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Kim and Park: A Meta Analysis on Variables related to Death Anxiety of Elderly in Korea
Original Article

Korean J Adult Nurs 2016;28(2):156-168.

Published online: April 2016

DOI: https://doi.org/10.7469/kjan.2016.28.2.156

A Meta Analysis on Variables related to Death Anxiety of Elderly in Korea

Sinhyang Kim1, Kyung Sook Park2

1Graduate School of Nursing, Chung-Ang University, Seoul

2Red-Cross College of Nursing, Chung-Ang University, Seoul, Korea

Corresponding author: Park, Kyung Sook Red-Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea. Tel: +82-2-820-5676, Fax: +82-2-824-7961, E-mail: kspark@cau.ac.kr

Received 29 January 201628 March 2016       Accepted 15 April 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to provide basic data by surveying the literature for the past fifteen years (2001-2015). The focus of the search was death anxiety among the elderly.

Methods

Sixty-two published works including graduate theses were selected for the Meta-analysis.

Results

Study results showed that variables related to familial factors were the most often cited in the review of the manuscripts as relevant to death anxiety among the elderly. Specifically family support was most important. The other variables reported in the literature review were classified into four other groupings: social, physical, psychological, and demographics. The significant variable in the social grouping was religious activities, health promotion in the physical grouping and ego integrity in the psychological group.

Conclusion

This study could provide effect sizes of variables based on materials, which are needed to make an intervention program that is related to death anxiety of the elderly. Since this study identified major variables as significant to death anxiety, several distinctions within these variables can be further studied as these relate to death anxiety.

Keywords: Elderly, Death anxiety, Meta analysis

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Figure 1.
Inclusion flow of studies from database search.
kjan-28-156f1.tif
Table 1.
Quality Evaluation of the Study
Variables Yes No
n (%) n (%)
Did you clearly present the study? 62 (100.0) 0 (0.0)
Did you talk about sampling? 42 (68.0) 20 (32.0)
Did you gain a measure of science and technology (reliability, validity)? 62 (100.0) 0 (0.0)
Did you clearly present the analytical method? 62 (100.0) 0 (0.0)
Has presented the sample size can be calculated based? 12 (19.0) 50 (81.0)
Table 2.
Effect Size of Variables related to Death Anxiety
Variables Categories K ES 95% % CI I2 (%) N Q (p) ERI (p) Fisher's Z and 95% CI
Demographic Age 8 -0.18 -0.26 -0.10 85.4 2,176 4.03 (.400) -2.74  
Education 10 -0.16 -0.23 -0.09 53.8 2,270   (.12)  
Economic conditions 9 -0.14 -0.21 -0.06 68.3 2,280      
Religious status 6 -0.13 -0.22 -0.04 24.0 1,514      
Marital status 5 -0.11 -0.21 -0.01 0.0 1,185      
Sub total 38 -0.15 -0.20 -0.10 65.4 9,425 107.01 (＜.001)    
Familial Family support 5 -0.42 -0.72 -0.13 96.7 778 18.22 (＜.001) 2.40  
Family cohesion 7 -0.30 -0.55 -0.06 94.1 1,721   (.76)  
Sub total 12 -0.35 -0.45 -0.26 95.4 2,499 239.46 (＜.001)    
Physical HPB 2 -0.23 -0.39 -0.07 0.0 487 5.04 (.080) 0.97  
Objective health status 6 -0.21 -0.30 -0.11 85.1 1,155   (.63)  
Subjective health status 13 -0.16 -0.22 -0.10 44.1 3,457      
Sub total 21 -0.18 -0.25 -0.11 66.7 5,099 60.04 (＜.001)    
Social Religious activities 6 -0.25 -0.36 -0.13 87.3 1,551 6.72 (.030) -4.59  
Social support 12 -0.22 -0.30 -0.14 84.9 2,978   (.11)  
Social activities 8 -0.17 -0.27 -0.07 75.0 3,527      
Sub total 26 -0.21 -0.27 -0.15 83.1 8,056 147.43 (＜.001)    
Psychological Ego integrity 21 -0.35 -0.42 -0.29 85.4 6,347 98.71 (＜.001) -1.40  
Depression† 24 -0.28 -0.34 -0.21 84.6 6,420   (.72)  
Spiritual well-being 9 -0.26 -0.36 -0.16 94.5 2,838      
Life satisfaction 16 -0.26 -0.34 -0.17 80.5 3,431      
Self-esteem 4 -0.24 -0.41 -0.08 0.0 716      
Death readiness 7 -0.18 -0.29 -0.06 71.3 2,117      
Mental health 2 -0.17 -0.40 0.06 0.0 371      
Meaning of life 3 -0.17 -0.35 0.02 0.0 702      
Afterlife view 5 -0.16 -0.30 -0.02 58.0 1,670      
Sub total 91 -0.27 -0.30 -0.23 86.1 24,612 640.53 (＜.001)    
Whole variable effect size of death anxiety 188 -0.23 -0.26 -0.21 86.2 49,691 1 ,359.14 (＜.001) -0.70  
  (.43) -0.8 -0.6 -0.4 -0.2 0

