Wheel Of Life At The End Of The Tunnel: A Phenomenological Study From The Lens Of Aged People
Keywords:
Death, Dying, End-Of-Life, Aged People, Elderly, Home CareAbstract
Death has always been feared, dreaded and misunderstood due to the complex emotions emanating from it. Various scientific studies and literary works have been written on this concern, and although most people choose not to discuss nor think about death, it remains inevitable. The objective of the study was to explore thoughts about death, dying, and end-of-life among the elderly living in a home care facility. Interpretative Phenomenological Analysis was used to explore the respondents’ experiences on their own terms. The selections of the key informants started by using a focused group discussion (FGD) in a large group of older people in the home care facility with the help of a gatekeeper. The research utilized a self-made semi-structured research instrument subjected to content validation by three qualified composed of two registered psychologists and a social worker. The findings revealed four pillars at the end of the tunnel based on the lived experience of the aged individual residing in a home care facility as follows: (1) personal concerns, (2) reluctance and unwillingness, (3) religiosity and spirituality, and (4) faith and good deeds. Based on the integration of the qualitative analysis, the Wheel of Life at the End of the Tunnel, an eidetic model about the end of life, was proposed that may serve as a basis for mental health programs for future studies.
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References
Ahn K.A. (2002). A study on the attitudes and prevention toward the death in the rural elderly. Research Institute for Hospice Palliative Care, 6, 39-52.
Klimczuk, A. Fabiś (2017). Theories of Death and Dying, [in:] B. Turner, P. Kivisto, W. Outhwaite, C. Kyung-Sup, C. Epstein, J.M. Ryan (eds.), The Wiley-Blackwell Encyclopedia of Social Theory, Wiley Blackwell, London, 1-7. http://dx.doi.org/ 10.1002/9781118430873.est0084.
Alftberg Å, Ahlström G, Nilsen P, Behm L, Sandgren A, Benzein E, Wallerstedt B, Rasmussen BH (2018). Conversations about Death and Dying with Older People: An Ethnographic Study in Nursing Homes. Healthcare (Basel), 6(2), 63. doi: 10.3390/ healthcare6020063. PMID: 29899220; PMCID: PMC6023469.
Antonio, Alfred (2015). Challenges to the Filipino Elderly as Traditional Caregivers: The Changing Landscape of Long Term Care Management of the Filipino Elderly.
Antonio, Alfred. (2015). Filipino Senior Citizen's Care Management: Current Status of Local Government Units' Response. Aralik: Elderly and Death. https://dergipark.org.tr/ tr/download/article-file/200450.
Beck, I, Törnquist, A, Broström & Wdberg AK (2012). Having to focus on doing either than being; nursing assistants' experience of palliative care in municipal residential care setting. Int J Nurs Stud., 49(4), 455-64. doi: 10.1016/jJjnurstu 2011.10.016
Broad JB, Gott M, Kim H, Hongsoo K, et al (2013). Where do people die? An international comparison of the percentage of deaths occurringin hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health, 58, 257-67.
Cameron ME (2002). Older persons’ ethical problems involving their health. Nurs Ethics, 9, 537-56.
Cicirelli, V.G. (2002). Fear of death in older adults; predictions from terror management theory. J. Gerontol. 57, 358-366.
David, R.D. (2015). A home, a village for older folks. Philippine Daily Inquirer. Retrieved https://raintreecare.com/a-home-a village-for-older-folks/
Depaola, S.J., Griffin, M., Young, J.R. & Neimeyer, R.A. (2003). Death anxiety and attitudes toward the elderly among older adults; the role of gender and ethnicity. Death Stud., 27, 335-354.
Department of Social Welfare and Development (DSWD) and Department of Health (DOH) (2007). Philippine Country Report: Community Services for the Elderly in the Philippines. A paper presented at the 5th ASEAN and Japan High Level Officials Meeting on Caring Societies held from August 27 30, 2007 in Tokyo, Japan. Retrieved July 6, 2014, http://www.mhlw. go.jp/ bunya/kokusaigyomu/asean/asean/kok
usai/siryou/dl/h19_philippines.pdf.
