Factors Associated with Death Anxiety Among Rural Chinese Older Adults: The Terror Management Perspective

Abstract

Objectives:

The aim of this study was to examine how the factors suggested by the Terror Management Theory are associated with death anxiety among rural Chinese older adults.

Method:

Data were derived from a longitudinal survey of older adults aged 60 and above, had at least one living child, and were living in rural areas of Anhui Province. The working sample included 1,362 older adults. Two-level random effects models were used.

Results:

Children’s financial support was negatively related to death anxiety, whereas emotional closeness with children was positively related to death anxiety. Older women reported more death anxiety than older men. Functional limitations were positively associated with death anxiety, and the widowed reported less death anxiety than the married. We did not find a significant association between religious belief and death anxiety.

Discussion:

The study highlights the importance of culture in shaping death anxiety among older adults in rural China.

Keywords

death anxiety intergenerational support religious belief gender functional limitations widowhood

Introduction

Death anxiety has been defined as an individual’s unpleasant thoughts and feelings arising from his/her own death (Lonetto & Templer, 1986). Awareness of one’s own death is a source of terror, as death ends a life and means total nonexistence. Death anxiety in older adults not only influences their quality of life and psychological well-being (Krause & Bastida, 2012; Missler et al., 2012), but also affects end-of-life decision making and preparation (A. J. Brown et al., 2014; Tong et al., 2016). There is a dearth of studies on death anxiety among older adults in rural China. Most studies on death anxiety in older adults have been conducted in Western countries (Cicirelli, 2002; Hui & Coleman, 2013; MacLeod et al., 2016). However, findings from Western countries may not be readily generalizable to rural China, given its unique socioeconomic and cultural characteristics. In Chinese culture, old-age support is mainly provided by adult children and their spouses; older adults in rural China mainly depend on children for support, because of the traditional norm of filial piety, older adults’ disadvantages in resources, and limited formal support provided by social welfare programs and public pensions (Pei & Cong, 2018; Yan, 2003). Moreover, there is still a lack of longitudinal studies concerning death anxiety, as cross-sectional studies are inclined to have common method variance (i.e., systematic method error due to the use of a singer rater or single source) bias and inability to establish causal relationships (Rindfleisch et al., 2008).

At present, the Terror Management Theory (TMT) (Greenberg et al., 1997; Pyszczynski et al., 2015; Solomon et al., 1991), appears to be the most comprehensive approach that deals with the causes and management of death anxiety and is supported by considerable empirical studies (Cicirelli, 2002). Guided by the Terror Management Theory, the study aimed to examine factors related to death anxiety among rural Chinese older adults by using a representative longitudinal survey data.

Background

Chinese Culture Toward Death and Dying

Taoism, Confucianism, and Buddhism, the main three philosophies or religious beliefs in Chinese culture, form the basis of Chinese culture and traditions (Hsu et al., 2009). Chinese people embrace continuous bonds with life after death and with the bereaved (Lalande & Bonanno, 2006). Death is viewed as a continuing and necessary part of life and is considered to be a transition over the life course (Wu et al., 2002). Cultural and religious practices such as burning offerings (e.g., paper money, paper house, and paper car) in funeral rituals are believed to assist the spirits of the deceased to live a well-off life in the afterworld and ransom from the yamens of hell, which is similar to courts for the dead in the underworld (Chan et al., 2005; Hsu et al., 2009; Lalande & Bonanno, 2006). Those practices foster the concept of continuing bonds among Chinese. The tradition of maintaining continuing attachments to the deceased are still common among widows and widowers in modern Chinese society. For example, in Hong Kong, among 52 counseling interviews, 33% of the widowed reported feeling, hearing, or seeing the loved ones and almost 50% of the interviewees reported having the experiences of talking with the deceased (Chan et al., 2005).

Terror Management Theory (TMT)

Aging promotes frailty and life-threatening illnesses, which remind older adults of their vulnerability to death. According to the Terror Management Theory, individuals use culture worldview validation, self-esteem enhancement, and close relationships as offense mechanisms to manage the terror of death; whereas mortality salience increases death anxiety (Greenberg et al., 1997; Mikulincer et al., 2003; Pyszczynski et al., 2015; Solomon et al., 1991). Variables related to the reduction of anxiety by following the values of culture, improving self-esteem, and maintaining close relationships (intergenerational support and religion) may be hypothesized to reduce death anxiety. Gender may be also related to death anxiety, as gender inequality is an important component of traditional Chinese culture. It can be argued that functional limitations and widowhood may increase the salience of death related to higher levels of death anxiety.

