After many years of running a Health Anxiety Clinic it became obvious to me that most of the patients who expressed a fear of dying were young. Very few are truly old. In fact, in a different context I have had occasion to take care of people who were old and were, in fact, dying or confronting the immanent possibility of death, and, for the most part, they were unafraid. Over time I came to realize that there are three reasons why the prospect of dying becomes less frightening with age:
1. The quality of life deteriorates. The aged are likely to be sick in a number of ways. They may have trouble seeing, hearing, eating or even moving without pain. Often their friends have died, and they are likely to feel more alone. If they live long enough, a spouse and even children die. They may have financial problems. They are unable to work at a job which may have mattered to them to the point where they were defined by their jobs, even if that job was staying home and taking care of a family. Because life is less valuable to them, they are less afraid of dying.
2. Similarly, if someone is old, that person becomes less afraid of being told that he or she is developing an illness, like cancer, or heart disease, that may be fatal in five or ten years Old people realize that they may not have much more time to live anyway. I remember a physician who underwent an operation for a rectal tumor. When I asked whether the tumor turned out to be malignant, he said, “What difference does it make?” He was likely to die from something else before the cancer, if that is what it was, would return. So, there is less to lose.
3. The old have diminished responsibilities. If they die, there will be fewer repercussions for children. They need not worry, like so many of my patients do, that their children will have to grow up orphans, with no one to care for them. If they die, the people they love will have to pay less of a price. and as time goes on less and less of a price. Their survival becomes less important as time goes on. Sometimes, for this reason, if an adult child dies first, and a grandparent has to take care of grandchildren, the grandparent becomes more vigorous and energetic–younger, it seems. For similar reasons, the death of a young parent is particularly tragic.
Of course, being old does not necessarily demand that any of these things happen. Old people are living, and working, to an older and older age and are suffering less from many of the diseases of aging. Life does not have to be unpleasant for them. Whether someone is old depends on attitude to a considerable extent. There are few things in life, including sex, that a healthy person can not undertake in his or her seventies and sometimes eighties. I know a woman who was ninety and had survived most of her friends. She went out and made new, younger friends (who were only in their seventies.) A number of my physician friends are still practicing medicine in their late seventies. So, work is often possible. Even paid work.
We all know people who seem to be old before their time. They plod through life doing the same things over and over, without passion or hope. Conversely, there are many old people who don’t seem to be old. They are looking forward to things, to meeting new people, visiting new places, and learning new things. They are focused on today and tomorrow. They are not haunted by what could have been in the past. I haven’t quite figured out why they too seem to be unafraid of dying. Perhaps because they are in general unafraid of living.
I talk about all this in more detail in my book “Worried Sick.”