported in Old World monkeys, and discussed the possible link between stillbirth, maternal care, and cannibalization towards deceased infants. In order to understand how primates comprehend the concepts of "death" and how their maternal relationships have evolved, it would be important to focus not only on maternal care toward dead infants but also cannibalism that could occur at the end of the caregiving.

Post-mortem changes of the vascular system-a thanatological study using multidetector computed tomography.

Forensic pathologists have to deal with post-mortem changes of the human body. Those post-mortem phenomena are familiar and largely described in thanatology. However, knowledge about the influence of post-mortem phenomena on the vascular system is more limited, except for the apparition and development of cadaveric lividity. The introduction of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the forensic field and the expansion of their usage in medico-legal routine, allow for exploring the inside of corpses differently and may play a part in the understanding of thanatological processes. This study aimed to describe post-mortem changes in the vascular system by investigating the presence of gas and collapsed vessels.We investigated post-mortem MDCT data of 118 human bodies. Cases with internal/external bleeding or corporal lesion allowing contamination with external air were excluded. Major vessels and heart cavities were systematically explored and a trained radiologist semi-quantitatively assessed the presence of gas.Collapsed veins were observed in 61.9% of cases (CI95% 52.5 to 70.6) and arteries in 33.1% (CI95% 24.7 to 42.3). Vessels most often affected were for arteries: common iliac (16.1%), abdominal aorta (15.3%), external iliac (13.6%), and for veins: infra-renal vena cava (45.8%), common iliac (22.0%), renal (16.9%), external iliac (16.1%), and supra-renal vena cava (13.6%). Cerebral arteries and veins, coronary arteries, and subclavian vein were unaffected. The presence of collapsed vessels was associated with a minor degree of cadaveric alteration. We observed that arteries and veins follow the same pattern of gas apparition for both the quantity and the location.In post-mortem radiology, collapsed vessels and intravascular gas are frequently visualized and as a result of all post-mortem changes, the assessment of the distribution of blood can be confusing. Therefore, knowledge of thanatological phenomena is crucial to prevent post-mortem radiological misapprehensions and possible false diagnoses.

Anxiety and fear of death in Health Professionals in Hospital Emergency services in Aragón.

OBJECTIVES: To describe the levels of anxiety in the face of death in professionals from hospital emergency services in Aragon. To analyse its association with sociodemographic, perception and work-related variables. METHODOLOGY: Observational, descriptive and cross-sectional study. The population and context of the study were health professionals in the hospital emergency services of Aragon. A non-probabilistic sampling selection was applied (n = 230 participants). The "Collet-Lester-Fear-of-Death-Scale" instrument was introduced to measure anxiety about death. The data was collected with a self-applied telematic questionnaire. Descriptive and inferential statistics were performed to analyse the association between the study variables. RESULTS: Mean values obtained for anxiety in the face of death were 94.58 ±â€¯21.66 with a CI of 95%: (91.76-97.39) (range of scale: 28-140 points). A significant association was identified with the professional category variables (physicians, medical residents, nurses, and auxiliary nurses) (p: 0,006), gender (p: 0.001), level of training in emotional self-management (p: 0.03), self-perceived level of mental health (p: 0.07) and perception of lack of support from palliative care/mental health professionals (p: 0.006). This association was not obtained with the variables age (Sig: 0.558), total professional experience (p: 0.762) and in emergencies (p: 0.191). CONCLUSION: The levels of anxiety in the face of death in the emergency hospital services are lower than those presented in other hospital units. Variables such as professional category, degree of training in emotional self-management and self-perceived level of mental health are related to levels of anxiety in the face of death and their study requires further work.

Natural Organic Reduction as a Means of Body Disposition.

