OMEGA, Vol. 67(4) 379-391, 2013
ATTITUDES TOWARD DYING AND DEATH: A COMPARISON OF RECREATIONAL GROUPS AMONG OLDER MEN JAMES D. GRIFFITH ALI TOMS JOEY REESE MICHAEL HAMEL LUCY L. GU Shippensburg University, Pennsylvania CHRISTIAN L. HART Texas Women’s University
ABSTRACT
Previous research reports examining the relationship between attitudes toward dying, death, and involvement in death-related occupations have provided mixed findings as no clear pattern has been identified. Examination of the relationship between attitudes toward dying, death, and recreational activity has not received much attention. The current study examined attitudes toward dying and death of older men categorized into four groups defined by recreational activities. The groups included skydivers (high death risk), nursing home residents (high death exposure), volunteer firefighters (high death risk and high death exposure), and a control group. The analyses found that skydivers reported the least fear of death, while nursing home residents reported the highest level. In addition, skydivers and firefighters had higher death acceptance scores than nursing home residents and the control group for the confrontation dimension, whereas skydivers had higher death acceptance scores than all groups, and firefighters were more accepting of death than nursing home residents for the integration dimension. 379 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/OM.67.4.c http://baywood.com
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Factors related to attitudes toward death has been an area of interest due to the increasing population of older people across most nations (Tomer, 2000). Factors related to death anxiety and fear of death have been examined for more than 40 years and have been outlined in recent review articles (Fortner & Neimeyer, 1999; Neimeyer, Wittkowski, & Moser, 2004). Research has examined differences on death anxiety across a variety of variables including age, gender, and occupational choice, to name a few. Of interest to many has been to find consistent patterns based upon experiences that can predict attitudes toward dying and death. Studies examining the relationship between death anxiety and occupational choices have yielded an inconsistent pattern. Some studies have found that individuals involved in death-related fields have more death anxiety than those in other professions (DePaola, Neimeyer, Lupfer, & Fiedler, 1992; Grant & Wade-Benzoni, 2009; Meisenhelder, 1994; Robbins, 1992; Thorson & Powell, 1991, 1996). For example, Hunt, Lester, and Ashton (1983) showed firefighters and policemen had an overall higher fear of dying and death than business students and college faculty members. In contrast, some research has shown that continued preparation for death and professional experience in one’s field (i.e., nursing) was related to a decreased fear of dying and death (Lester, Getty, & Kneisl, 1974; Yeaworth, Kapp, & Winget, 1974). A study that provided mixed results was conducted by Lattanner and Hayslip (1985), who further examined the relationship between occupational choice and the different types of fear regarding death. The study was completed by participants falling into two categories, which included those in death-related occupations (firemen, funeral personnel) and those in non-death-related fields (secretaries, accountants, and teachers). Participants in the non-death-related group tended to show more denial regarding the death of others than participants in the death-related group. The results also suggested that the death-related group might be oversensitive to death (Lattanner & Hayslip, 1985). Lastly, there have been studies that have found no differences between occupational groups. For example, Lewis, Espe-Pfeifer, and Blair (1999-2000) compared the relationship between death anxiety and denial scores between people employed in death risk (military personnel), death-exposure healthcare employees, and low-risk (college students) occupations. Results did not reveal significant differences between the groups on either scale. Ford, Alexander, and Lester (1971) found no significant difference between the fear of dying and death of the self and others among policemen and mailmen as well as policemen and male undergraduates, which was consistent with other studies (Dattel & Neimeyer, 1990; Kane & Hogan, 1985; White & Handal, 1990). Although a considerable amount of work has been conducted on examining the relationship between occupation and death anxiety, a clear pattern has not yet emerged. Another dimension to consider related to occupation that may eventually provide more consistent patterns of responding is that of recreational choice. Among the work done on attitudes toward death, there has been limited research that examined the relationship between death anxiety and recreational activities.
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One study examined the relationship between age and death anxiety on the frequency of engaging in health-promoting activities (Bozo, Tunca, & Simsek, 2009). The researchers found that younger individuals with high death anxiety showed more health-promoting behaviors than older persons with high death anxiety. They also found a positive relationship between levels of death anxiety and health-promoting behaviors. Few studies have looked at risky recreational activities, and those studies that have delved into risky recreational activities have reported inconsistent findings. For example, Schrader and Wann (1999) found that death anxiety was not a good predictor of participation in high-risk recreation. They hypothesized that the young age of the participants (i.e., M = 21.8 years) could have impacted the results. Feifel & Nagy (1981) determined little relationship between participation in risky sports and one’s perspective on death. Another study comparing parachute jumpers and nonjumpers also yielded null results (Alexander & Lester, 1972). One issue to consider in the context of these studies is the subjective appraisal of the recreation as a high death-risk activity. For example, skydiving is relatively low in death exposure as there is a fatality about one every 95,000 jumps (Griffith & Hart, 2002), and skydivers rarely observe a fatality. There is, however, a public perception that skydiving is one of the most dangerous recreational activities (Pedersen, 1997). In contrast to these findings, Griffith and Hart (2005) found that collegiate skydivers reported lower death anxiety than their non-skydiving counterparts on three dimensions, which included fear of death of self, fear of death of others, and fear of dying of others. It has been suggested that these differences may be explained by the fact that skydivers have personal control over when and how they face death, whereas those in other death-related activities have less personal control over when and how they face death (Griffith & Hart, 2005). Another interpretation of the findings may be found from the model of stress and coping provided by Folkman and Lazarus (1985). According to this model, cognitive appraisal of a potential stressor is a two-step process. The first step assesses if an event is irrelevant, benign/positive, or stressful. In the case of a skydive, it would certainly be assessed as being stressful. Stressful appraisals are then characterized by threat, challenge, or harm/loss. Skydivers most likely have stress appraisals that are some combination of threat and challenge depending on their experience. Novice skydivers probably have higher levels of threat (i.e., the potential for harm), and experienced skydivers most likely have higher levels of challenge (i.e., the potential for growth, mastery, or gain). The secondary appraisal involves the individual evaluating coping resources and options. Thus, as more experience is gained, the threat dimension is diminished and the challenge dimension expands. As such, repeated participation in voluntary death-related recreation may serve to decrease death anxiety. This process may occur by successful coping strategies of an event that was once considered a significant threat. In other words, skydivers may have initially believed that making a jump was a
