(see Poster Gallery) Association Between Sense of Control and Death Anxiety in Older Adults

Background and Purpose

Older age is associated with declining health, decreased functional control, and increased proximity to death. These factors may jointly produce emotional distress regarding one’s death, known as death anxiety. Although locus of control, a belief about the extent to which one’s health is in internal or external control, was found to be negatively significantly associated with death anxiety of cancer patients, physicians, and college-age students, limited—and antiquated—studies have examined this association in older adults. The health belief model (HBM) provides a robust way to conceptualize this relationship. Under the HBM, increasing internal locus of control could improve older adults’ quality of life and facilitate positive aging by promoting positive health behaviors. Thus, the purpose of this study was to explore the association between the sense of control and death anxiety in older adults.

Methods

This cross-sectional study used secondary data from the 2018 Leave-Behind Questionnaire of the Health and Retirement Study, which is nationally representative of Americans ≥50 years of age. The analytic sample was restricted to participants ≥65 years old (N = 3,193) to meet with conventional thresholds of older adulthood in the U.S. Average age was 75.3 years (SD = 7.4). Most participants were female (58.7%), White (79.0%), and married (56.2%).

The dependent variable, death anxiety, was measured through a single item and recoded to reflect whether or not participants experienced any death anxiety during the past week. The primary independent variable, sense of control, was assessed through the Midlife Developmental Inventory. These 10 items are scored on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). Higher sum scores indicated greater sense of control. Control variables included race, gender, age, education level, self-rated health status, and marital status. Binary logistic regression analysis was used.

Results

Over one third of participants (35.3%) reported experiencing death anxiety in the past week. Regression results indicated that increased sense of control was significantly associated with lower odds of death anxiety. Specifically, for each 1-unit increase in sense of control, the odds of experiencing death anxiety decreased by 5.0% (OR = 0.95, p < 0.001). Similarly, compared to participants with poor self-rated health, those with very good self-rated health (OR = 0.58, p = .005) and those with excellent self-rated health (OR = 0.41, p < 0.001) demonstrated lower odds of experiencing death anxiety.

Conclusions and Implications

Older adults with higher sense of control had lower odds of experiencing death anxiety. These results highlight the role of sense of control as a potentially effective mechanism for decreasing death anxiety in older adults. Social workers and other health professions could achieve this by working with older adults to strengthen their self-efficacy and decrease perceptions about barriers and constraints, which are core elements of the HBM. In accordance with the HBM, higher perceptions of self-rated health were associated with lower odds of experiencing death anxiety. Future studies should consider further application of the HBM to death anxiety research.