Intergenerational Support and Death Anxiety

As a result of rural-urban migration, instrumental support has been significantly weakened due to the unavailability of children in proximity (Cong & Silverstein, 2008; Yan, 2003). In this study, we concentrate on financial and emotional support, because these two kinds of support are not constrained by distance and bring hope and comfort that is important for older adults’ well-being (Cong & Silverstein, 2011; Silverstein et al., 2006).

Given that rural Chinese older adults mainly rely on adult children for support, financial and emotional support may be an effective strategy that rural Chinese older adults use as a defense against death anxiety. The traditional Confucian norms of filial norm expect adult children to provide financial and emotional support to their older parents (Sung, 1995, 1998). Moreover, financial and emotional support from adult children play an important role in improving self-esteem and keeping close relationships for rural Chinese older adults. Therefore, according to the Terror Management Theory, higher levels of financial and emotional support from children are associated with less degree of death anxiety.

Previous studies found that wealth and material objects can function as a buffer of death anxiety in Western societies (Zaleskiewicz et al., 2013). For patients with breast cancer, perceived social support from family members and friends is negatively associated with death anxiety (Bibi & Khalid, 2020). Older adults with a greater close support network have less death anxiety in the U.S. (Cicirelli, 2002). It was also found that older adults who had stronger social support had less death anxiety than others among older Arab adults (Azaiza et al., 2010). Thus, we develop the following two hypotheses:

H1: The more financial support from children, the less death anxiety older adults would have.

H2: The more emotional closeness with children, the less death anxiety older adults would have.

Religion and Death Anxiety

According to the Terror Management Theory (Solomon et al., 1991), religion is one effective defense against death anxiety. This is because religion not only provides a comprehensive framework to explain the world events, life challenges, and psychological resources (e.g., self-esteem), but also provides a promise of life after death and of reunion with departed loved ones (Wink & Scott, 2005; Zhang et al., 2020). Increasing evidence shows that older adults with stronger religious belief had less death anxiety in different cultures (Cicirelli, 2002; Krause & Bastida, 2012). Previous studies on religion and health in China suggest that religious affiliations and participation were positively associated with self-rated health and happiness (Zhang et al., 2020). Therefore, we propose the following hypothesis:

H3: Older adults who have a religious belief have less death anxiety than those without a religious belief.

Gender and Death Anxiety

Aging is a gendered experience, because older women have special challenges due to accumulative social, economic, and health disadvantages across the life course (Cong & Pei, 2017). Because of that, older adults of different gender could be exposed to different experiences of death anxiety. Older women have less accessibility to the rewards and acceptance of the culture, indicating less belief in the traditional culture value and thus may have greater death anxiety (Cicirelli, 2002). In rural China, the influence of gender could be similar because men have stronger adherence to traditional values due to their advantageous status in patrilineal families. This is indicated by the observation that older men’s filial expectations lag behind those of older women (Cong & Silverstein, 2012), and that females are less likely to participate in ancestor worship (Hu, 2016). In addition, older women are more likely than older men to worry about how their deaths would affect their loved ones (Missler et al., 2012). This is possibly because women are socialized to be more expressive and interpersonal than men (Hill et al., 2016). In the US and Netherlands, older women are found to have greater death anxiety than older men (Cicirelli, 2002; Missler et al., 2012). Therefore, we hypothesize that:

H4: older women have greater death anxiety than older men.

Functional Limitations, Widowhood and Death Anxiety

It could be argued that two other variables, functional limitations and loss of spouse, may increase a sense of vulnerability to death, as the increased mortality salience is related to higher levels of death anxiety. Strong evidence shows that older adults with poorer health have greater death anxiety. Missler and colleagues (2012), in a study of older adults in institutions, found that worse physical health was associated with greater death anxiety. In a systematic review paper, Fortner and colleagues found that poorer physical health was associated with greater death anxiety (Fortner & Neimeyer, 1999). Therefore, we expect that higher levels of functional limitations are associated with greater death anxiety.

