Older and middle-aged adults differ in their views on death in that middle-aged adults typically
The concept of death changes as we develop from early childhood to late adulthood. Cognitive development, societal beliefs, familial responsibilities, and personal experiences all shape an individual’s view of death (Batts, 2004; Erber & Szuchman, 2015; National Cancer Institute, 2013).
Infancy: Certainly infants do not comprehend death, however, they do react to the separation caused by death. Infants separated from their mothers may become sluggish and quiet, no longer smile or coo, sleep less, and develop physical symptoms such as weight loss.
Early Childhood: As you recall from Piaget’s preoperational stage of cognitive development, young children experience difficulty distinguishing reality from fantasy. It is therefore not surprising that young children lack an understanding of death. They do not see death as permanent, assume it is temporary or reversible, think the person is sleeping, and believe they can wish the person back to life. Additionally, they feel they may have caused the death through their actions, such as misbehavior, words, and feelings.
Middle Childhood: Although children in middle childhood begin to understand the finality of death, up until the age of 9 they may still participate in magical thinking and believe that through their thoughts they can bring someone back to life. They also may think that they could have prevented the death in some way, and consequently feel guilty and responsible for the death.
Late Childhood: At this stage, children understand the finality of death and know that everyone will die, including themselves. However, they may also think people die because of some wrong doing on the part of the deceased. They may develop fears of their parents dying and continue to feel guilty if a loved one dies.
Adolescence: Adolescents understand death as well as adults. With formal operational thinking, adolescents can now think abstractly about death, philosophize about it, and ponder their own lack of existence. Some adolescents become fascinated with death and reflect on their own funeral by fantasizing on how others will feel and react. Despite a preoccupation with thoughts of death, the personal fable of adolescence causes them to feel immune to the death. Consequently, they often engage in risky behaviors, such as substance use, unsafe sexual behavior, and reckless driving thinking they are invincible.
Early Adulthood: In adulthood, there are differences in the level of fear and anxiety concerning death experienced by those in different age groups. For those in early adulthood, their overall lower rate of death is a significant factor in their lower rates of death anxiety. Individuals in early adulthood typically expect a long life ahead of them, and consequently do not think about, nor worry about death.
Middle Adulthood: Those in middle adulthood report more fear of death than those in either early and late adulthood. The caretaking responsibilities for those in middle adulthood is a significant factor in their fears. As mentioned previously, middle adults often provide assistance for both their children and parents, and they feel anxiety about leaving them to care for themselves.
Late Adulthood: Contrary to the belief that because they are so close to death, they must fear death, those in late adulthood have lower fears of death than other adults. Why would this occur? First, older adults have fewer caregiving responsibilities and are not worried about leaving family members on their own. They also have had more time to complete activities they had planned in their lives, and they realize that the future will not provide as many opportunities for them. Additionally, they have less anxiety because they have already experienced the death of loved ones and have become accustomed to the likelihood of death. It is not death itself that concerns those in late adulthood; rather, it is having control over how they die.
Well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life—i.e., their “well-being.”1, 2 Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy.3, 4
Why is well-being useful for public health?
Well-being is associated with numerous health-, job-, family-, and economically-related benefits.8 For example, higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity.9-13 Individuals with high levels of well-being are more productive at work and are more likely to contribute to their communities.4, 14
Previous research lends support to the view that the negative affect component of well-being is strongly associated with neuroticism and that positive affect component has a similar association with extraversion.15, 16 This research also supports the view that positive emotions—central components of well-being—are not merely the opposite of negative emotions, but are independent dimensions of mental health that can, and should be fostered.17, 25 Although a substantial proportion of the variance in well-being can be attributed to heritable factors,26, 27 environmental factors play an equally if not more important role.4, 5, 28
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How does well-being relate to health promotion?