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serious threat, but as they gain experience, the threat diminishes because of the steps they have taken in making repeated skydives resulting in no harm. In recent years, there has been an interest in death anxiety differences within the elderly population. For example, Kastenbaum (1992) found that elderly subjects who lived alone had higher levels of death anxiety compared to those who lived with family members. Feifel and Nagy (1980) found that older subjects with higher self-reported fear of death viewed death more negatively. In addition, this same group tended to avoid death related experiences (e.g., funerals) more often than those who did not view death as negatively. In a review article, Fortner and Neimeyer (1999) suggested that higher death anxiety in the elderly was predicted by lower ego integrity, increased physical problems, increased psychological problems, and residing in a nursing home. DePaola, Griffin, Young, and Neimeyer (2003) examined gender and ethnicity differences on death anxiety in an elderly sample. In terms of gender, their results showed that women had higher death anxiety than men. When examining ethnicity, their results showed that Caucasians displayed higher death anxiety in terms of fear of the dying process, and African Americans displayed higher death anxiety in terms of fear of the unknown, fear of conscious death, and fear of body after death. Additionally, researchers have begun to study differences between socioenvironmental influences on death anxiety in the elderly (e.g., Azaiza, Ron, Shoham, & Tinsky-Roimi, 2011). Despite the interest in the elderly population, studies that have attempted to measure occupational or recreational differences in death anxiety within an elderly population are limited. One issue with using occupation among this group is that many will be retired by the time they reach 60 years old. Recreational choice seemed like a viable factor to explore because participants were actively engaged in the activity. The current study was conducted in order to determine the relationship between attitudes toward dying and death across four elderly groups participating in different types of recreational activities. The recreational activities were chosen because of findings from prior research and conceptualized on the basis of how occupations were categorized in prior studies. The four groups consisted of skydivers, nursing home residents, volunteer firefighters, and a control group. The recreational activities were classified as high death risk or high death exposure. Skydivers were classified as high death risk because they essentially save their own life each time they jump from an airplane. If they do not execute the appropriate sequence of steps, they will die. Although prior studies (e.g., Alexander & Lester, 1972; Griffith & Hart, 2005) that examined skydivers used young adults as participants, technological changes in the skydiving industry during the past 20 years have provided opportunities for older adults as well. Nursing home residents were selected because they often have very limited opportunities for any type of recreational activity, and they are often in an environment with high death exposure, as other residents dying around them is common. Volunteer firefighters were classified as high death risk and high death
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exposure because they save others’ lives in addition to risking their own lives when fighting fires and assisting victims in emergency situations. Lastly, there was a control group that was not involved in any of the aforementioned activities or environments. It was hypothesized that participants living in the nursing homes would report the highest level of fear of death and lowest level of death acceptance in agreement with Fortner and Neimeyer (1999), whereas skydivers would report the lowest level of fear of death and highest level of death acceptance, supporting the findings by Griffith and Hart (2005). METHOD Participants All participants were male in an effort to achieve adequate sample size, because participation in the recreational activities were largely male dominated (i.e., skydivers and volunteer firefighters). In addition, all participants were at least 60 years old. Four distinct groups were selected to represent different recreational activity choices that may be related to death risk or exposure. The first group consisted of 54 individuals who were licensed skydivers and represented the high death-risk group. The average age of participants was 66.5, and individuals had a mean of 1,412 skydives. All participants jumped within the last 30 days. The second group consisted of 49 residents at a nursing home and represented the high death-exposure group. All of these participants were residents in a nursing home facility for at least 6 months and had an average age of 68.7. The third group consisted of 48 volunteer firefighters, who represented the high death-risk and high death-exposure group. Participants had to be involved in firefighting activities for at least 5 years and had to have participated in firefighting during the past 30 days. The average age was 64.5, and the mean length of time involved in firefighting was 27.1 years. The fourth group served as the control group and consisted of 50 individuals who could not be grouped in any of the previous three categories. Participants in the control group had an average age of 66.9. Instruments Collett-Lester Fear of Death Scale
The most recent revision of the Collett-Lester Fear of Death Scale (Lester & Abdel-Khalek, 2003) was used to assess four dimensions of the fear of death. The revised Collett-Lester Fear of Death scale is a 28-item instrument that measures four fear dimensions: death of self, dying of self, death of others, and dying of others. Each subscale has seven items, and the instrument instructs respondents to rate how disturbed they are by each item on a 5-point Likert scale, anchored by (1) “Not at all” to (5) “Very.” The score on each subscale can range from 7 to 35, with higher values reflecting increased levels of fear of death. The internal consistency reliabilities for the four fear dimensions (i.e.,
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death of self, dying of self, death of others, and dying of others) were .84, .76, .85, and .84, respectively. The Death Acceptance Scale
The Death Acceptance Scale (Klug & Sinha, 1988) is a 16-item instrument that measures two dimensions of death acceptance including confrontation and integration. Participants rated each item using a 4-point Likert scale, anchored by (1) “Strongly disagree” to (4) “Strongly agree.” Each subscale has eight items, and scores can range from 8 to 32, with higher values reflecting a higher level of death acceptance. The internal consistency reliabilities for the two dimensions (confrontation and integration) were .82 and .81, respectively. Procedure The same procedure was used in all five different recruiting settings. Researchers worked in pairs and approached potential participants who they assumed were at least 60 years old. Potential participants were briefed on the nature of the study and asked if they would be willing to participate in the study. If potential subjects agreed, they were asked their age to confirm they met the 60-year-old criterion. The skydivers were sampled at two drop zones in Florida during several events sponsored by an organization called Skydivers Over Sixty and were surveyed prior to making any jumps that day. The nursing home residents were recruited from nursing homes in Pennsylvania. The volunteer firefighters were recruited from fire stations in Pennsylvania and Maryland. The control group was recruited from outside several shopping centers. After they agreed to participate, the control group was asked if they were a member of a volunteer fire company, engaged in skydiving, or lived at a nursing home to ensure they were different from the other groups. The percentages of skydivers, firefighters, nursing home residents, and controls who agreed to participate in the study after being approached were 90%, 85%, 88%, and 18%, respectively. When participants agreed to take part in the study, they were told about the nature of the study and asked to complete the consent form and two-page survey. RESULTS Two MANOVAs were conducted on the independent variable (i.e., group) across the subscales for fear of death and death acceptance. For the MANOVA conducted on the four fear of death subscales, the analyses yielded a significant effect for group, F(12, 531) = 6.05, p < .001. Because of the significant findings, a series of four ANOVAs were performed on each the dependent variables. The univariate analyses indicated significant effects for death of self, F(3, 178) = 11.91, p < .001; dying of self, F(3, 178) = 10.32, p < .001; death of others, F(3, 178) = 5.41, p < .01; and dying of others F(3, 178) = 4.13, p < .01. Table 1 shows
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Table 1. Fear of Death Subscale Means and Standard Deviations
Subscale
Skydivers M
Nursing home residents M
Death of self
14.4 (6.1)a
28.8 (4.9)c
18.9 (5.9)b
24.1 (6.9)c
Dying of self
18.8 (5.2)a
27.9 (5.5)c
21.5 (6.5)ab
23.5 (5.9)b
Death of others
19.1 (5.5)a
27.8 (5.1)b
24.7 (6.0)b
23.9 (7.1)b
Dying of others
19.2 (6.7)a
28.0 (5.8)b
25.8 (5.2)b
26.4 (6.3)b
Firefighters M
Control M
Note: Scores on each subscale can range from 7 to 35, with larger numbers reflecting higher levels of fear of death in that domain. Standard deviations are in parentheses. Scores in each row with different subscripts indicate significant differences between the means, p < .05.