However, the association between widowhood and death anxiety may depend on culture. According to Terror Management Theory, older adults may use their cultural beliefs to defend death anxiety because of the mortality salience associated with losing a spouse (Solomon et al., 1991). Chinese people have the most successful continuous culture in the world (Hsu et al., 2009). The belief in the afterlife and reincarnation could foster the hope of reunion or reconciliation with the bereaved person for the widowed (Chan et al., 2005), and thus may decrease the death anxiety among them. On the contrary, the married counterparts may have to face the separation from the loved one when death comes (Firestone, 1987; MacLeod et al., 2016). Among New Zealanders, who consider death as a cycle of life, the widowed are found to have lower levels of death anxiety than those of all other marital statuses (MacLeod et al., 2016). Among Mexican American older adults, who have similar cultures that also value continuing bonds with the deceased, the stronger continuing bonds with the deceased are associated with lower levels of death anxiety (Krause & Bastida, 2012). Thus, we develop the following two hypotheses:

H5: Higher levels of functional limitations are associated with greater death anxiety.

H6: Widowed older adults have less death anxiety than married older adults.

Methods

Sample

Data was drawn from “The Well-Being of elderly in Anhui province,” a representative longitudinal study. Located in the east-central part of China, Anhui is one of the mostly rural provinces with almost 75% rural population (National Bureau of Statistics of China, 2010). It was chosen because of its particularly low per capita amount of arable land, which led to high proportions of labor migration to the cities of Hefei, Nanjing, and Shanghai. The sampling frame consisted of the population aged 60 years and older living in 72 villages within six rural townships in the Chaohu region. Using a stratified multistage method, the eligible respondents were randomly selected from village rosters, with an oversampling of people 75 years and older. Of the 1,800 eligible respondents selected in 2001, 1,715 completed the survey, yielding a response rate of 95.3%. The number of original respondents who participated in 2003, 2006, 2009, 2012, and 2015 waves was 1,391, 1,067, 807, 605, and 437, respectively. Mortality was the major reason for attrition. The number of replenished new respondents based on the 2009 new sample frame in 2009, 2012 and 2015 waves was 416, 374, and 326, respectively.

The construct death anxiety was first introduced in 2012 and was measured again in 2015. There were 2,133 observations who had at least one child after merging 2012 and 2015 data. The final analytical sample included 2,048 observations, which were nested within 1,362 participants, after excluding those who were never married or divorced (n = 7) and had missing values on variables involved (n = 78).

Dependent Variable

Death anxiety was measured by an 8-item scale at each wave which was abbreviated from the Death Anxiety Questionnaire and covered dimension of death anxiety including fear of the unknown, fear of suffering, fear of loneliness, and fear of personal extinction (Conte et al., 1982). The 8 items were: “Does it upset you to think others may see you suffering before you die?,” “Do you worry that you may be alone when you are dying?,” “Does the thought bother you that you might lose control of your mind before death?”, “Do you worry that expenses connected with your death will be a burden to other people?,” “Does it worry you that your instructions or will about your belongings may not be carried out after you die?,” “Does the thought of leaving loved ones behind when you die disturb you?,” “Do you worry that those you care about may not remember you after your death?,” and “Are you worried about not knowing what to expect after death?.” Factor analyses showed a four-factor structure of the abbreviated scale and the alpha was 0.68 to 0.69 for the 2012 and 2015 wave respectively. We summed the eight items, resulting in a death anxiety score ranging from 0 to 16, with a higher score indicating greater death anxiety.

Independent Variable

Financial transfers from children at each wave were based on the total amount of money that the aging parent received from each child during the year prior to when the survey was conducted. Participants (older parents) were asked to provide the actual amount of money first, and if they could not give an exact number, they were asked to choose from the following categories (Chinese RMB currency): 0 = none, 1 = less than 50, 2 = 50–99, 3 = 100–199, 4 = 200–499, 5 = 500–999, 6 = 1,000–2,999, 7 = 3,000–4,999, 8 = 5,000–9,999, and 9 = 10,000 and above. In our analysis, we took the reported amount if it was available or used the median amount of the category if the respondent didn’t provide the exact amount. We used the maximum value across all children at each wave to represent financial support that older adults received. This value was logged (+1) to improve its distribution from a strong positive skew.

We measured emotional closeness at each wave by using three questions adapted from the intergenerational solidarity inventory (Mangen et al., 1988) that assesses emotional cohesion between generations. The questions were: (a) “Taking everything into consideration, how close do you feel to (this child)?”; (b) “How much do you feel that this child would be willing to listen when you need to talk about your worries and problems?”; (c) “Overall, how well do you and (this child) get along together?”. The items were coded as follows: 0 (not at all close/not at all/not at all well), 1 (somewhat close/somewhat /somewhat well), or 2 (very close/very much/very well). An additive scale will be computed for each child, ranging from 0 to 6. For each older adult, we took the highest score across all children for each older parent to indicate the construct. The alpha of this scale was .80 to .81 for the two waves respectively.

