Assessment of Thanatophobia Among Elderly People Admitted in a Selected Hospital

INTRODUCTION

Death is an inevitable phenomenon that is beyond the control of human beings. More or less every human being feels worry and distress related to death. Fear of death and death anxiety were synonymous with Thanatophobia. Anxiety due to the thoughts of death or anything related to the dying process was termed as ‘Thanatophobia’ by Sigmund Freud in 1915. Thoughts of his/her own death or loved ones could eventually develop Thanatophobia.¹

Ergin E et al. (2023) conducted a descriptive study that revealed that 66.7% elderly people had no death anxiety, whereas 33.3% had death anxiety.² Hashim H M et al. in 2021 showed that 68.3% have a low level of death anxiety and 31.7% have a high level of death anxiety.³ Though previous studies showed the majority of the elderly people did not have death anxiety, the occurrence of death anxiety was quite higher among elderly people than other age groups and was affected by age, education, presence of chronic diseases, perceived physical and psychological wellbeing, and religious commitment.⁴

Due to the limited availability of published theses focusing on Thanatophobia among elderly people in West Bengal, conducting further research could fill this gap and uncover the mental health condition of elderly people.

MATERIAL AND METHODS

A descriptive cross-sectional study was conducted between 2024 and 2025 in the medicine wards of Bolpur Subdivisional Hospital, Birbhum. Quantitative approach was adopted for this present study. Ethical permission was obtained from the Institutional Ethics Committee, Burdwan Medical College, Purba Bardhaman, West Bengal. Informed consent was taken from all of the study participants before data collection.

The study comprised 385 elderly people admitted to the medicine wards of Bolpur Sub-divisional Hospital, Birbhum, aged 60 years or above, and willing to participate in this study. Study participants were selected using Simple Random Sampling.

Elderly people who were not able to communicate and/ or were severely ill were excluded from this study. The data were collected through interviewing technique by using semi structured interview schedule for socio-demographic information (age, gender, religion, place of residence, marital status, education, occupation, types of family, income (per capita), diagnosis, co-morbidity, no. of days staying in hospital in present illness, no. of hospitalization in last 1 year, history of mental disorder), and death anxiety questionnaire (DAQ) for assessing the level of Thanatophobia.

RESULTS

The results revealed that the majority of the respondents (370, 96.10%) had a low level of Thanatophobia. Mean score of the level of Thanatophobia with standard deviation was 0.91±3.30. Values regarding the level of Thanatophobia are shown in [Table 1]. In the area-wise distribution, the majority had a fear of personal extinction.

It was also noted that the majority of the respondents were female and belonged to the age group of 60-69 years from rural areas with no formal education. Maximum respondents belonged to a middle-class nuclear family with a per capita income of Rs. 2816-4692. Most of the respondents were diagnosed with chronic obstructive pulmonary disease (COPD) and had co-morbidity, but did not have a history of mental disorder.

According to findings presented in [Table 2], there was a significant association between levels of Thanatophobia with gender (x²=6.101, p<0.05), types of family (x²=6.521, p<0.05), and history of mental disorder (x²=17.164, p<0.0001).

The study findings revealed that there was no significant relationship between educational qualification, occupation, income per capita, age, religion, place of residence, marital status, current diagnosis, presence of co-morbidity, no. of days staying in hospital, and no. of hospitalizations in the last year.

DISCUSSION

In the present study, the majority of the respondents (370; 96.10%) had a low level of Thanatophobia, and the rest of the respondents (15; 3.90%) had a high level of Thanatophobia. There were studies that supported the present study findings up to a certain limit. Ergin E et al. (2023) conducted a descriptive study that revealed that 66.7% elderly people had no death anxiety, whereas 33.3% had death anxiety.² There were also studies that were contrary to the findings of this present study. Hamza H G et al. (2022) conducted a descriptive correlational study, revealing that the majority of the respondents had (53.3% a high level of death anxiety, 30.8% had a moderate level of death anxiety, and 15.8% had no death anxiety.⁵

The present study showed that there was a significant association between the level of Thanatophobia, gender (x²=6.101), types of family (x²=6.521) at the 0.05 level of significance, and history of mental disorder (x²=17.164) at the 0.0001 level of significance. The study findings revealed that there was no significant relationship between educational qualification, occupation, income per capita, age, religion, place of residence, marital status, current diagnosis, presence of co-morbidity, o. of days staying in hospital, and no. of hospitalizations in the last year. This finding was supported by various previous studies. Tadi A et al. in 2022 revealed a significant association between gender and education and level of Thanatophobia at p<0.001.⁶ Another study conducted by Ergin E et al. (2023) showed an association between level of Thanatophobia and gender (x²=0.055, p=0.815), education (x²=0.015, p=0.901).² Passyavula SK et al. (2019) in their study revealed that the type of family was significantly associated with death anxiety, and gender, education, and religion were not associated with the level of Thanatophobia.⁷ Bala R et al. (2019) also revealed that family type and occupation were significantly associated with Thanatophobia, and gender, religion was not associated with the level of Thanatophobia.⁸ Hashim H M et al. (2021) revealed that demographic variable such as gender (x²=12.25 at p=0.001) was associated with the level of Thanatophobia, and occupation was not associated with the level of Thanatophobia.³ Dr. Alvi A S et al. (2022) revealed that family size (x²=16.674, p=0.004) had a significant association with the level of Thanatophobia.⁹ Ali DESS et al. revealed that education and occupation were associated with the level of Thanatophobia.⁴

CONCLUSION

Aging was an important factor that affected the presence of Thanatophobia among elderly people. In the present study, the majority of the respondents had a low level of Thanatophobia. Previous studies showed that a high level of Thanatophobia was present among terminally ill patients, so there was a need to assess the level of Thanatophobia among elderly people in a tertiary healthcare center where the prevalence of terminally ill patients was quite high. In the present study, the majority of the respondents were from rural areas where the presence of loneliness was quite low due to a strong community style and closer family relationships, so further research could be conducted in hospitals of Urban areas or in Urban communities. The present study revealed an association between the level of Thanatophobia and a history of mental illness, so there could be more studies on this topic among elderly people who have had psychiatric illness or a history of psychiatric illness to understand the topic more effectively.