the means and standard deviations for each of the groups across each measure of fear of death. Fisher’s LSD post hoc comparisons were used to examine the differences for each subscale. For death of self, skydivers had less fear than all groups, and volunteer firefighters had less anxiety than nursing home residents and the control group. For dying of self, skydivers had less anxiety than nursing home residents and the control group, whereas the firefighters had less anxiety than the nursing home residents. In terms of death of others and dying of others, skydivers’ scores were lower than all groups, indicating less fear of death. The MANOVA on the death acceptance measures also revealed significant effects, F(6, 390) = 8.25, p < .001. The follow-up univariate analyses indicated significant effects for confrontation, F(3, 195) = 7.89, p < .001, and integration, F(3, 195) = 9.88, p < .001. Table 2 shows the means and standard deviations for each of the groups across both measures of death acceptance. Fisher’s LSD post hoc comparisons were used to examine the differences for each subscale. For confrontation, skydivers and firefighters had higher death acceptance scores than nursing home residents and controls. For the integration dimension, skydivers had higher death acceptance scores than all groups, and firefighters were more accepting of death than nursing home residents. DISCUSSION The present study examined the relationship between attitudes toward dying and death as conceptualized as fear of death and death acceptance across different groups of elderly recreationists (i.e., skydivers and volunteer firefighters), nursing home residents, and a control group. Skydivers were shown to have significantly lower reported levels of fear of death compared to the other groups in the study. These results conflict with a prior study (Alexander & Lester, 1972), which
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Table 2. Death Acceptance Subscale Means and Standard Deviations
Subscale
Skydivers M
Nursing home residents M
Confrontation
28.1 (4.8)a
18.2 (5.3)b
27.8 (5.5)a
22.6 (4.7)b
Integration
29.4 (5.1)a
19.1 (6.5)c
25.9 (6.8)b
22.3 (4.9)bc
Firefighters M
Control M
Note: Scores on each subscale can range from 8 to 32, with larger numbers reflecting higher levels of death acceptance in that domain. Standard deviations are in parentheses. Scores in each row with different subscripts indicate significant differences between the means, p < .05.
reported no differences between fear of dying and death between parachute jumpers and non-jumpers. However, the results of this study provide additional support to Griffith and Hart’s (2005) more recent finding that skydivers do indeed exhibit different reactions to thoughts of dying and death. It may be possible that control over when and how one faces death could play into the amount of experience by different recreational groups. Skydiving is a high-risk or heightened-death-risk activity, yet it is also a voluntarily chosen recreational activity. This “choice” may in fact work as part of a continuous control mechanism. This sense of choice may allow skydivers to perceive themselves as having direct control over their risk of dying and death. This is supported by evidence from studies that show that continued preparation and professional experience are linked to a decreased fear of dying and death (Lester et al., 1974; Yeaworth et al., 1974). On every jump, skydivers voluntarily choose to board the plane, jump out of the plane, control the point at which they decide to deploy their parachute, and steer it to an open area for a safe landing. After completing over 1,400 successful jumps, it seems possible that a person who voluntarily chooses to put his life in his own hands and continuously succeeds would have a lower amount of anxiety over dying and death in comparison to people who do not directly and intentionally participate in life-threatening situations (i.e., nursing home residents and the control group). It could also be that the skydivers feel that they have control over their lives when they jump (Laurendeau, 2006) and view skydiving as a challenge rather than a threat (Folkman & Lazarus, 1985). Consistent with Pollak (1979), people with an internal locus of control tend to report lower levels of death anxiety. Because skydivers believe that they have complete control over their lives when they jump, they would be exhibiting an internal locus of control. This sense of control may be why skydivers tend to report lower levels of fear of death and more death acceptance. Although locus of control was not investigated, it is certainly a direction that future research might consider.
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Nursing home residents had consistently high levels of fear of death and low levels of death acceptance compared to the other groups. This finding parallels Fortner and Neimeyer (1999), suggesting that individuals residing in high death-exposure settings tend to have more negative attitudes toward dying and death. This heightened fear of death may be elevated by the fact that many residents of nursing homes know they will eventually die at that particular facility. In other words, it is the last place that many individuals will live, and there is an expectation of death, and it is simply a matter of waiting for it to happen. Rather than thinking about making a jump or fighting fires, residents at nursing homes may tend to think about their own ailments, discomfort, and inevitable death. It may be the case that the other groups, including the control group, may have ample opportunities to think about topics other than death, whereas there may be daily reminders of mortality for the nursing home residents due to the nature of the facilities and how they are operated. Firefighting can be seen as having both high risk and high death exposure, and the firefighters in the sample were shown to have less fear of death of self in comparison to nursing home residents and the control sample. Firefighters were also shown to have less fear of death of self in comparison to nursing home residents. All of the firefighters in the sample were from volunteer stations, so the activity they are involved in can be considered voluntary, similar to skydiving. So why did the firefighters in the sample show less fear of death in comparison to low-risk groups but more fear of death than their skydiving cohorts who are also engaged in high-risk activity? The answer to this question may be related to the fact that there is a choice difference of initiation/response between a skydiving jump and approaching a burning building. As previously stated, a skydiver directly chooses to initiate in the death-related activity, whereas a firefighter does not initiate the activity but responds to an already initiated activity that is unknown until arriving at the fire or accident. Choosing to respond to a high-risk activity is fundamentally different than having the choice to initiate engagement in a high-risk activity, and this may be partially responsible for differences in attitudes toward dying and death between skydivers and firefighters. Firefighters may have reported reduced levels of fear of death and had higher levels of death acceptance when compared to others in low-risk death-related activities due to successful experience with personal survival in high-risk activities, just like skydivers. This is supported further by evidence that both skydivers and firefighters have higher scores of death acceptance than low-risk death-related groups. However, because of the differences between initiation and response in their corresponding activities, firefighters do not have as high a sense of control over their own dying and death as skydivers do. Volunteer firefighters choose when to volunteer their time, but they do not get to choose when to respond to fires and other high-risk activities involved with firefighting. When looking at dying and death of others, firefighters reported more anxiety than skydivers. This could be related to the fact that skydiving is relatively low