Older adults’ religious belief at each wave was coded as: 1 = yes, 0 = no.

Gender. Older adults’ gender was measured at baseline, and was codded as: 1 = women.

Older adults’ functional limitations at each wave were based on the sum of 15 items reflecting difficulties in performing personal activities of daily living and instrumental activities of daily living. Participants were asked the level of difficulty performing each task: 0 (no difficulty), 1 (some difficulty), and 2 (cannot do it without help). The alpha for this scale was .95 to .96 across waves. The summed scale ranged from 0 (no difficulties) to 30 (unable to perform all tasks).

Marital status. Older adults’ marital status at each wave was codded as: 1 = widowed.

Older adult’s characteristics at baseline included age (in years), education (1 = had some formal schooling), occupation (1 = agricultural occupation), wave (1 = follow-up) and cohort (0 = cohort recruited in 2001, 1 = new participants recruited in 2012, and 2 = new participants recruited in 2015). Older parents’ characteristics that changed with time included the number of children, income (lg (1+x)), and proximity to children (1 = at least one child were living in the village).

Each older adult could contribute to up to two observations, two-level random effects model was used to examine the factors that were associated with death anxiety. The random effects model yields unbiased standard errors due to clustering and introduces a random intercept based on group membership to control for the intraperson variance (Rabe-Hesketh & Skrondal, 2008). The multivariate analyses were conducted in two steps. First, in Model 1, only intergenerational support, gender, widowhood experience and functional health were added in the model. Next, we included other older adults’ characteristics in Molder 2. We include all of the variables at either level 1 (time varying) or level 2 (time invariant) in each model.

Results

As shown in Table 1, death anxiety averaged 3.10 (SD = 2.54) out of a possible of 16. The average of financial support that participants received from children was 6.60 (SD = 2.19), and emotional closeness averaged at 5.28 (SD = 1.13) out of a possible 6. 12.3% had religion believes. About 51% of participants were female, the average functional limitations was 4.1 out of a possible 30 (SD = 6.38), and 31% were widowed.

Table 1.

Description of Analytic Variable (N _observations = 2,048, N _participants = 1,362).

Variable	M/%	SD	Coding Scheme
Dependent variable
Death anxiety	3.10	2.54	0 (none)–16 (most)
Independent variable
Intergenerational support
Financial support from children (ln(x+1))	6.60	2.19	0–11.00
Emotional closeness with children	5.28	1.13	0 (not close)–6 (very close)
Any religious belief	12.30%		0 (no), 1 (yes)
Gender	51.03%		0 (male), 1 (female)
Marital status	31.25%		0 (married), 1(widowed)
Functional limitations	4.09	6.38	0 (none)–30 (the most)
Control variable
Age	64.35	4.69	56–86
Education	35.61%		0 (no), 1(yes)
Income (ln(x+1))	8.10	1.18	0–12.73
Number of children	3.53	1.41	1–8
Proximity to Children
Living with at least one child	18.36%		0 (no), 1 (yes)
Not coresiding but having at least one child in the village	32.81%		0 (no), 1 (yes)
All children lived beyond village	48.83%		0 (no), 1 (yes)
Chronic disease	50.54%		0 (no), 1 (yes)
Wave
Baseline	39.94%
Follow-up	60.06%
Cohort
Cohort recruited in 2001	40.75%		0 (no), 1 (yes)
Cohort replenished in 2009	25.84%		0 (no), 1 (yes)
Cohort replenished in 2015	33.41%		0 (no), 1 (yes)

The average age of the participants was 64 (SD = 4.69), 35.6% of them received some education. The average income (ln (x+1)) was 8.10 (SD = 1.18). On average, each participant had four living children (SD = 1.41). About 18.4% of participants lived with children, 32.8% had at least one child living in the same village with them, and 48.8% with all children living outside the village. Fifty one percent of participants had chronic disease. About 40% observations were from the baseline wave and 60.1% were in the follow-up wave. Forty one per cent, 25.8% and 33.4% of participants were from the cohort recruited in 2001, replenished in 2009 and 2015, respectively.