Ersek, M., Grant, M.M. & Millr Kraybill, B. (2005). Enhancing end-of-life care in nursing homes: Palliative care educational resource team (PERT) program. Journal of Palliative Medicine, 8, 556-566.
Fleming J & Farquhar M (2016). Cambridge City over-75s Cohort (CC75C) study collaboration, Brayne C, Barclay S. Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care Qualitative Research within a Population-Based Cohort Study. PLoS One, 5, 11(4), e0150686. doi: 10.1371/journal.
pone.0150686. PMID: 27045734; PMCID: PMC4821585.
Froggatt, K., Payne, S., Morbey, H., Edwards, M., Finne-Soveri, H., Gambassi, G., Pasman, H.R. Szczerbinska, K., Van den Block, L. (2017). PACE - Palliative care development in European care homes and nursing homes: Application of a typology of implementation. J. Am. Med. Dir. Assoc., 18, 55027.
Głuszak, J.K. (2006). Czy umieranie musi boleć...? Refleksje po konferencji. Pol. Med. Paliatywna, 5, 131-133.
Greenwood N, Menzies-Gow E, Nilsson D, Aubrey D, Emery CL & Richardson A (2018). Experiences of older people dying in nursing homes: A narrative systematic review of qualitative studies. BMJ Open, 8(6), e021285. doi: 10.1136/bmjopen-2017- 021285.
Haley, William & Larson, Dale & Kasl Godley, Julia & Neimeyer, Robert & Kwilosz, Donna (2003). Roles for Psychologists in End-of-Life Care: Emerging Models of Practice. Professional Psychology: Research and Practice, 34, 626-633. 10.1037/0735- 7028.34.6.626.
Hall, S., Petkova, H., Tsouros, A., Constantini, M. & Higginson, I. (2011). Palliative Care for Older People: Better Practices. World Health Organization, Regional Office for Europe: Copenhagen, Denmark.
Howarth, G. (2018). Death and Dying: A Sociological Introduction; Polity (accessed on 7 May 2018).
J, Farquhar M, Brayne C, Barclay S (2016). Death and the oldest old atitudes and preferences for end-of life care-qualitative research within a population-based cohort study. PLoS One, 5, 11(4). doi: 10.1371/ joumal.pone.0150686
Jang SH (2009). Study on the adult education for death preparation [Master's thesis]. Seoul: Hanyang Univ.
Jenull, B. & Brunner, E. (2011) Death and dying in nursing homes: A burden for the staff? J. Appl. Gerontol, University Press: Oxford, UK; New York, NY, USA.
Jeon, Hye-Won & Kim, Myoung-Hee & Yoon, Jeong-Ah (2015). Death Perception, Death Preparation and Need for Death Educational Program of the Elderly. Indian Journal of Science and Technology, 8. 10.17485/ijst/2015/v8i25/80275.
Kellehear, A (2007). A Social History of Dying. Cambridge University Press: Cambridge, UK; New York, NY, USA.
Klimczuk, A. & Fabiś, A. (2017). Death and Dying, theories of. In B. Turner (Ed.), The Wiley Blackwell Encyclopedia of Social Theory (pp. 1-7). London: Wiley
Blackwell. https://doi.org/10.1002/97811184 30873.est0084
Ko SD, Kim EJ & Kim YK (1999). A study on the influence of the preparation education on the elderly's attitude for death. Journal of Korean Society for Health Education and Pro motion, 16(2), 81-92.
Lan, H.M., Linh, T.T. and Trang N.M. (2017) Death Attitudes and Perception about the Death of the Vietnamese Elderly. Open Journal of Social Sciences, 5, 300-317. https://doi.org/10.4236/jss,2017.510026
Lockhart LK, Bookwala J, Fagerlin A, et al. (2001). Older Adults’ Attitudes Toward Death: Links to Perceptions of Health and Concerns about End-of-Life Issues. OMEGA - Journal of Death and Dying. 43(4), 331-347. doi:10.2190/09B5-CCWE-D5GA-F0MA
Major RJ, Whelton WJ, Schimel J, Sharpe D (2016). Older Adults and the Fear of Death: The Protective Function of Generativity. Can J Aging, 35(2), 261-72. doi: 10.1017/ S0714980816000143.
