The later years are associated with thoughts of looming death. The realization of death affects different people in different ways. Some individuals face the reality of death calmly and with careful preparation. They draw up wills, dispose of assets, and solidify relationships. Others resist any thoughts about dying and grimly struggle to ignore what fate has foreordained. Still others succumb to thoughts of death by retreating into depression. As you can imagine, no matter how well prepared a person seems to be for the end, death anxieties inevitably creep in. How these worries are handled and evaluated goes far in determining whether one passes through these years in a state of integrity or despair.

Death today is a complicated matter. No longer is it a matter of “not breathing.” Modern technology has introduced ethical, legal, religious, and cultural matters into what was formerly a biological conclusion. For several decades, slow deaths disappeared from most people’s immediate presence. Retirement homes, nursing homes, and hospitals were the most frequent locations for the death of an elderly person.

More recently, the final scene of life has begun finding new terminal locations. As AIDS, drugs, and widespread violence have brought death to a steadily increasing number of younger people, the reality of death has once again returned to the community as families supported by hospice care, healthcare workers, police officers, and other parties become more involved in the dying process.

Whether one agrees with her views on death or not, Elizabeth Kubler-Ross (1969) is widely credited for her efforts to call attention to the psychological needs of the dying. After interviewing 200 terminally ill patients, she identified five stages that people pass through when they realize that death is inescapable (Table 74-1).

Kubler-Ross herself retreated from the rigidity of a stage theory of death. People simply do not follow a set formula in how they face death. In death, as in life, individual differences are the norm. Dying people exhibit many of these characteristics, but they do not unfailingly follow this prescribed pattern. People, as they did in their lives,
use individual techniques of coping with death. Also, different cultures make different interpretations of death. Some Native Americans, for example, are taught that death is part of nature’s cycle, so it is not to be feared but rather faced with stoicism and composure. Still, to Kubler-Ross’s credit, she created a sense of awareness and sensitivity to the feelings and emotions of those facing death.