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death exposure as there is a fatality about one every 95,000 jumps (Griffith & Hart, 2002). Firefighting is both high death risk and high death exposure. Skydivers rarely, if ever, physically see anyone die while they are skydiving. They also tend to jump successfully with close friends who also engage in the same high-risk activity without consequences. This may explain why they show low anxiety about dying and death of others. Firefighters, however, tend to see death and destruction more often when they are responding to a burning building or an accident. They are more likely to see people severely injured or deceased and are exposed to such situations more often, which may explain why they show greater anxiety about dying and death of others. Although this study provides new data on the relationship between attitudes toward dying and death among elderly men with different recreational pursuits, there are four limitations that need to be discussed. First, convenience sampling was used rather than random sampling, thus the generalizability of the findings should be made with caution. It is not known how representative each of the groups are within that given population. Second, one factor that was not measured but may be a mediating or moderating variable is that of social support. The skydiving and volunteer firefighting communities tend to be very social in nature, as individuals typically spend a fair amount of time with others both when engaging in those specific recreational activities and beyond those environments. The control group may have also had varying levels of social support, and it is speculated that the nursing home residents probably had the least amount of social support. Third, other recreational activities should be considered. The present study chose to focus on recreational activities as they related to death risk and exposure. There are other recreational activities that are more social, psychological, or spiritual in nature that may be related to attitudes toward dying and death. Fourth, the majority of these men have worked 40 years or more, and the study did not ask about their occupation. It may be possible that participants’ experiences, including their occupation, may have been related to the development of attitudes toward dying and death. For example, it may be possible that skydivers had more military experience compared to the other groups. There are several directions in which future studies should focus. First, an examination on whether lower fear of death and higher levels of death acceptance is associated with other high-risk, directly initiated recreational activities would be a beneficial direction to pursue. There is a multitude of other activities like skydiving to choose from, including spelunking, surfing, mountaineering, and whitewater kayaking, to name a few. Second, direct measures of perceived control would also be of interest in determining differences between these types of directly initiated activities and other types of recreational activities involving volunteers (i.e., emergency medical technicians and FEMA aids) in which the participant is a respondent to a high-risk situation. A third potential avenue of research could explore the role of dosage or amount of a particular exposure within a single group. For example, among volunteer fire departments, there are some
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companies that are busier than others based on location and the amount of people served. Thus, it may be the case that different levels of death risks and exposures may be related to varying levels of attitudes toward dying and death within a group. Fourth, the role of social support should also be examined to determine the possible mediating or moderating effects, as that may have been an unmeasured variable of importance in the current study. Lastly, researchers investigating this area should consider mixed mode studies in which quantitative and qualitative methodologies are combined. Access to some of these populations is sometimes challenging, and a variety of methodologies would be both efficient and provide more depth of understanding. This study provided evidence of variation in attitudes toward dying and death in an elderly sample of men when comparing death risk and exposure on the basis of recreational activities. Skydivers were found to have overall lower fear of death and were more accepting of death in comparison to other recreational groups. Firefighters were found to have lower fear of death in comparison to lower-risk recreational groups, including nursing home patients and a control group. Nursing home residents tended to have the highest levels of fear of death and lowest level of death acceptance, probably due to their environment. The importance of recreational activities among the elderly should be a focus of continued research in order to identify themes that are associated with attitudes toward dying and death. REFERENCES Alexander, M., & Lester, D. (1972). Fear of death in parachute jumpers. Perceptual and Motor Skills, 34, 338. Azaiza, F., Ron, P., Shoham, M., & Tinsky-Roimi, T. (2011). Death and dying anxiety among bereaved and nonbereaved elderly parents. Death Studies, 35, 610-624. Bozo, O., Tunca, A., & Simsek, Y. (2009). The effect of death anxiety and age on health-promoting behaviors: A terror management theory perspective. The Journal of Psychology, 143, 377-389. Dattel, A. R., & Neimeyer, R. A. (1990). Sex differences in death anxiety: Testing the emotion expressiveness hypothesis. Death Studies, 14, 1-11. DePaola, S. J., Griffin, M., Young, J. R., & Neimeyer, R. A. (2003). Death anxiety and attitudes toward the elderly among older adults: The role of gender and ethnicity. Death Studies, 27, 335-354. DePaola, S. J., Neimeyer, R. A., Lupfer, M. B., & Fiedler, J. (1992). Death concern and attitudes toward the elderly in nursing home personnel. Death Studies, 16, 537-555. Feifel, H., & Nagy, V. (1980). Death orientation and life threatening behavior. Journal of Abnormal Psychology, 89, 38-45. Feifel, H., & Nagy, V. (1981). Another look at fear of death. Journal of Consulting and Clinical Psychology, 49, 278-286. Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150-170.
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Ford, R. E., Alexander, M., & Lester, D. (1971). Fear of death of those in a high stress occupation. Psychological Reports, 29, 502. Fortner, B. V., & Neimeyer, R. A. (1999). Death anxiety in older adults: A quantitative review. Death Studies, 23, 387-411. Grant, A., & Wade-Benzoni, K. (2009). The hot and cool of death awareness at work: Mortality cues, aging, and self-protective and prosocial motivations. Academy of Management Review, 34, 600-622. Griffith, J. D., & Hart, C. L. (2002). A summary of U.S. skydiving fatalities: 1993-1999. Perceptual and Motor Skills, 94, 1089-1090. Griffith, J. D., & Hart, C. L. (2005). Collegiate skydivers: Do they fear death? Journal of Worry and Affective Experience, 1(2), 71-76. Hunt, D. M., Lester, D., & Ashton, N. (1983). Fear of death, locus of control, and occupation. Psychological Reports, 53, 1022. Kane, A. C., & Hogan, J. D. (1985). Death anxiety in physicians: Defensive style, medical specialty, and exposure to death. Omega: Journal of Death and Dying, 16, 11-22. Kastenbaum, R. (1992). Death, suicide and the older adult. Suicide and Life-Threatening Behavior, 22, 1-14. Klug, L., & Sinha, A. (1988). Death acceptance: A two component formulation and scale. Omega: Journal of Death and Dying, 18, 229-235. Lattanner, B., & Hayslip, H. (1984-85). Occupation-related differences in levels of death anxiety. Omega: Journal of Death and Dying, 15, 53-66. Laurendeau, J. (2006). “He didn’t go in doing a skydive”: Sustaining the illusion of control in an edgework activity. Sociological Perspectives, 49, 583-605. Lester, D., & Abdel-Khalek, A. (2003). The Collett-Lester Fear of Death Scale: A correction. Death Studies, 27, 81-85. Lester, D., Getty C., & Kneisl, C. (1974). Attitudes of nursing students and nursing faculty toward death. Nursing Research, 23, 50-53. Lewis, J. G., Espe-Pfeifer, P., & Blair, G. (1999-2000). A comparison of death anxiety and denial in death-risk and death-exposure occupations. Omega: Journal of Death and Dying, 40, 421-434. Meisenhelder, J. B. (1994). Contributing factor to fear of HIV contagion in registered nurses. Image, 26, 65-69. Neimeyer, R. A., Wittkowski, J., & Moser, R. P. (2004). Psychological research on death attitudes: An overview and evaluation. Death Studies, 28, 309-340. Pedersen, D. M. (1997). Perceptions of high risk sports. Perceptual and Motor Skills, 85, 756-758. Pollak, J. M. (1979). Correlates of death anxiety: A review of empirical studies. Omega: Journal of Death and Dying, 10, 97-121. Robbins, R. A. (1992). Death competency: A study of hospice volunteers. Death Studies, 16, 557-569. Schrader, M. P., & Wann, D. L. (1999). High-risk recreation: The relationship between participant characteristics and degree of involvement. Journal of Sport Behavior, 22, 426-441. Thorson, J. A., & Powell, F. C. (1991). Medical students’ attitudes towards aging and death: A cross-sequential study. Medical Education, 25, 32-37.