Maria Fe A. Domingo (2011). Old Age: Meanings, Perceptions, and Situations. University of the Philippines. Philippine Journal of Psychology.
Mathie E, Goodman C, Crang C, et al (2012). An uncertain future: the unchanging views of care home residents about living and dying. Palliat Med, 26, 734-43.
McInnis-Dittrich, K. (2005). Dying, bereavement, and the advance directives. Social Work with Elders. A Biopsychosocial Approach to Assessment and Intervention,
(Second edition), Pearson Education Inc., Boston, 346-524379.
Oh JT, Kim CG (2009). Effects of death education attitude toward death and depression in older adults. Journal of the Korean Gerontological Society, 29(1), 51-69.
Österlind J, Ternestedt BM, Hansebo G, & Hellström I. Feeling lonely in an unfamiliar place: Older people's experiences of life close to death in a nursing home. Int J Older People Nurs. 12(1). doi:10.1111/opn.12129.
Park SA & Hur JS (2012). Determinants of the death anxiety among the elderly. Mental Health and Social Work, 40(1), 59-88.
Park SY (2005). Comparative study on attitude toward death between elderly people living in solitude and elderly people living with family. Pusan: Pusan National Univ.
Rahm Hallberg, I. (2004). Death and dying from old people's point of view. A literature review. Aging clinical and experimental research, 16(2), 87-103. http://www.kurtis. it/magazine/aging/aging2004_02_01.pdf
Rivolta MM, Rivolta L, Garrino L & Di Giulio P (2014). Communication of the death of a patient in hospices and nursing homes: A qualitative study. Eur J Oncol Nurs., 8(1), 29- 34. doi: 10.1016/j.ejon.2013.09.012.
Schon P, Lagergren M & Karleholt I (2016). Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: Results from a
population-based study. Health Soc Care Community, 24(5), 631-8.
Teno, J. (2003). Now is the time to embrace nursing homes as a place of care for dying persons. Journal of Palliative Medicine, 6, 293-296.
Tjernberg, J. & Bökberg, C. (2020). Older persons’ thoughts about death and dying and their experiences of care in end-of-life: A qualitative study. BMC Nurs, 19, 123. https://doi.org/10.1186/s12912-020-00514-x
United Nations (2019). World Population Prospects 2019. Retrieved from United Nations Population Division:
https://population.un.org/wpp/Download/Sta ndard/Population/
Victor G. Cicirelli (2002). Fear of Death in Older Adults: Predictions from Terror Management Theory. The Journals of Gerontology: Series B, 57(4), P358-
P366. https://doi.org/10.1093/geronb/57.4.P3 58
Villegas, Justine Kristel A. (2014). Graying Matters: Aging in Contemporary Philippine Society. Philippine Sociological Review, 62, 139-57. http://www.jstor.org/stable/434863
Werkander Harstade, C. & Sandgren, A. (2016). Confronting the forthcoming death: A classic grounded theory. J. Palliat. Care Med., 6, 289.
WHO Definition of Palliative Care. Available online: http://www.who.int/cancer/palliative/ definition/en/ Press: Cambridge
Wink, P. & Scott, J. (2005). Does religiousness buffer against the fear of death and dying in late adulthood? Findings from a longitudinal study. J. Gerontol. 60, 207-214.
Wijngaarden, E, Leget, C & Goossensen A (2015). Ready to give up on life: The lived experiences of elderly people who feel life is completed and no longer worth living. http;//dx.doi.org/10,1016/j.socscimed.2015.0 5.015
Wright, Scott, Breier, Jennifer, Depner, Rachel, Grant, Pei & Lodi-Smith, Jennifer (2017). Wisdom at the end of life: Hospice patients’ reflections on the meaning of life and death. Counselling Psychology Quarterly, 31. 10.1080/09515070.2016.1274253.
Wu, A.M.S., Tang, C.S.K. & Kwok, T.C.Y. (2002). Death anxiety among Chinese elderly people in Hong Kong. J. Aging Health, 14, 42- 56.
Wysokiński M, Fidecki W & Jarosz M (2019). Elderly People's Acceptance of Death: A Study of a Polish Cohort. Int J Environ Res Public Health, 16(18), 3374. doi: 10.3390/ ijerph16183374.