NOR (Natural Organic Reduction) is the four-to-six-week process of composting a human corpse into soil. While to the general public, NOR may sound like a biologically-sound, basic, holistic answer to the question of body disposition, death care industry professionals know it is not nearly that simple. With NOR recently legalized in New York, major problems will be brought forth in five categories including the following: (1) Disease control with regard to soil, water and air contamination, (2) Cost efficiency, (3) Soil retrieval issues, (4) Impossible accommodations during an epidemic or pandemic, and (5)Failure to Protect What Should Be Sacred Ground/Failure To Provide A Physical Memorial For Decedents. This article will explain the NOR process and address the five problematic issues this process brings forth.

Life and death of a disabled wild capuchin monkey infant.

The evolutionary roots of care for injured, ill, and disabled group members remain unclear. The same can be said about care for dying and dead group members. Accumulating case reports in a variety of nonhuman primates can shed light on these origins. Here we provide a detailed account of interactions of a wild capuchin monkey mother and other group members with a disabled infant before and after its death. Limb disability caused the infant to be in unstable positions when carried, which appeared to increase the frequency of body readjustments by the adults and may have contributed to its death. After death, no adults other than the mother made contact with the corpse, but four immatures approached and touched it. The mother foraged only on flies surrounding the corpse while carrying it, stopped several times to set the corpse down on the branches, and let it finally fall as she leapt between trees. The difficulty of carrying disabled and dead individuals up in the trees may help to explain the scarcity of reports in platyrrhines, and suggests that terrestriality and increasing ease of bipedality may have contributed to the evolution of these behaviors in primates.

Reactions to a dead adult female in Japanese macaques at Arashiyama: Why did a non-affiliated female groom the corpse?

Reporting reactions to death in nonhuman primates can provide valuable information for understanding the evolutionary origin of human ways of dealing with death. Although many studies have reported nonhuman primates' reactions to infant corpses, less is known about their reactions toward dead adults or adolescents. The deaths of adult primates, who usually form complex social relationships, may have social impacts. Here, we described in detail the reactions of Japanese macaques (Macaca fuscata) to the corpse of an adult female in a free-ranging multi-male multi-female group. We analyzed quantitative data on the whole group to determine how death-related behaviors were related to social relationships. Most group members in this case, including social partners of the deceased, exhibited no notable interest in the corpse. Only one adult female, who was not a grooming partner of the female before she died, touched and groomed the corpse. We examined four possible reasons why this female groomed the corpse: unawareness of death, learning about death, desire to consume insects, and reputation-building with other group members. This study highlights the potential value of closer examination of associations between reactions to dead adults or adolescents and social relationships before and after death in primate groups.

Using Zoom and Card Game to Conduct Advance Care Planning Classes: An Innovative Practice.

BACKGROUND: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic. AIMS: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying. METHODS: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used. RESULTS: Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.

Os cuidados paliativos na visão de internos de um curso de medicina: estudo transversal / Palliative care from the perspective of internal medicine students: a cross-cross study / Cuidados paliativos desde la perspectiva de estudiantes de medicina: un estudio transversal

Este estudo teve por objetivo verificar o conhecimento de estudantes de medicina sobre cuidados paliativos em saúde durante a sua formação. Método: Estudo transversal com 58 participantes dentre um universo de 200 internos de medicina dos quatro últimos períodos da graduação (internato médico) de uma instituição de ensino superior brasileira privada sem fins lucrativos, que tem um currículo integrado com o uso intensivo de metodologias ativas de ensino-aprendizagem. Foi utilizado um questionário, enviado por meio eletrônico e que foi baseado no instrumento americano "Physician's End-of-Life Care Attitude Scale". A coleta de dados ocorreu no terceiro trimestre de 2020 e os dados foram analisados por meio da estatística descritiva simples. Resultados: Participaram 58 estudantes, entre 20 e 34 anos, sendo 72% mulheres. Apenas 15,5% se consideraram competentes em dar notícias ruins. Quanto ao manejo clínico, 65,5% necessitaram maior supervisão ou instrução básica na dispneia terminal. Na decisão de retirada do suporte ventilatório de um paciente incapaz de decidir por si, 74,1% se preocuparam com questões legais e profissionais e 77,6% com questões éticas. Em relação ao pensamento sobre a morte do paciente, 67,2% se manifestaram ansiosos ou desconfortáveis. 80% dos estudantes classificaram como importante ou muito importante abordar a temática dos cuidados paliativos durante o internato. Conclusão: Os estudantes expressaram graus variados de conhecimento acerca do tema. Manifestaram maior segurança no manejo dos principais sintomas clínicos. Observou-se que o tema morte provoca certo grau de angústia e desconforto nos estudantes, que consideram necessário o conhecimento sobre cuidados paliativos.