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Thorson, J. A., & Powell, F. C. (1996). Undertakers’ death anxiety. Psychological Reports, 78, 1228-1230. Tomer, A. (Ed.). (2000). Death attitudes and the older adult: Theories, concepts, and applications. Washington, DC: Taylor & Francis. White, W., & Handal, P. J. (1990). The relationship between death anxiety and mental health/distress. Omega: Journal of Death and Dying, 22, 13-24. Yeaworth, R., Kapp, F., & Winget, C. (1974). Attitudes of nursing students toward the dying patient. Nursing Research, 23, 20-24.
Direct reprint requests to: James Griffith Shippensburg University Department of Psychology – FSC 119 Shippensburg, PA 17257 e-mail: [email protected]
ATTITUDES TOWARD DYING AND DEATH: A COMPARISON OF RECREATIONAL GROUPS AMONG OLDER MEN JAMES D. GRIFFITH ALI TOMS JOEY REESE MICHAEL HAMEL LUCY L. GU Shippensburg University, Pennsylvania CHRISTIAN L. HART Texas Women’s University
ABSTRACT
Previous research reports examining the relationship between attitudes toward dying, death, and involvement in death-related occupations have provided mixed findings as no clear pattern has been identified. Examination of the relationship between attitudes toward dying, death, and recreational activity has not received much attention. The current study examined attitudes toward dying and death of older men categorized into four groups defined by recreational activities. The groups included skydivers (high death risk), nursing home residents (high death exposure), volunteer firefighters (high death risk and high death exposure), and a control group. The analyses found that skydivers reported the least fear of death, while nursing home residents reported the highest level. In addition, skydivers and firefighters had higher death acceptance scores than nursing home residents and the control group for the confrontation dimension, whereas skydivers had higher death acceptance scores than all groups, and firefighters were more accepting of death than nursing home residents for the integration dimension. 379 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/OM.67.4.c http://baywood.com
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Factors related to attitudes toward death has been an area of interest due to the increasing population of older people across most nations (Tomer, 2000). Factors related to death anxiety and fear of death have been examined for more than 40 years and have been outlined in recent review articles (Fortner & Neimeyer, 1999; Neimeyer, Wittkowski, & Moser, 2004). Research has examined differences on death anxiety across a variety of variables including age, gender, and occupational choice, to name a few. Of interest to many has been to find consistent patterns based upon experiences that can predict attitudes toward dying and death. Studies examining the relationship between death anxiety and occupational choices have yielded an inconsistent pattern. Some studies have found that individuals involved in death-related fields have more death anxiety than those in other professions (DePaola, Neimeyer, Lupfer, & Fiedler, 1992; Grant & Wade-Benzoni, 2009; Meisenhelder, 1994; Robbins, 1992; Thorson & Powell, 1991, 1996). For example, Hunt, Lester, and Ashton (1983) showed firefighters and policemen had an overall higher fear of dying and death than business students and college faculty members. In contrast, some research has shown that continued preparation for death and professional experience in one’s field (i.e., nursing) was related to a decreased fear of dying and death (Lester, Getty, & Kneisl, 1974; Yeaworth, Kapp, & Winget, 1974). A study that provided mixed results was conducted by Lattanner and Hayslip (1985), who further examined the relationship between occupational choice and the different types of fear regarding death. The study was completed by participants falling into two categories, which included those in death-related occupations (firemen, funeral personnel) and those in non-death-related fields (secretaries, accountants, and teachers). Participants in the non-death-related group tended to show more denial regarding the death of others than participants in the death-related group. The results also suggested that the death-related group might be oversensitive to death (Lattanner & Hayslip, 1985). Lastly, there have been studies that have found no differences between occupational groups. For example, Lewis, Espe-Pfeifer, and Blair (1999-2000) compared the relationship between death anxiety and denial scores between people employed in death risk (military personnel), death-exposure healthcare employees, and low-risk (college students) occupations. Results did not reveal significant differences between the groups on either scale. Ford, Alexander, and Lester (1971) found no significant difference between the fear of dying and death of the self and others among policemen and mailmen as well as policemen and male undergraduates, which was consistent with other studies (Dattel & Neimeyer, 1990; Kane & Hogan, 1985; White & Handal, 1990). Although a considerable amount of work has been conducted on examining the relationship between occupation and death anxiety, a clear pattern has not yet emerged. Another dimension to consider related to occupation that may eventually provide more consistent patterns of responding is that of recreational choice. Among the work done on attitudes toward death, there has been limited research that examined the relationship between death anxiety and recreational activities.
