The Psychology of Transition in Older Adults: Dying and Death

This essay delves into the psychological transitions experienced by older adults, particularly focusing on the challenges associated with dying and death. It examines Erik Erikson's stages of psychosocial development, highlighting the conflict between integrity and despair in elderly individuals. The essay explores how factors such as trauma, neurocognitive disorders, and functional impairments can disrupt integrity, leading to despair. It further discusses the impact of comorbid diseases, cognitive decline, and the difficulties older adults face in adjusting to life's transitions. The study explores the experiences of an elderly person in transition, considering the feelings of grief, loss, and the reflection of life lived. The essay also analyzes the psychosocial impact of transitioning to end-of-life care, addressing the crises of identity, emotional clarity, and acceptance. It emphasizes the importance of social support, spiritual healing, and holistic healthcare approaches. The essay concludes by highlighting interventions to address the needs of the dying person and the significance of easing discomfort and providing emotional support to ensure a peaceful transition.

Running head: OLDER ADULTS AND TRANSITION
OLDER ADULTS AND TRANSITION
Name of Student
Name of University
Author note

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There are various transitions that a human individual go through during the stages of
life and according to Erik Erikson’s stages of psychosocial development, there are certain
conflicts that arises as an individual advances through the age groups of life (French et al.,
2017).. For an elderly person whose age is more sixty-five years of age, the conflict arises in
between two emotions and constructs of personality that is integrity and despair. If the
fulfillment and feelings of security and belongingness is present in this stage of life, the
elderly person is generally satisfied and feels the integrity is intact in life. Other the other
hand when the integrity is disturbed through some trauma, neuropsychological conditions or
increased sense of dependency on others due to functional impairment (which is common
after reaching 65 years of age) or some post-traumatic stress that disrupts the normal physical
and mental functioning – the elderly is likely to feel despair than integrity. In the advanced
age, the prevalence of dementia, Alzheimer’s, Parkinson’s disease and various other
neurocognitive disorders increases thus affecting the emotion, mood and even personality
plus behavior of the individual and emotional derangement in the elderly can lead to
psychosocial disorders and even depression (Xiong et al., 2020). The chances of
cardiovascular accidents, cerebrovascular accidents and comorbid diseases are very much
higher in the elderly population and it is critical to note that in the elderly age, there is mild to
severe cognitive impairment that follows up with the advancing age. The changes of
complications developments in the clinical scenario is higher with the old patients and it is
difficult for an elderly person to adjust to the fast transitioning phases of life and illness that
further adds to the self-conflict between the integrity and the despair of the subject and it is
highly important that the conflicts are taken into considerations by the clinicians and the
families in order to assess the transitional changes with respect to the mood, thoughts,
feelings, beliefs and emotions of the old person, in an effective and critical manner. This
helps in the better planning of the treatments and the intervention strategies that is required

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for the better fulfillment of the subject and better plus effective addressing of his signs and
symptoms. When a transition happens, older adults face the psychosocial, existential, and
family ramifications and in this study, the experiences of an elderly person with transition in
relation to ‘dying and death’ are explored.
The feelings of grief and loss or the feelings of content, satisfaction, happiness and
profoundness actually arise from looking back at the long life that has been lived by the
individual. Reflections of the meaning of the life lived and the lived experiences of the
elderly person are the actual factors that contribute to the feelings of fulfillment and integrity
or to the feelings of loss and grief when one fails to find the congruency of the lived life with
the very meaning and purpose of it. These feelings of grief, loss due to materialistic or
emotional loss resulting from death and detachment from people of same or higher age or
from this arousal of the past traumas of younger years which has not been transformed and
has surfaced from the repressed memories – can lead to deterioration of health and well-being
of the elderly person through the transitional stages. In a case where a person is suffering
from terminal disease such as cancer in an advanced stage and due to acute illness plus
symptomatic deterioration- the subject has been put in acute care such as critical care
department. In the critical care department, he is been administered with the strong pain
killers and sedatives that is eventually producing a momentary relief but a long term
deterioration of endurance capacity. The pain person in the person is increasing gradually and
increasing doses of the medication is only affecting the health, comfort and well-being of the
subject in a very adverse manner (Powell et al., 2017). The subject, out of pain and agony,
feels his self-identity shifting as the fear of death sets in gradually. When the person decides
to shift to end of life care from this pain evoking ‘pain and palliative care’ which is not being
able to address his condition anyways and the patients along with his family, clinicians and
other carers have accepted the fact the person has not chance of recovery, there comes the