Table 2 presents two models predicting death anxiety. In Model 1, we found that the more financial support from children, the less death anxiety among older adults (B = −.110, p < .001). However, emotional closeness with children was positively associated with death anxiety (B = .115, p < .05). Religious belief was not associated with death anxiety (B = −.146, p > .05). Older women had more death anxiety than older men (B = .278, p < .05). Functional limitations were positively associated with death anxiety (B = .037, p < .001). Widowed older adults had less death anxiety than the married one (B = −.438, p < .01). In Model 2, when adjusting for all the other control variables, financial support from children (B = −.114, p < .001) and widowhood (B = −.349, p < .05) were still negatively associated with death anxiety, whereas emotional closeness (B = .114, p < .05), gender (B = .264, p < .05), and functional limitations (B = .042, p < .001) remained positively associated with death anxiety. None of the other control variables was associated with death anxiety in Model 2.

Table 2.

Multilevel Models Predicting Death Anxiety of the Older Adults (N _observations = 2,048, N _participants = 1,362).

Variables	Model 1	Model 2
Intergenerational support
Financial support from children (ln(x+1))	−.110***	−.114***
Emotional closeness with children	.115*	.114*
Female	.278*	.264*
Widowed	−.438**	−.349*
Religion	−.146	−.138
Functional limitations	.037***	.042***
Control variable
Age		−.015
Education		.040
Income		−.075
Number of children		−.045
Proximity to Children (ref = living with one of children)
Having at least one child in the village		.068
All children live beyond village		.169
Chronic disease		.136
Follow-up wave		.108
Cohort		.096
Constant	3.084***	4.506***
D.F.	6	15
LR χ²	7.40	7.04

Discussion

This study examined factors associated with death anxiety among rural Chinese older adults from terror management perspective. The hypothesis that financial support from children would be negatively associated with death anxiety for older adults (H1) is supported. This is to some extent consistent with previous research that wealth and material objects provide self-esteem and a sense of security, and thus are able to function as a death anxiety buffer in Western societies (Zaleskiewicz et al., 2013). Under the context of rural China, where older adults mainly rely on children for financial support because of their low socioeconomic status, Confucian norms of filial piety, and lack of social security (Pei & Cong, 2018), receiving financial support from children may be a relatively important way of enhancing self-esteem and a sense of security for older adults in later life. The finding supported the Terror Management Theory and highlights that receiving financial support from adult children plays an important role in shaping death anxiety among rural Chinese older adults.

The second hypothesis (H2) that older adults who reported higher levels of emotional closeness with children would have lower levels of death anxiety was not supported. On the contrary, we found that emotional closeness with children was positively associated with death anxiety. This finding is inconsistent with previous studies that perceived social support decreased death anxiety (Azaiza et al., 2010; Bibi & Khalid, 2020; Cicirelli, 2002). This inconsistency may be related to the measurement of emotional support. Our study focused on the emotional closeness between older parents and their adult children, whereas the perceived emotional support in the other three studies was broader and included different sources of emotional support. Several explanations may account for the positive relationship between emotional closeness with children and death anxiety in rural China. First, older adults may need moderate death anxiety to protect themselves. In one study conducted among cancer patients in the U.S., it was found that those with low levels of death anxiety may lack awareness of deaths and show psychological readiness for mortality (Tong et al., 2016). Second, given that Chinese social relations are centered on the family, strong emotional closeness with children may remind older adults of the impermanence of all things in existence due to bitter sweetness in the emotional bonding separation, and thus increase older adults’ death anxiety (Bassett, 2007; Firestone, 1987). To our knowledge, this is the first study that considered the role of emotional closeness with children in shaping death anxiety among Chinese population. Future studies are needed to better understand the role of emotional closeness with children in relation to death anxiety.

The third hypothesis (H3) that older adults with religious belief would have lower levels of death anxiety than those without religious belief was not supported. Contrary to previous studies conducted in Western societies (Cicirelli, 2002; Krause & Bastida, 2012), we didn’t find a significant association between religious belief and death anxiety. This inconsistency may be related to the unique regulation of religion in China. Religious beliefs and practices were regarded as a type of feudalistic superstition and strictly controlled during the socialist regime. Since 1979, a revival of religious beliefs and practices has transformed China, especially in rural China (Fan, 2003). For example, more than 70% of the adults participated in ancestor worship practice (Hu, 2016). Taoism, Confucianism, and Buddhism are not only the main religions but also the main philosophies in Chinese cultures that have been influencing Chinese people for thousands of years (Hsu et al., 2009). The renaissance of religious beliefs and practices accompanied by continuing religion control by government and Community Party encourage interests in religious faiths on the one hand and lead to confusion about individuals’ religious awareness on the other hand (Yao, 2007). Our study finding suggests that the belief of reincarnation is well accepted by older adults in rural China regardless of their religious beliefs.