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One study examined the relationship between age and death anxiety on the frequency of engaging in health-promoting activities (Bozo, Tunca, & Simsek, 2009). The researchers found that younger individuals with high death anxiety showed more health-promoting behaviors than older persons with high death anxiety. They also found a positive relationship between levels of death anxiety and health-promoting behaviors. Few studies have looked at risky recreational activities, and those studies that have delved into risky recreational activities have reported inconsistent findings. For example, Schrader and Wann (1999) found that death anxiety was not a good predictor of participation in high-risk recreation. They hypothesized that the young age of the participants (i.e., M = 21.8 years) could have impacted the results. Feifel & Nagy (1981) determined little relationship between participation in risky sports and one’s perspective on death. Another study comparing parachute jumpers and nonjumpers also yielded null results (Alexander & Lester, 1972). One issue to consider in the context of these studies is the subjective appraisal of the recreation as a high death-risk activity. For example, skydiving is relatively low in death exposure as there is a fatality about one every 95,000 jumps (Griffith & Hart, 2002), and skydivers rarely observe a fatality. There is, however, a public perception that skydiving is one of the most dangerous recreational activities (Pedersen, 1997). In contrast to these findings, Griffith and Hart (2005) found that collegiate skydivers reported lower death anxiety than their non-skydiving counterparts on three dimensions, which included fear of death of self, fear of death of others, and fear of dying of others. It has been suggested that these differences may be explained by the fact that skydivers have personal control over when and how they face death, whereas those in other death-related activities have less personal control over when and how they face death (Griffith & Hart, 2005). Another interpretation of the findings may be found from the model of stress and coping provided by Folkman and Lazarus (1985). According to this model, cognitive appraisal of a potential stressor is a two-step process. The first step assesses if an event is irrelevant, benign/positive, or stressful. In the case of a skydive, it would certainly be assessed as being stressful. Stressful appraisals are then characterized by threat, challenge, or harm/loss. Skydivers most likely have stress appraisals that are some combination of threat and challenge depending on their experience. Novice skydivers probably have higher levels of threat (i.e., the potential for harm), and experienced skydivers most likely have higher levels of challenge (i.e., the potential for growth, mastery, or gain). The secondary appraisal involves the individual evaluating coping resources and options. Thus, as more experience is gained, the threat dimension is diminished and the challenge dimension expands. As such, repeated participation in voluntary death-related recreation may serve to decrease death anxiety. This process may occur by successful coping strategies of an event that was once considered a significant threat. In other words, skydivers may have initially believed that making a jump was a
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serious threat, but as they gain experience, the threat diminishes because of the steps they have taken in making repeated skydives resulting in no harm. In recent years, there has been an interest in death anxiety differences within the elderly population. For example, Kastenbaum (1992) found that elderly subjects who lived alone had higher levels of death anxiety compared to those who lived with family members. Feifel and Nagy (1980) found that older subjects with higher self-reported fear of death viewed death more negatively. In addition, this same group tended to avoid death related experiences (e.g., funerals) more often than those who did not view death as negatively. In a review article, Fortner and Neimeyer (1999) suggested that higher death anxiety in the elderly was predicted by lower ego integrity, increased physical problems, increased psychological problems, and residing in a nursing home. DePaola, Griffin, Young, and Neimeyer (2003) examined gender and ethnicity differences on death anxiety in an elderly sample. In terms of gender, their results showed that women had higher death anxiety than men. When examining ethnicity, their results showed that Caucasians displayed higher death anxiety in terms of fear of the dying process, and African Americans displayed higher death anxiety in terms of fear of the unknown, fear of conscious death, and fear of body after death. Additionally, researchers have begun to study differences between socioenvironmental influences on death anxiety in the elderly (e.g., Azaiza, Ron, Shoham, & Tinsky-Roimi, 2011). Despite the interest in the elderly population, studies that have attempted to measure occupational or recreational differences in death anxiety within an elderly population are limited. One issue with using occupation among this group is that many will be retired by the time they reach 60 years old. Recreational choice seemed like a viable factor to explore because participants were actively engaged in the activity. The current study was conducted in order to determine the relationship between attitudes toward dying and death across four elderly groups participating in different types of recreational activities. The recreational activities were chosen because of findings from prior research and conceptualized on the basis of how occupations were categorized in prior studies. The four groups consisted of skydivers, nursing home residents, volunteer firefighters, and a control group. The recreational activities were classified as high death risk or high death exposure. Skydivers were classified as high death risk because they essentially save their own life each time they jump from an airplane. If they do not execute the appropriate sequence of steps, they will die. Although prior studies (e.g., Alexander & Lester, 1972; Griffith & Hart, 2005) that examined skydivers used young adults as participants, technological changes in the skydiving industry during the past 20 years have provided opportunities for older adults as well. Nursing home residents were selected because they often have very limited opportunities for any type of recreational activity, and they are often in an environment with high death exposure, as other residents dying around them is common. Volunteer firefighters were classified as high death risk and high death
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exposure because they save others’ lives in addition to risking their own lives when fighting fires and assisting victims in emergency situations. Lastly, there was a control group that was not involved in any of the aforementioned activities or environments. It was hypothesized that participants living in the nursing homes would report the highest level of fear of death and lowest level of death acceptance in agreement with Fortner and Neimeyer (1999), whereas skydivers would report the lowest level of fear of death and highest level of death acceptance, supporting the findings by Griffith and Hart (2005). METHOD Participants All participants were male in an effort to achieve adequate sample size, because participation in the recreational activities were largely male dominated (i.e., skydivers and volunteer firefighters). In addition, all participants were at least 60 years old. Four distinct groups were selected to represent different recreational activity choices that may be related to death risk or exposure. The first group consisted of 54 individuals who were licensed skydivers and represented the high death-risk group. The average age of participants was 66.5, and individuals had a mean of 1,412 skydives. All participants jumped within the last 30 days. The second group consisted of 49 residents at a nursing home and represented the high death-exposure group. All of these participants were residents in a nursing home facility for at least 6 months and had an average age of 68.7. The third group consisted of 48 volunteer firefighters, who represented the high death-risk and high death-exposure group. Participants had to be involved in firefighting activities for at least 5 years and had to have participated in firefighting during the past 30 days. The average age was 64.5, and the mean length of time involved in firefighting was 27.1 years. The fourth group served as the control group and consisted of 50 individuals who could not be grouped in any of the previous three categories. Participants in the control group had an average age of 66.9. Instruments Collett-Lester Fear of Death Scale
