A Multidimensional Analysis of Death Anxiety and Coping Strategies Among Community-Dwelling Older Adults

Background: Death anxiety—the fear of dying and death—tends to increase with health decline, loss, and social isolation and is associated with poorer mental and physical well-being. Although death is universal, it is often a taboo topic that evokes fear and avoidance, and it has been linked to depression, anxiety, and lower life satisfaction. Coping responses vary, ranging from avoidance and denial to spirituality, cultural practices, and meaning making, with evidence suggesting higher levels among women than men. This study examines how gender, life satisfaction, and coping strategies relate to death anxiety, focusing on gender differences, the role of life satisfaction, and coping mechanisms.

Methods: This cross-sectional study targeted American older adults aged 60 and older who are living in rural counties in Northwest Ohio. Data was gathered in January and March 2026 through both online and paper surveys, using convenience and snowball sampling methods. The survey consisted of demographic questions, items related to advance directives, the Death Anxiety Scale (DAS; Templer, 1970; α = .76), and open-ended questions about managing thoughts of death. Coping strategies were measured with the Brief COPE, a 28-item instrument. It consists of 14 two-item subscales (Cronbach’s α = .50 to .90), with each coping strategy measured on a 4-point Likert scale, where higher scores indicate greater use of that strategy. Analyses included descriptive statistics, correlations, independent t-tests, and latent profile analysis (LPA) to identify coping profiles. Model fit was evaluated using AIC, BIC, and SABIC, along with LMR-LRT, BLRT, and entropy, and the final model was selected based on fit, interpretability, and parsimony.

Results: Among 175 older adults (M age = 77.22), most were White and female; 42.3% lived alone, 61.2% reported life satisfaction, 80% rated health as good or very good, and 59% had advance directives. Death anxiety was moderate (M = 8.48/15) and higher among women, those living alone, and those with poorer health (p < .001). All coping styles were positively associated with death anxiety, with emotion-focused coping most frequently used. Latent profile analysis supported a three-class model (LMR-LRT p = .0335; entropy = .846), identifying Low (20.8%, n = 36), Moderate (52.0%, n = 90), and High (27.2%, n = 47) coping groups, showing increasing coping engagement and greater use of acceptance and positive reframing at higher levels, while self-blame remained relatively lower. Qualitative findings highlighted religious faith, acceptance, and end-of-life planning, including living wills, DNR orders, and funeral arrangements.

Implications: Implementing faith-based support and spiritual counseling, along with advance care planning education and acceptance-based, present-focused coping strategies, may help reduce death anxiety among older adults. Coping in later life is not uniformly low or maladaptive; rather, it ranges from minimal engagement to highly adaptive strategies. Findings support moving beyond one-size-fits-all interventions toward profile-based approaches tailored to coping patterns. Those with low coping engagement may benefit from emotional regulation and problem-solving skills training, while those with higher coping levels may need support to reduce maladaptive strategies such as self-blame.