The fourth hypothesis (H4) that women would have higher levels of death anxiety than men was supported. The finding is consistent with previous studies in the US and Netherlands, that older women had more death anxiety than older men (Cicirelli, 2002; Missler et al., 2012). This may be because older women have disadvantageous status in patrilineal families, have less strong adherence to traditional norms compared with men; and men are more concerned of the influences of their deaths on the loved ones than older women are (Cicirelli, 2002; Cong & Silverstein, 2012; Missler et al., 2012). Our finding highlights the important role of gender in shaping death anxiety among older adults in rural China settings.

The fifth hypothesis (H5) that functional limitation would be positively associated with death anxiety was supported. The finding is consistent with previous studies that poorer physical health is associated with greater death anxiety (Fortner & Neimeyer, 1999; Missler et al., 2012). It may be because greater functional limitations remind older adults’ of mortality salience, and thus increase death anxiety. The hypothesis that widowed older adults would have lower levels of death anxiety than the married ones (H6) was also supported. The finding was consistent with previous studies that continuous bonds were negatively associated with death anxiety among Mexican American older adults, and that the widowed individuals had less death anxiety than the married ones among New Zealanders, who also considered death as a transition of life as Chinese (Krause & Bastida, 2012; MacLeod et al., 2016). Chinese special culture of death and dying, such as continuous bonds, the afterlife, and the reincarnation may explain the role of widowhood in decreasing death anxiety among older adults. The finding highlights the importance of culture in shaping death anxiety among older adults, suggesting that the belief of reincarnation is well accepted by rural Chinese older adults

In the present study, we didn’t find that age was associated with death anxiety among rural Chinese older adults. This finding confirmed the previous study conducted in Western countries that death anxiety was stable between the age of 61 and 87 after a decline during middle adulthood (Fortner et al., 2000). Future studies need to compare death anxiety between older adults and other age groups in China, in order to have a better understanding of the relationship between age and death anxiety.

There are some limitations in the present study. First, the sample was limited to a poor, rural region in China, where the Confusionist norm of filial piety and traditional belief in death and dying is strong. Cautions should be taken when the findings of this study is generalized to older populations in other areas in China. Second, the internal consistency of death anxiety was less than optimal. The death anxiety measure and its domains need to be modified to reflect Chinese perspectives of death and dying in future studies. Third, self-reported death anxiety is likely to be influenced by the awareness or ability to reflect on mortality (Tong et al., 2016). A clinical assessment is also needed to be included in future studies. Fourth, although self-esteem and personal cultural belief in the afterworld are important concepts related to the Terror Management Theory, we didn’t measure these two variables in this study. Therefore, it is important to consider them in future studies on death anxiety.

However, the present study is the first longitudinal study that investigates factors related to death anxiety from the terror management perspective in rural China. We found that financial support from children was negatively associated with death anxiety, whereas emotional closeness with children was positively associated with death anxiety. Religious belief was not associated with death anxiety. Older women had greater death anxiety than older men. Higher levels of functional limitations were associated with greater death anxiety. Widowed older adults had less death anxiety than the married. Not all of the findings support Terror Management Theory, our study stresses the importance of culture in shaping death anxiety.

Studies on death anxiety have important practical implications in terms of improving the quality of life and end-of-life decision-making and preparation. Given the fact that financial insecurity is a major issue among rural older adults, this study illustrates the importance of financial support from children in easing death anxiety. Our study suggests that the belief of reincarnation is well accepted by rural Chinese older adults, it is important to help them improve quality of life and psychological well-being by helping them to derive meaning and optimism from life after death (Wu et al., 2002). To conclude, more understanding of death anxiety among older adults will assist families and professionals in promoting quality of life and preparing older adults’ end of life.

Footnotes

Acknowledgments

We would like to thank Drs. Iris Chi, and Dongmei Zuo for their invaluable contributions to this project.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is partly supported by the National Natural Science Foundation of China (Grant number 71573207, 72074177).

ORCID iDs

Yaolin Pei

Merril Silverstein

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