The most recent revision of the Collett-Lester Fear of Death Scale (Lester & Abdel-Khalek, 2003) was used to assess four dimensions of the fear of death. The revised Collett-Lester Fear of Death scale is a 28-item instrument that measures four fear dimensions: death of self, dying of self, death of others, and dying of others. Each subscale has seven items, and the instrument instructs respondents to rate how disturbed they are by each item on a 5-point Likert scale, anchored by (1) “Not at all” to (5) “Very.” The score on each subscale can range from 7 to 35, with higher values reflecting increased levels of fear of death. The internal consistency reliabilities for the four fear dimensions (i.e.,
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death of self, dying of self, death of others, and dying of others) were .84, .76, .85, and .84, respectively. The Death Acceptance Scale
The Death Acceptance Scale (Klug & Sinha, 1988) is a 16-item instrument that measures two dimensions of death acceptance including confrontation and integration. Participants rated each item using a 4-point Likert scale, anchored by (1) “Strongly disagree” to (4) “Strongly agree.” Each subscale has eight items, and scores can range from 8 to 32, with higher values reflecting a higher level of death acceptance. The internal consistency reliabilities for the two dimensions (confrontation and integration) were .82 and .81, respectively. Procedure The same procedure was used in all five different recruiting settings. Researchers worked in pairs and approached potential participants who they assumed were at least 60 years old. Potential participants were briefed on the nature of the study and asked if they would be willing to participate in the study. If potential subjects agreed, they were asked their age to confirm they met the 60-year-old criterion. The skydivers were sampled at two drop zones in Florida during several events sponsored by an organization called Skydivers Over Sixty and were surveyed prior to making any jumps that day. The nursing home residents were recruited from nursing homes in Pennsylvania. The volunteer firefighters were recruited from fire stations in Pennsylvania and Maryland. The control group was recruited from outside several shopping centers. After they agreed to participate, the control group was asked if they were a member of a volunteer fire company, engaged in skydiving, or lived at a nursing home to ensure they were different from the other groups. The percentages of skydivers, firefighters, nursing home residents, and controls who agreed to participate in the study after being approached were 90%, 85%, 88%, and 18%, respectively. When participants agreed to take part in the study, they were told about the nature of the study and asked to complete the consent form and two-page survey. RESULTS Two MANOVAs were conducted on the independent variable (i.e., group) across the subscales for fear of death and death acceptance. For the MANOVA conducted on the four fear of death subscales, the analyses yielded a significant effect for group, F(12, 531) = 6.05, p < .001. Because of the significant findings, a series of four ANOVAs were performed on each the dependent variables. The univariate analyses indicated significant effects for death of self, F(3, 178) = 11.91, p < .001; dying of self, F(3, 178) = 10.32, p < .001; death of others, F(3, 178) = 5.41, p < .01; and dying of others F(3, 178) = 4.13, p < .01. Table 1 shows
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Table 1. Fear of Death Subscale Means and Standard Deviations
Subscale
Skydivers M
Nursing home residents M
Death of self
14.4 (6.1)a
28.8 (4.9)c
18.9 (5.9)b
24.1 (6.9)c
Dying of self
18.8 (5.2)a
27.9 (5.5)c
21.5 (6.5)ab
23.5 (5.9)b
Death of others
19.1 (5.5)a
27.8 (5.1)b
24.7 (6.0)b
23.9 (7.1)b
Dying of others
19.2 (6.7)a
28.0 (5.8)b
25.8 (5.2)b
26.4 (6.3)b
Firefighters M
Control M
Note: Scores on each subscale can range from 7 to 35, with larger numbers reflecting higher levels of fear of death in that domain. Standard deviations are in parentheses. Scores in each row with different subscripts indicate significant differences between the means, p < .05.
the means and standard deviations for each of the groups across each measure of fear of death. Fisher’s LSD post hoc comparisons were used to examine the differences for each subscale. For death of self, skydivers had less fear than all groups, and volunteer firefighters had less anxiety than nursing home residents and the control group. For dying of self, skydivers had less anxiety than nursing home residents and the control group, whereas the firefighters had less anxiety than the nursing home residents. In terms of death of others and dying of others, skydivers’ scores were lower than all groups, indicating less fear of death. The MANOVA on the death acceptance measures also revealed significant effects, F(6, 390) = 8.25, p < .001. The follow-up univariate analyses indicated significant effects for confrontation, F(3, 195) = 7.89, p < .001, and integration, F(3, 195) = 9.88, p < .001. Table 2 shows the means and standard deviations for each of the groups across both measures of death acceptance. Fisher’s LSD post hoc comparisons were used to examine the differences for each subscale. For confrontation, skydivers and firefighters had higher death acceptance scores than nursing home residents and controls. For the integration dimension, skydivers had higher death acceptance scores than all groups, and firefighters were more accepting of death than nursing home residents. DISCUSSION The present study examined the relationship between attitudes toward dying and death as conceptualized as fear of death and death acceptance across different groups of elderly recreationists (i.e., skydivers and volunteer firefighters), nursing home residents, and a control group. Skydivers were shown to have significantly lower reported levels of fear of death compared to the other groups in the study. These results conflict with a prior study (Alexander & Lester, 1972), which
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Table 2. Death Acceptance Subscale Means and Standard Deviations
Subscale
Skydivers M
Nursing home residents M
Confrontation
28.1 (4.8)a
18.2 (5.3)b
27.8 (5.5)a
22.6 (4.7)b
Integration
29.4 (5.1)a
19.1 (6.5)c
25.9 (6.8)b
22.3 (4.9)bc
Firefighters M
Control M
Note: Scores on each subscale can range from 8 to 32, with larger numbers reflecting higher levels of death acceptance in that domain. Standard deviations are in parentheses. Scores in each row with different subscripts indicate significant differences between the means, p < .05.
reported no differences between fear of dying and death between parachute jumpers and non-jumpers. However, the results of this study provide additional support to Griffith and Hart’s (2005) more recent finding that skydivers do indeed exhibit different reactions to thoughts of dying and death. It may be possible that control over when and how one faces death could play into the amount of experience by different recreational groups. Skydiving is a high-risk or heightened-death-risk activity, yet it is also a voluntarily chosen recreational activity. This “choice” may in fact work as part of a continuous control mechanism. This sense of choice may allow skydivers to perceive themselves as having direct control over their risk of dying and death. This is supported by evidence from studies that show that continued preparation and professional experience are linked to a decreased fear of dying and death (Lester et al., 1974; Yeaworth et al., 1974). On every jump, skydivers voluntarily choose to board the plane, jump out of the plane, control the point at which they decide to deploy their parachute, and steer it to an open area for a safe landing. After completing over 1,400 successful jumps, it seems possible that a person who voluntarily chooses to put his life in his own hands and continuously succeeds would have a lower amount of anxiety over dying and death in comparison to people who do not directly and intentionally participate in life-threatening situations (i.e., nursing home residents and the control group). It could also be that the skydivers feel that they have control over their lives when they jump (Laurendeau, 2006) and view skydiving as a challenge rather than a threat (Folkman & Lazarus, 1985). Consistent with Pollak (1979), people with an internal locus of control tend to report lower levels of death anxiety. Because skydivers believe that they have complete control over their lives when they jump, they would be exhibiting an internal locus of control. This sense of control may be why skydivers tend to report lower levels of fear of death and more death acceptance. Although locus of control was not investigated, it is certainly a direction that future research might consider.