K=number of studies; ES=effect size; CI=confidence interval, Q=Q-value between subgroups; I

2 =the proportion of true variance; N=sample size; ERI=Egger's regression intercept; HPB=health promoting behaviors;

† Coding reverse.

Table 3.
Effect Size of the Adjustment Factors
Variables Categories K ES 95% CI I2 (%) Q p
Type of residence Facility 26 -0.26 -0.33 -0.20 82.3 1.79 .410
Home 158 -0.23 -0.25 -0.20 86.9
Facility· Home 4 -0.15 -0.32 0.02 0.0
Source PhD. dissertation 15 -0.23 -0.31 -0.14 84.2 4.04 .130
Master's thesis 82 -0.20 -0.24 -0.17 77.4
Journal 91 -0.26 -0.29 -0.22 89.8
Measurement of death anxiety FODS 94 -0.22 -0.25 -0.18 86.6 3.76 .290
PDAS 26 -0.27 -0.34 -0.20 89.4
RDAS 12 -0.29 -0.38 -0.20 91.6
TDAS 56 -0.22 -0.27 -0.18 78.9

K=Number of studies; ES=Effect Size; CI=Confidence interval; I

2 =the proportion of true variance; Q=Q-value between subgroups; FODS=Fear of Death Scale; TDAS=Templer Death Anxiety Scale; RDAS=Revised Death Anxiety Scale.