Health is more than the absence of disease; it is a resource that allows people to realize their aspirations, satisfy their needs and to cope with the environment in order to live a long, productive, and fruitful life.25, 29-31 In this sense, health enables social, economic and personal development fundamental to well-being.25, 30, 31 Health promotion is the process of enabling people to increase control over, and to improve their health.25, 30, 32 Environmental and social resources for health can include: peace, economic security, a stable ecosystem, and safe housing.30 Individual resources for health can include: physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy. Health promotion activities aimed at strengthening such individual, environmental and social resources may ultimately improve well-being.24, 25
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How is well-being defined?
There is no consensus around a single definition of well-being, but there is general agreement that at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning.4, 33-35 In simple terms, well-being can be described as judging life positively and feeling good.36, 37 For public health purposes, physical well-being (e.g., feeling very healthy and full of energy) is also viewed as critical to overall well-being. Researchers from different disciplines have examined different aspects of well-being that include the following4, 34, 38, 39, 41-46:
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How is well-being measured?
Because well-being is subjective, it is typically measured with self-reports.40 The use of self-reported measures is fundamentally different from using objective measures (e.g., household income, unemployment levels, neighborhood crime) often used to assess well-being. The use of both objective and subjective measures, when available, are desirable for public policy purposes.5
There are many well-being instruments available that measure self-reported well-being in different ways, depending on whether one measures well-being as a clinical outcome, a population health outcome, for cost-effectiveness studies, or for other purposes. For example, well-being measures can be psychometrically-based or utility-based. Psychometrically-based measures are based on the relationship between, and strength among, multiple items that are intended to measure one or more domains of well-being. Utility-based measures are based on an individual or group’s preference for a particular state, and are typically anchored between 0 (death) to 1 (optimum health). Some studies support use of single items (e.g., global life satisfaction) to measure well-being parsimoniously. Peer reports, observational methods, physiological methods, experience sampling methods, ecological momentary assessment, and other methods are used by psychologists to measure different aspects of well-being.42
Over the years, for public health surveillance purposes, CDC has measured well-being with different instruments including some that are psychometrically-based, utility-based, or with single items:Public Health Surveillance
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What are some findings from these studies?
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What are some correlates and determinants of individual-level well-being?
There is no sole determinant of individual well-being, but in general, well-being is dependent upon good health, positive social relationships, and availability and access to basic resources (e.g., shelter, income).
Numerous studies have examined the associations between determinants of individual and national levels of well-being. Many of these studies have used different measures of well-being (e.g., life satisfaction, positive affect, psychological well-being), and different methodologies resulting in occasional inconsistent findings related to well-being and its predictors.37, 56 In general, life satisfaction is dependent more closely on the availability of basic needs being met (food, shelter, income) as well as access to modern conveniences (e.g., electricity). Pleasant emotions are more closely associated with having supportive relationships.5
Some general findings on associations between well-being and its associations with other factors are as follows:
Genes and Personality
At the individual level, genetic factors, personality, and demographic factors are related to well-being. For example, positive emotions are heritable to some degree (heritability estimates range from 0.36 to 0.81), suggesting that there may be a genetically determined set-point for emotions such as happiness and sadness.26,27,57,58,59 However, the expression of genetic effects are often influenced by factors in the environment implying that circumstances and social conditions do matter and are actionable from a public policy perspective. Longitudinal studies have found that well-being is sensitive to life events (e.g., unemployment, marriage).60, 61 Additionally, genetic factors alone cannot explain differences in well-being between nations or trends within nations.
Some personality factors that are strongly associated with well-being include optimism, extroversion, and self-esteem.20, 62 Genetic factors and personality factors are closely related and can interact in influencing individual well-being.
While genetic factors and personality factors are important determinants of well-being, they are beyond the realm of public policy goals.
Age and Gender
Depending on which types of measures are used (e.g., life satisfaction vs. positive affect), age and gender also have been shown to be related to well-being. In general, men and women have similar levels of well-being, but this pattern changes with age,63 and has changed over time.64 There is a U-shaped distribution of well-being by age—younger and older adults tend to have more well-being compared to middle-aged adults.65
Income and Work
The relationship between income and well-being is complex.4, 39, 65 Depending on which types of measures are used and which comparisons are made, income correlates only modestly with well-being. In general, associations between income and well-being (usually measured in terms of life satisfaction) are stronger for those at lower economic levels, but studies also have found effects for those at higher income levels.66 Paid employment is critical to the well-being of individuals by conferring direct access to resources, as well as fostering satisfaction, meaning and purpose for some.67 Unemployment negatively affects well-being, both in the short- and long-term.61, 65, 67
Having supportive relationships is one of the strongest predictors of well-being, having a notably positive effect.68, 69
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What are some correlates of well-being at the national level?