This study aimed to verify the knowledge of medical students about palliative health care during their training. Method: Cross-sectional study with 200 medical students from the last four periods of graduation (medical internship) at a private, non-profit Brazilian higher education institution, which has an integrated curriculum with the intensive use of active teaching-learning methodologies. A questionnaire was used, sent electronically and based on the American instrument "Physician's End-of-Life Care Attitude Scale". Data collection took place in the third quarter of 2020 and the data were analyzed using simple descriptive statistics. Results: 58 students, aged between 20 and 34 years old, 72% of whom were women. in terminal dyspnea. In the decision to withdraw ventilatory support from a patient unable to decide for himself, 74.1% were concerned with legal and professional issues and 77.6% with ethical issues. Regarding the thought about the patient's death, 67.2% expressed anxiety or discomfort. 80% of the students classified it as important or very important to address the topic of palliative care during the internship. Conclusion: The students expressed varying degrees of knowledge about the topic. They showed greater confidence in the management of the main clinical symptoms. It was observed that the theme of death causes a certain degree of anguish and discomfort in students.

Este estudio tuvo como objetivo verificar el conocimiento de los estudiantes de medicina sobre los cuidados paliativos en salud durante su formación. Método: Estudio transversal con 200 estudiantes de medicina de los últimos cuatro períodos de graduación (internado médico) en una institución de educación superior brasileña privada, sin fines de lucro, que tiene un plan de estudios integrado con el uso intensivo de metodologías activas de enseñanza-aprendizaje. Se utilizó un cuestionario, enviado electrónicamente y basado en el instrumento estadounidense "Physician's End-of-Life Care Attitude Scale". La recolección de datos se realizó en el tercer trimestre de 2020 y los datos se analizaron mediante estadística descriptiva simple. Resultados: 58 estudiantes, con edades entre 20 y 34 años, de los cuales el 72% eran mujeres. En la decisión de retirar el soporte ventilatorio a un paciente incapaz de decidir por sí mismo, el 74,1% se preocupó por cuestiones legales y profesionales y El 77,6% con problemas éticos. En cuanto al pensamiento sobre la muerte del paciente, el 67,2% manifestó ansiedad o malestar. El 80% de los estudiantes calificaron como importante o muy importante abordar el tema de cuidados paliativos durante la pasantía. Conclusión: Los estudiantes expresaron diversos grados de conocimiento sobre el tema. Mostraron mayor confianza en el manejo de los principales síntomas clínicos. Se observó que el tema de la muerte provoca cierto grado de angustia y malestar en los estudiantes.

Holy Simplicity: The Physician's Role in End-of-Life Conversations.

Early initiation of end-of-life (EOL) conversations has been shown to improve patient agency in dying, increase early access to hospice care, and facilitate a dignified death. Despite the benefits of early initiation, EOL conversations do not occur as readily as physicians or patients wish. While medicine is commonly considered both a science and an art, increasing medicalization may narrow a clinician's focus towards procedures or specialized clinical frameworks rather than a patient's end-of-life wishes. Since physicians are ambassadors of clinical knowledge and are trusted patient advocates, it is important they facilitate EOL conversations early in the dying process. Patients desire their physicians to convene these conversations. However, physicians are often hesitant to do so. Notable theologians, philosophers, and physicians offer a broad framework outlining the importance of physician-led EOL conversations.

