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Qualitative analysis of participants’ concerns over death and dying. To supplement the quantitative results, a content analysis was carried out to find other sources of death and dying anxieties that were untapped by the Repulsion by Death subscale in the Time 1 survey, as well as protective factors underlying the lack of death and dying concerns among some older adult British Christians in their own words. Four participants did not respond to this section.

Ninety participants identified at least one death and dying concern, and these concerns could be categorized into ten domains. The majority of participants (66.67%) dreaded a bad death. Bad death was described in many forms. The overriding fear was a long and painful dying process. Participants who spoke of a bad death might also worry about loss of dignity and about inability to self care due to mental and physical decline. Some participants did not want to die alone or feared that they would have no one to call on when they were very unwell or close to death. Others dreaded being unprepared to meet God after their death. Some participants were fearful of an unnatural death, such as being buried alive. Others feared about receiving inadequate care near the end of life.

The second death and dying concern (32.22%) related to becoming a financial and/or emotional burden to the family or carers. For example, some participants dreaded pre-deceasing their spouse who might still need them and worried that their surviving spouse would be unable to cope after their death.

The third death and dying concern (16.67%) centred on the lack of control or being helpless over the quality of end-of-life care. Inability to self care and being dependent on others due to worsening bodily functions were particularly worrying to some

participants. Others dreaded whether anyone could be trusted to look after them when they were unable to communicate their needs. They also feared that others would make unsolicited end-of-life decisions on their behalf or would not carry out their living will.

Around 15 per cent of the participant remarked that they had death and dying concerns but “dread” was too strong a term with which to describe their mortality concerns. The fifth death and dying concerns (11.11%) was about departure from people or things they enjoyed or loved. Several participants did not wish to leave their family and friends or feared that death would put an end to their pleasant life.

The sixth death and dying concern (10%) related to past unpleasant death-related experiences, such as having close family members or friends who suffered from a painful lingering death or who received inadequate care at the end of life. I suspected that these participants might fear suffering in a similar manner before they died.

Interestingly, five participants (5.55%) were doubtful of a promised afterlife, despite their belief in God. The eighth death and dying concern (5.55%) was fear towards the possibility, vulnerability or actual diagnosis of a life-threatening illness, such as cancer

or dementia, which would decrease their quality of life and increase their dependency on others. This was followed by concerns about the well-being of their surviving non-Christian family members whom they believed they might not meet after their death or who might not attain salvation (2.22%). Lastly, one participant (1.11%) reported a longing for longevity.

Taken together, the qualitative data on older adult British Christians’ written death and dying concerns mainly centred on their anxieties over dying in a horrific and

undignified way. It also uncovered four areas of personal death anxiety that warranted further investigation in the Time 2 survey. The first is their worry over the grieving of their close ones and disruptions to their significant interpersonal relationships that might be caused by their personal death. The second is their fear of losing worldly involvement. The third is their fear of not conforming to the standard of their religious faith. Probably because God is the gatekeeper to heaven, some Christian participants might worry about the consequences of being unprepared to meet God after death.

The fourth is their fear of ambiguity at the moment of death and the unknown in the hereafter.

Qualitative analysis of participants’ lack of death and dying concerns. Forty-nine participants claimed that they did not have any death and dying concerns and some respondents nominated more than one reason for their response. Their reasons could be categorized into six domains. More than two-third of them (77.55%) explained that their faith in an afterlife, God and/or Jesus Christ had helped them face mortality without fear. They believed that they would meet their Creator and His Son after death.

They also believed that death was a transition to a better place than here on Earth. In addition, some of them were very reassured of a promised afterlife because they had a strong belief in the Scriptures. Others believed that God would sustain them near the end of life.

The second reason for their lack of mortality concern (26.53%) centred on the fact that death was inevitable, so some participants found it pointless to fear death and thought it was more sensible to accept the reality of death. Some of them went on to reason that death was part of God’s will, so they did not dread mortality.

The third reason for their lack of mortality concern (24.49%) related to their past pleasant death-related experiences, such as witnessing the good death of others. I suspected that these participants might think that they could die with dignity and integrity just like those fortunate people whom they witnessed had died in peace.

Some of them were also convinced by the personal testimony of people who survived a near-death experience.

The fourth reason for their lack of mortality fear (16.32%) related to legitimating death.

Some participants considered old age as a right time to die. Rather than worrying about death, they focused on the present and were thankful for the blessings in their lives.

About 14 per cent of the participants did not dread death because they said they could be reunited with those who had died. Lastly, six participants (12.24%) said that they had no death and dying concerns because they believed they would be supported or would be well cared for when they were dying. They also believed that there would be medication available to relieve their suffering if they needed it. Others were positive that they would have access to good hospice care when needed.

Taken together, three major themes emerged from the older adult British Christians’

account of their lack of death and dying concerns. The first and foremost is their faith, which sustained their belief in achieving a good afterlife and in reuniting with the dead. The second is their preparation for and acknowledgement of death as an inevitable reality of life. Indeed, mortality acceptance may be a resilience factor underlying low personal death anxiety in later life, a trend that has been observed by many prior studies (see section 1.2.4.1). Hence, mortality acceptance was incorporated into and examined in the Time 2 survey for its potential correlation with personal death anxiety (see section 5.2.2.18). The third is their past pleasant experiences with the dying of others, which is speculated to have lessened their fear of the dying process.

Test-retest reliability for death-related attitudes. Three death-related attitudes were measured both in Time 1 and Time 2 surveys. They are personal death anxiety, personal dying anxiety and perceived attraction to death. Given that the values of skewness and kurtosis were within the range under the univariate normality

assumption, Pearson’s correlation with listwise case exclusion was run to examine the test-retest reliability for these three death-related attitudes. It should be noted that correlation was performed on the same set of retained personal death anxiety items as measured by the Repulsion by Death subscale to be consistent across Time 1 and Time 2 surveys. Test-retest reliability was moderate for personal death anxiety and personal dying anxiety, but was fair for perceived attraction to death. Table 8 shows the

descriptive statistics and bivariate correlations with listwise case exclusion (N = 137) among three death-related attitudes across Time 1 and Time 2 surveys.

Table 8

Descriptive Statistics (N = 143) and Bivariate Correlations (Liswise N = 137) among Three Death-Related Attitudes across Time 1 and Time 2 Surveys

1. 2. 3. 4. 5. 6.