Countries differ substantially in their levels of well-being.4, 70 Societies with higher well-being are those that are more economically developed, have effective governments with low levels of corruption, have high levels of trust, and can meet citizens’ basic needs for food and health.4, 5 Cultural factors (e.g., individualsm vs. collectivism, social norms) also play a role in national estimates of well-being.70
What is the difference between health-related quality of life, well-being, flourishing, positive mental health, optimal health, happiness, subjective well-being, psychological well-being, life satisfaction, hedonic well-being, and other terms that exist in the literature?71
Some researchers suggest that many of the terms are synonymous, whereas others note that there are major differences based on which dimensions are independent and contribute most to well-being.37, 71 This is an evolving science, with contributions from multiple disciplines. Traditionally, health-related quality of life has been linked to patient outcomes, and has generally focused on deficits in functioning (e.g., pain, negative affect). In contrast, well-being focuses on assets in functioning, including positive emotions and psychological resources (e.g., positive affect, autonomy, mastery) as key components. Some researchers have drawn from both perspectives to measure physical and mental well-being for clinical and economic studies. Subjective well-being typically refers to self-reports contrasted with objective indicators of well-being. The term, “positive mental health” calls attention to the psychological components that comprise well-being from the perspective of individuals interested primarily in the mental health domain. From this perspective, positive mental health is a resource, broadly inclusive of psychological assets and skills essential for well-being.24, 25 But, the latter generally excludes the physical component of well-being. “Hedonic” well-being focuses on the “feeling” component of well-being (e.g., happiness) in contrast to “eudaimonic” well-being which focuses on the “thinking” component of well-being (e.g., fulfillment).35 People with high levels of positive emotions, and those who are functioning well psychologically and socially are described by some as having complete mental health, or as “flourishing.” 46
In summary, positive mental health, well-being and flourishing refer to the presence of high levels of positive functioning—primarily in the mental health domain (inclusive of social health). However, in its broadest sense, well-being encompasses physical, mental, and social domains.
The reasons why well-being and related constructs should be measured and evaluating how these domains can be changed should help inform which domains (e.g., life satisfaction, positive affect, autonomy, meaning, vitality, pain) should be measured, and which instruments and methods to use.71
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What is CDC doing to examine and promote well-being?
CDC’s Health-Related Quality of Life Program has led an effort since 2007 to examine how well-being can be integrated into health promotion and how it can be measured in public health surveillance systems.55 A number of studies have examined the feasibility of existing scales for surveillance, including application of item-response theory to identify brief, psychometrically sound short-form(s) that can be used in public health surveillance systems.72,73 CDC and three states (OR, WA, NH) collected data using the Satisfaction with Life Scale and other well-being measures on the 2010 Behavioral Risk Factor Surveillance System.74 CDC also led the development of overarching goals related to quality of life and well-being for the Healthy People 2020External initiative.
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Page last reviewed: October 31, 2018
What is a major difference between the feelings of younger adults who are dying and those of older adults who are dying?
Terms in this set (56) What is a major difference between the feelings of younger adults and those of older adults who are dying? Younger adults feel cheated. acutely aware and concerned about separation and loss.
At what age are fears about death the greatest?
The presence of death anxiety is reported to peak in middle age and disappear in the elderly (20, 24, 25).
Which of the following lists Kübler
The stages of the Kubler-Ross theory include denial, anger, bargaining, depression, and acceptance.
Which of the following statements is an accurate criticism of Kübler
Which of the following statements is an accurate criticism of Kübler-Ross' theory of dying? Neither she nor independent research have demonstrated that the five stages actually exist.