Appen dix: Summary of Characteristic cs of f Studi ies included for Meta- -Analy sis
Researchers Title SS Source Related variables TR DM
Yim (2001) A study on the social support, self-esteem and death anxiety of the elderly 311 Thesis Social support, self-esteem Home PDAS
Sim (2001) The relationships between death anxiety and social support in the elderly people 263 Thesis Social support Home FODS
Bae (2002) The relationships between death anxiety and family support in the elderly people 70 Thesis Family support Home FODS
Kwon et al. (2003) A correlation study on spiritual well-being and death anxiety of the elderly 358 Journal Spiritual well-being Home PDAS
Yim (2003) A study on death-fear, health improvement activity and life satisfaction of old people 130 Thesis Health improvement activity, life satisfaction Home FODS
Yeo et al. (2005) The impact of the death anxiety and social activity on the depression in the elderly 517 Journal Social activity, depression Home RDAS
Lee (2005) A study of factors influencing the death anxiety of the aged in nursing home for the patients with the mental disorders 151 Thesis Family relation ship, family support, education, age, ego integrity, religious activities, sense of alienation, personality change Facility TDAS
Yeo et al. (2006) Effects of reminiscence function, depression, death-anxiety and social activity on the ego-integrity in the elderly 517 Journal Social activity, ego integrity Home Facility TDAS
Kim (2006) Meaning in life and death anxiety in the elderly 285 Thesis Meaning in life Home FODS
Jang et al. (2007) The effect of family factors on death anxiety of the aged 238 Journal Family cohesion, family support Home FODS
Kim et al. (2007) A study of quality of life, death anxiety and spiritual well being in elders 76 Journal Quality of life, spiritual well-being Facility PDAS
Kim (2007) Relationship between spiritual well-being and anxiety toward death of the elderly 156 Thesis Spiritual well-being Facility PDAS
Kim (2007) Death anxiety of hospitalized elderly patients 104 Thesis Health status Facility FODS
Lee (2008) Impact of religious activities on life satisfaction and death anxiety in the elderly 137 Thesis Life satisfaction, religious activities Home FODS
Moon et al. (2008) The relaeionship between the death preparation of the aged and successful aging: focusing depression and death anxiety as mediators 283 Journal Depression, ego integrity Home RDAS
Park (2008) Elderly preparation for death and anxiety of death 200 Thesis Preparation for death Home PDAS
Oh (2008) Study of senior housing residents’ fear of death 140 Thesis Self-esteem Facility FODS
Kwon (2008) A survey on the determinants of death anxiety in nursing-home residents 280 Journal Depression, ADL, ego integrity, self-esteem, mental health, social support, health status Facility TDAS
Suh et al. (2008) A study on death anxiety of older adults focusing on gender and spouse -on the basis of the four dimensions of death anxiety- 296 Journal Preparation for death, afterlife view, education Home FODS
Kim (2009) Effects of spirituality in old age on death anxiety 247 Thesis Family function, living together family, age, spirituality, ego integrity, chronic disease, subjective health status, subjective economy status, Home TDAS
Kim et al. (2009) Death anxiety and quality of life among the elderly 156 Journal Life satisfaction Home PDAS
Kim et al. (2009) The relationship between sociodemographic variables and death anxiety among the elderly 156 Journal Family relation ship, education, gender, age, living together family, past occupation, subjective economy status, religious activities, subjective health status Home PDAS
Choi (2009) The effect of the spiritual well-being of the aged on ego integrity and death anxiety 405 Thesis Spiritual well-being, ego integrity Home TDAS
Seo (2009) The effect of anxiety of death of the elderly on mental health: focused on the mediating effect verification of preparation of death 231 Thesis Preparation for death, mental health Home FODS
Moon (2009) The influence of death preparation and forgiveness of the elderly on successful aging: focused on the mediating effects of depression and death anxiety 498 Thesis Depression, ego integrity, preparation for death, forgiveness, psychological well-being, afterlife view Home RDAS
Jung (2009) Social support of the elderly are factors impact on death anxiety 157 Thesis Social support Home FODS
Park (2009) Structural model for the death anxiety factors of home-staying elderly people 494 Thesis Social support, social activities, age, spiritual well-being, ego integrity, religious activities, death readiness, preparation for death, Home FODS
Lee et al. (2010) A study on the factors influencing death anxiety: examintion of impact of family function. Spirtual well-being and ego-integrity 247 Journal Family function, life satisfaction Home TDAS
Hwang (2005 ) The effect that self-esteem, level of preparation for death and view of life after death influence on the death anxiety in the elderly 150 Thesis Afterlife view, self-esteem, preparation for death Home FODS
Yoon (2010) The impact on the participation of the elderly religious life satisfaction: mediated death anxiety and depression 154 Thesis Life satisfaction, depression, religious activities Home FODS
Jang (2010) Study on the ecological factors affecting the death anxiety among the elderly 236 Journal Education, afterlife view, religious activities, the presence of a spouse, social support, age, social activity, gender, subjective health status, ego integrity, subjective economy status Home PDAS
Nam et al. (2010) The influence of participation in religious and social activities of the elderly on their life satisfaction -focusing on depression and death anxiety- 320 Journal Life satisfaction, depression, religious activities, social activity Home TDAS
Kim (2010) A study on the influence of ego integrity on death anxiety for elderly people and the moderating effect of death preparation: mainly focus on users of senior leasure welfare facilities 200 Thesis Education, social support, gender, ego integrity, Leisure activity, religious activities, subjective health status, subjective economy status, preparation for death, marital state, economic activity, age, Home FODS