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Nursing home residents had consistently high levels of fear of death and low levels of death acceptance compared to the other groups. This finding parallels Fortner and Neimeyer (1999), suggesting that individuals residing in high death-exposure settings tend to have more negative attitudes toward dying and death. This heightened fear of death may be elevated by the fact that many residents of nursing homes know they will eventually die at that particular facility. In other words, it is the last place that many individuals will live, and there is an expectation of death, and it is simply a matter of waiting for it to happen. Rather than thinking about making a jump or fighting fires, residents at nursing homes may tend to think about their own ailments, discomfort, and inevitable death. It may be the case that the other groups, including the control group, may have ample opportunities to think about topics other than death, whereas there may be daily reminders of mortality for the nursing home residents due to the nature of the facilities and how they are operated. Firefighting can be seen as having both high risk and high death exposure, and the firefighters in the sample were shown to have less fear of death of self in comparison to nursing home residents and the control sample. Firefighters were also shown to have less fear of death of self in comparison to nursing home residents. All of the firefighters in the sample were from volunteer stations, so the activity they are involved in can be considered voluntary, similar to skydiving. So why did the firefighters in the sample show less fear of death in comparison to low-risk groups but more fear of death than their skydiving cohorts who are also engaged in high-risk activity? The answer to this question may be related to the fact that there is a choice difference of initiation/response between a skydiving jump and approaching a burning building. As previously stated, a skydiver directly chooses to initiate in the death-related activity, whereas a firefighter does not initiate the activity but responds to an already initiated activity that is unknown until arriving at the fire or accident. Choosing to respond to a high-risk activity is fundamentally different than having the choice to initiate engagement in a high-risk activity, and this may be partially responsible for differences in attitudes toward dying and death between skydivers and firefighters. Firefighters may have reported reduced levels of fear of death and had higher levels of death acceptance when compared to others in low-risk death-related activities due to successful experience with personal survival in high-risk activities, just like skydivers. This is supported further by evidence that both skydivers and firefighters have higher scores of death acceptance than low-risk death-related groups. However, because of the differences between initiation and response in their corresponding activities, firefighters do not have as high a sense of control over their own dying and death as skydivers do. Volunteer firefighters choose when to volunteer their time, but they do not get to choose when to respond to fires and other high-risk activities involved with firefighting. When looking at dying and death of others, firefighters reported more anxiety than skydivers. This could be related to the fact that skydiving is relatively low
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death exposure as there is a fatality about one every 95,000 jumps (Griffith & Hart, 2002). Firefighting is both high death risk and high death exposure. Skydivers rarely, if ever, physically see anyone die while they are skydiving. They also tend to jump successfully with close friends who also engage in the same high-risk activity without consequences. This may explain why they show low anxiety about dying and death of others. Firefighters, however, tend to see death and destruction more often when they are responding to a burning building or an accident. They are more likely to see people severely injured or deceased and are exposed to such situations more often, which may explain why they show greater anxiety about dying and death of others. Although this study provides new data on the relationship between attitudes toward dying and death among elderly men with different recreational pursuits, there are four limitations that need to be discussed. First, convenience sampling was used rather than random sampling, thus the generalizability of the findings should be made with caution. It is not known how representative each of the groups are within that given population. Second, one factor that was not measured but may be a mediating or moderating variable is that of social support. The skydiving and volunteer firefighting communities tend to be very social in nature, as individuals typically spend a fair amount of time with others both when engaging in those specific recreational activities and beyond those environments. The control group may have also had varying levels of social support, and it is speculated that the nursing home residents probably had the least amount of social support. Third, other recreational activities should be considered. The present study chose to focus on recreational activities as they related to death risk and exposure. There are other recreational activities that are more social, psychological, or spiritual in nature that may be related to attitudes toward dying and death. Fourth, the majority of these men have worked 40 years or more, and the study did not ask about their occupation. It may be possible that participants’ experiences, including their occupation, may have been related to the development of attitudes toward dying and death. For example, it may be possible that skydivers had more military experience compared to the other groups. There are several directions in which future studies should focus. First, an examination on whether lower fear of death and higher levels of death acceptance is associated with other high-risk, directly initiated recreational activities would be a beneficial direction to pursue. There is a multitude of other activities like skydiving to choose from, including spelunking, surfing, mountaineering, and whitewater kayaking, to name a few. Second, direct measures of perceived control would also be of interest in determining differences between these types of directly initiated activities and other types of recreational activities involving volunteers (i.e., emergency medical technicians and FEMA aids) in which the participant is a respondent to a high-risk situation. A third potential avenue of research could explore the role of dosage or amount of a particular exposure within a single group. For example, among volunteer fire departments, there are some
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companies that are busier than others based on location and the amount of people served. Thus, it may be the case that different levels of death risks and exposures may be related to varying levels of attitudes toward dying and death within a group. Fourth, the role of social support should also be examined to determine the possible mediating or moderating effects, as that may have been an unmeasured variable of importance in the current study. Lastly, researchers investigating this area should consider mixed mode studies in which quantitative and qualitative methodologies are combined. Access to some of these populations is sometimes challenging, and a variety of methodologies would be both efficient and provide more depth of understanding. This study provided evidence of variation in attitudes toward dying and death in an elderly sample of men when comparing death risk and exposure on the basis of recreational activities. Skydivers were found to have overall lower fear of death and were more accepting of death in comparison to other recreational groups. Firefighters were found to have lower fear of death in comparison to lower-risk recreational groups, including nursing home patients and a control group. Nursing home residents tended to have the highest levels of fear of death and lowest level of death acceptance, probably due to their environment. The importance of recreational activities among the elderly should be a focus of continued research in order to identify themes that are associated with attitudes toward dying and death. REFERENCES Alexander, M., & Lester, D. (1972). Fear of death in parachute jumpers. Perceptual and Motor Skills, 34, 338. Azaiza, F., Ron, P., Shoham, M., & Tinsky-Roimi, T. (2011). Death and dying anxiety among bereaved and nonbereaved elderly parents. Death Studies, 35, 610-624. Bozo, O., Tunca, A., & Simsek, Y. (2009). The effect of death anxiety and age on health-promoting behaviors: A terror management theory perspective. The Journal of Psychology, 143, 377-389. Dattel, A. R., & Neimeyer, R. A. (1990). Sex differences in death anxiety: Testing the emotion expressiveness hypothesis. Death Studies, 14, 1-11. DePaola, S. J., Griffin, M., Young, J. R., & Neimeyer, R. A. (2003). Death anxiety and attitudes toward the elderly among older adults: The role of gender and ethnicity. Death Studies, 27, 335-354. DePaola, S. J., Neimeyer, R. A., Lupfer, M. B., & Fiedler, J. (1992). Death concern and attitudes toward the elderly in nursing home personnel. Death Studies, 16, 537-555. Feifel, H., & Nagy, V. (1980). Death orientation and life threatening behavior. Journal of Abnormal Psychology, 89, 38-45. Feifel, H., & Nagy, V. (1981). Another look at fear of death. Journal of Consulting and Clinical Psychology, 49, 278-286. Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150-170.
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Thorson, J. A., & Powell, F. C. (1996). Undertakers’ death anxiety. Psychological Reports, 78, 1228-1230. Tomer, A. (Ed.). (2000). Death attitudes and the older adult: Theories, concepts, and applications. Washington, DC: Taylor & Francis. White, W., & Handal, P. J. (1990). The relationship between death anxiety and mental health/distress. Omega: Journal of Death and Dying, 22, 13-24. Yeaworth, R., Kapp, F., & Winget, C. (1974). Attitudes of nursing students toward the dying patient. Nursing Research, 23, 20-24.
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