Psychological Issues in Terminal Illness
Old vs. New: 100 years ago people were dying in different ways. The age at which people die is very
different. Previously they were dying of acute illness; now they are dying of chronic illnesses that
develop over time (these are at least partially predictable)
A mere 100 years ago people died primarily of acute disorders, such as tuberculosis or pneumonia.
In 1926, the first year for which vital stats were centrally compiled in all provinces, only 1 in 6 deaths
(17%) occurred in people aged 65 and older.
By 2002, nearly 80% of deaths were in this age group.
Because of preventive medical technologies and public health advances that took off in the 20 century,
these acute illnesses are now much less widespread in developed countries.
On average, Canadians now live till 81 years.
Hence, when death does come, it will probably stem from chronic illness, such as heart disease or
cancer, which accounted for about two-thirds of deaths in 2002.
This means that, instead of facing a rapid, unanticipated death, the average adult is now aware of what
he or she will probably die from ahead of time.
Leading cause of death in Canada: cancer, heart disease, stroke
Although these lists should not be a surprise, I’m just showing you some statistics.
In Canada, the top three leading causes of death are cancer, heart disease, and cerebrovascular
Similarly, in other high income countries around the world, these are the leading causes as well.
However, taking into account developing countries, lower respiratory infections are actually the third
leading cause of death worldwide.
And so this is what I mean when I say the average adult in this day and age does not suffer a rapid,
unanticipated death, because all these leading causes of death are all chronic conditions that develop
over very long periods of time and are at least predictable. In developing countries acute illnesses still are a leading cause of death
Skipping the topic of death in childhood and young adulthood, where congenital abnormalities and car
accidents are the main causes of death, and moving right into middle age.
This is the period in which death becomes more realistic.
Some would argue that death takes fearful proportions in middle age, because it is more common, as
people develop chronic health problems, and see people around them aging as well.
Not surprisingly, it has been found that fear of death is more prominent during middle-age than in later
With that said, what happens when middle age adults are reminded of their mortality, or the possibility
Social psychology studies have found that reminding adults of their mortality, say by asking participants
to write about their own death or watch video depictions of death, polarizes cultural values or
Participants then show in-group favouritism and prejudice towards out-group members.
Interestingly, consistent with previous middle age fear of death research, the effects of mortality
salience is not observed in older adults, just like how a fear of death is not as prominent in this age
Modern medicine: we focus on curing a disease or treating it, average life expectancy has increased, &
people are now in institutions and are dying more often in the hospital
Death in middle age: fear of death is most prominent in middle age and not in older adults
Thought of death: ask people to write about their future death—if you remind them of death they
become more polarized in their cultural values and they show prejudices in out-group members (people
dissimilar to self)
This is not observed in older adults
Pre-mature death in middle ages: Stroke mortality study: 2000 males self reported psychological distress. When comparing the groups of
men (those who reported distress and those who didn’t)
Results: those who reported distress were 3.36 times more likely to have a fatal stroke later on
To help answer these questions, I’m going to present a couple of studies.
The first one being a study of 2201 middle-aged men.
Self-reported anxiety and depression served as an index of psychological distress. Incidence of nonfatal
and fatal ischemic stroke during the subsequent 14 years were recorded.
The Stroke Victims...
• Men who had a stroke:
• Slightly older
• Heavier in weight
• Had higher systolic blood pressure
• More likely to have a manual occupation
• More likely to be current smokers
• Tend to report more symptoms of anxiety and depression
Stroke Mortality in Middle Age:
Adjusting for physiological and health-behavior covariates (age, BMI, SBP, smoking, drinking, social
class, and marital status), men who reported psychological distress were 3.36 times more likely to have
an incident of fatal ischemic stroke, relative to those who did not show symptoms of psychological
On the other hand, psychological distress did not significantly predict nonfatal ischemic stroke.
It may be that distressed subjects might have had more severe stokes than their non-distressed
MI mortality in middle age: Next, I’m going to present to you a study examining predictors of mortality in myocardial infarction, or
heart attack, patients.
222 patients aged 24 to 88 were in the study. They were well enough to be discharged from the hospital
at the beginning of the study.
These patients were interviewed between 5 and 15 days following the MI episode about a number of
psychosocial and demographic factors, including depression.
The incidence of cardiac-related deaths at 6-months was recorded.
222 patients who just had a heart attack (may not be their first one) were interviewed right when they
were healthy enough to go home and leave the hospital and they were diagnosed whether they had
depression or not and they looked to see death rates among these people at a 6 month follow up
Results: the group which was diagnosed as depressed are more likely to have passed away at 6 months
due to cardiac reasons
**possible third variable: other health behaviours such as exercise (maybe the people in the depressed
group were not as mobile and that is the cause for their early deaths)
Death in old age: these people are living close to the projected age.
Now that we’ve gone through some research on pre-mature death that happens before the projected
age of 79, we are going to move on to examine psychological factors that predict mortality among older
What predicts death that happens in an age group that has lived to or at least close to the projected
This is a study using the National Population Health Survey in 1994, with a sample size of 2440.
Wilkins examined psychological characteristics such as distress, financial, and family-related stress.
Death rates and causes of death were calculated based on death certificate information from 1994 to
In senior women, psychological distress assessed in 1994 was positively associated with mortality over
the next 8 years, after adjusting for covariates.
This relationship did not hold for senior men after adjusting for chronic conditions.
For senior men, low education and widowhood increased the likelihood of dying over this 8-year period.
Clearly, psychological factors play an important role in health and illness throughout the life course. In part of such findings, health goals for the elderly now focus less on reduction of mortality and more
on improving quality of life.
In Canada, older adults aged 65 and up now experience less morbidity and fewer restricted activity
days, when compared to 15 years ago.
This is obviously a rather important and urgent emphasis as the baby boom generation is moving into
old age and there i