Kim et al. (2010) Psychological and spiritual factors associated with death anxiety of elderly people living at home 494 Journal Ego integrity, psychological well-being, depression, afterlife view, preparation for death Home FODS
Lee (2010) A study on the effects of depression on death anxiety and the moderating effect of life satisfaction of elders 81 Journal Life satisfaction, depression Home TDAS
Ju (2011) The influence of spirituality, ego integrity, and death anxiety on life satisfaction among Korean elderly 194 Thesis Education, the presence of a spouse, gender, life satisfaction, subjective economy status, ego integrity, religious activities, spirituality, subjective health status, age, Home TDAS
Jang (2000) The effects of ego integrity on death anxiety of the elderly: focusing on the mediating effect of depression 313 Journal Depression, ego integrity Home TDAS
Lim et al. (2011) A study about the model of subjective quality of life for the elderly: focused on the mediating effects of death anxiety 330 Journal Depression, monthly income, subjective health status, subjective economy status Home RDAS
Lee et al. (2011) Factors influencing death anxiety in the aged. 357 Journal Family function, health promotion behaviors, ego integrity, morale Home FODS
Nam et al. (2011) The influence of social activity and social support perceived by elderly women living alone on their quality of life: focusing on the mediating effect of depression and death-anxiety 353 Journal Education, social support, quality of life, age, social activity, depression, religious activities Home FODS
Nam et al. (2011) The effects of group reminiscence counseling on ego integrity, depression, death anxiety of the elderly 27 Journal Depression, ego integrity Facility TDAS
Jo et al. (2012) Effect of family cohesion, subjective happiness and other factors on death anxiety in Korean elders 280 Journal Family cohesion, subjective happiness Home FODS
Lee (2012) Relationship between senior citizens' social support and anxiety over death: by comparing senior citizens participating' elderly care by elderly' project with non-participating ones 203 Thesis Education, the presence of a spouse, social support, gender, age, monthly income, religious activities, subjective health status Home FODS
Oh et al. (2012) Influence of depression on psychological death anxiety of the elderly: moderate effect of self-esteem. 146 Journal Education, gender, age, depression, self-esteem Home FODS
Song (2012) Relationships among religious activity, life satisfaction and death anxiety in elders 199 Thesis Life satisfaction, religious activities Home FODS
Park et al. (2012) Determinants of the death anxiety among the elderly 250 Journal Education, the presence of a spouse, gender, age, subjective health status, social support, leisure activity, depression, monthly income, ego integrity, religious activities , Home FODS
Lee (2013) A study institutionalized elderly depression, death anxiety and end-of-life medical care. Treatment preference 189 Thesis Depression Facility TDAS
Park et al. (2013) Correlation among depression, death anxiety, and quality of life of aged women 115 Journal Quality of life, depression Home PDAS
Kim et al. (2013) Self-transcendence, spiritual well-being, and death anxiety of the elderly. 243 Journal Spiritual well-being, self-transcendence Home TDAS
Lee (2013) A study on the effects of the social activity of the elderly to death anxiety 238 Journal Education, the presence of a spouse, gender, age, subjective health status, social activity, subjective economy status, religious Home FODS
Jung (2013) The effect of a well-dying program on death anxiety and successful aging of elderly 60 Thesis Self efficiency, life satisfaction Facility FODS
Park (2013) The impact of depression and death anxiety in the elderly life satisfaction 303 Thesis Education, the presence of a spouse, age, social activity, depression, religious activities, subjective health status, subjective economy status, life satisfaction Home FODS
Choi (2014) The effects of availability of social support, meaning of life and the sense of loss on death anxiety in elderly 325 Thesis Social support, meaning in life, sense of loss Home PDAS
Kim (2014) The relationship between illness perception, death anxiety, family support and life satisfaction in elderly inpatients 147 Thesis Family support, life satisfaction, illness perception Facility PDAS
Kim et al. (2014) Relationships among family support, ageism experience, loneliness, helplessness and death anxiety in elders 155 Journal Family support, feeling of loneliness, elderly discrimination, helplessness Home TDAS
Park (2014) Death anxiety factors of eldery parents caring for their adult children with developmental disabilities - focusing on ego-integrity, family cohesion, and social support 196 Thesis Social support, ego integrity, family cohesion Home TDAS
Yoon (2014) The factors that affect death anxiety of the elderly with heart disease 168 Thesis Social support, depression, helplessness Home Facility FODS
Kim (2015) Effects of death anxiety and meaning of life on somatization of grandparent raising grandchildren. 92 Journal Life meaning, somatization Home TDAS
Lee (2015) The effects of life goal attainment on death anxiety in elderly -focusing on the mediating effect of ego integrity- 426 Thesis Life goal achievement, ego integrity Home PDAS
Ko (2015) The effects of ego-integrity and intrinsic religious orientation on death anxiety for elderly people 259 Thesis Ego integrity, implicit religion tends Home FODS
Kim (2015) Relationships among networks, death anxiety, and self-rated health in the elderly 112 Thesis Subjective health status, social network Home TDAS
Lee (2015) Factors influencing fears of death of elderly patients in geriatric hospitals 273 Thesis Ego integrity Facility PDAS
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