Dead-infant carrying by chimpanzee mothers in the Budongo Forest.

It has been suggested that non-human primates can respond to deceased conspecifics in ways that suggest they experience psychological states not unlike humans, some of which could indicate they exhibit a notion of death. Here, we report long-term demographic data from two East African chimpanzee groups. During a combined 40-year observation period, we recorded 191 births of which 68 died in infancy, mostly within the first year. We documented the post-mortem behaviour of the mothers and describe nine occasions where Budongo chimpanzee mothers carried infants for 1-3 days after their death, usually until the body started to decompose. We also observed three additional cases of extended carrying lasting for more than 2 weeks, one of which was followed by the unusual extended carrying of an object and another which lasted 3 months. In each case, the corpses mummified. In addition, we report four instances of recurring dead-infant carrying by mothers, three of whom carried the corpse for longer during the second instance. We discuss these observations in view of functional hypotheses of dead-infant carrying in primates and the potential proximate mechanisms involved in this behaviour.

Online Presence of the Funeral Industry: The Example of the Quebec Federation of Funeral Cooperatives.

The digitalization of modern societies has offered new tools for funeral industries to reach the communities they serve, ranging from using technologies in funeral planning, in commemoration of the dead, or to support the bereaved. The COVID-19 pandemic only pushed this need for online presence of the funeral industries further. We explore the digitalization of funeral industries through the example of Quebec (Canada), where many funeral institutions are regrouped under a federation of funeral cooperatives. We analyze how this influences the delivery of funeral services and allows the development of common services answering various needs of the population (e.g., a funding program for youth funerals, an ecological memorialization program, online grief support). Finally, we discuss how the federation's online presence contributes to its mission, and more largely whether it changes the perception of the industry.

Viewing the rare through public lenses: insights into dead calf carrying and other thanatological responses in Asian elephants using YouTube videos.

Documenting the behavioural repertoire of an animal species is important for understanding that species' natural history. Many behaviours such as mating, parturition and death may be observed only rarely in the wild due to the low frequency of occurrence, short duration and the species' elusiveness. Opportunistic documentation of rare behaviours is therefore valuable for deciphering the behavioural complexity in a species. In this context, digital platforms may serve as useful data sources for studying rare behaviours in animals. Using videos uploaded on YouTube, we document and construct a tentative repertoire of thanatological responses (death-related behaviours) in Asian elephants (Elephas maximus). The most frequently observed thanatological responses included postural changes, guarding/keeping vigil, touching, investigating the carcass, epimeletic behaviours and vocalizations. We also describe some infrequently observed behaviours, including carrying dead calves by adult females, re-assurance-like behaviours and attempts to support dying or dead conspecifics, some of which were only known anecdotally in Asian elephants. Our observations indicate the significance of open-source video data on digital platforms for gaining insights into rarely observed behaviours and support the accumulating evidence for higher cognitive abilities of Asian elephants in the context of comparative thanatology.

"We Will All Go, But What We All Seek Is Good Death": Cultural Notions of Good Death And Related Mortuary Rituals Among the Akan of Ghana.

Thanatologists who have researched mortuary beliefs and practices from around the world posit that many societies differentiate between good and bad deaths. The current study utilized in-depth interviews with 30 Akan culture experts to investigate what the Akan ethnic group of Ghana considers to be good death. The results show that Akan good death is natural harmonious death that occurs at advanced age. The deceased would also have experienced a meaningful life devoid of immorality or turpitude. While the bodies of decedents of Akan bad deaths are interred without much ceremony, good deaths are associated with elaborate burial rites and funerary obsequies that serve to honor the decedent. Findings show that Akans generally aspire to achieve a good death, be granted solemn burial rites, and to receive a fitting funerary celebration that would launch them on a journey to join ancestral kin in the hereafter.