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most difficult of the transitions that affects the emotional state, psychosocial state and the
identity of the person drastically and often in a very agonizing manner. Hopelessness,
remorsefulness, pessimism and despair built on the initial signs of loss or grief and this
affects not only the patient but the other stakeholders involved in the caring process of the
patient as well. The psychosocial impact of despair is ramifying for the clinicians and the
families and of course it affects the patient in a very direct manner. When the person is
transitioning through to the more advancing stages of cancer and has been put in the ‘end of
life care settings’ for the betterment of his quality of life, in this few last months, the conflicts
with respect to the integrity, esteem, self-concept, self-image, self-concept and identity
becomes very depressing and straining for the subject and can be indeed very ramifying for
the surrounding social environment of the person that is the nurses who are in constant touch
with the person, the doctors and family who are visiting the subject almost regularly (Nouvet
et al., 2016). Nearing the days of death and attributed to the feelings of grief and loss plus
agony due to unfulfilled desires, the integrity, esteem, self-concept, self-image, self-concept
and identity of the person is distorted and broken, leading to the formation of
psychopathological complexes and sadness, depression and more often, a deep sense of
existential crisis. The dying to death transition takes a lot of bearing, endurance and tests the
resilience of the dying person and it transforms the fast, shifting identity and physical state of
the person along with transforming spiritual state and this is where, the social support in the
form of collaborative support of the clinicians, the family members and the other supportive
stuffs is often required and this the essence of the end of life care settings, to ease the person
through the hard, unbearable and ramifying transitions of life. The existential and identity
crisis, in the end of life care settings where the person has few months of live - is bettered
with the calming and emotional, spiritual healing that comes from humanistic and holistic
health care approaches. The crisis when analyzed, has two aspects to it and these are lack of

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emotional clarity and the lack of situational clarity (Heyland et al., 2016).. It is the lack of
these psychosocial clarities that make the transition through the stages of the life to dying and
finally death – difficult. Another very important factor that makes the crisis, situation and
state plus condition of the old person often very difficult is non-acceptance (Harrison et al.,
2017). Non-acceptance of self and the non-acceptance of the situation while transitioning and
when an elderly person is presented with the conscious fear of death and dying make the
situation even more ramifying. It is highly important to understand that there are major
questions that come to interplay according to the Erik Erikson’s stages of psychosocial
development (Conlon et al., 2019). The questions surrounds around integrity versus despair,
fulfillment versus regret and whether the lived life was purposeful and meaningful to him or
in the eyes of others or both and it is to be critically seen that when the acceptance of reality
of death and dying is finally accepted, the ‘bigger questions’ about the life that is lived comes
to play and it is in these existential issues, the various aspects of conflicts are forged (Xiong
et al., 2020). The signs of dying are another critical area that is to be noted and understood
very closely in order to expand on the physical, social, psychosocial, existential, identity and
spiritual crisis faced by the dying old man. Preparedness or non-preparedness to death, loss of
self-control and self –resilience, connectedness to or detachment from self and others are the
various important factors that leads to the formation of negative complexes in the dying
person, causing self-imprisonment (Claxton-Oldfield, 2018). Spiritual growth and spiritual
redress is often required in this transition stage. The five physical signs that a person is dying
are labored breathing, loss of appetite, urination output changes and swelling in various parts
of the body generally but there is a stagnation in the process of psychological, existential and
the spiritual growth that affects the person in the dying stages and through these transition
phases that poses the most of the issues and the problems as well. The fact that the person has
chosen or determined his own fate of passive death by choosing to withdraw the biomedical

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life support services himself – can still be comforting to have taken a decision for himself but
these can be conflicting in the beginning and the acceptance of the reality might come later
on. Forgiveness, acceptance of others in their very forms and acceptance of our true selves
can be very rewarding and it can support the transition from dying to death in a very positive
manner (DeCaria et al., 2017). The transition from late care to end of life care to hospice care
and transitions of the old persons through these stages are associated with the above
mentioned crisis, psychosocial disturbances and loss plus regret and grief leading to
depression and despair. But as a matter of fact, there are various interventions to address the
needs of the dying person and these are addressing the person with dignity and comfort,
addressing the person with esteem and help the person restore or connect to his or her inner
self, finding comfort. Hence, transition to hospice care from end of life care in the last days of
the patient’s life is critical and this can comfort the agitation of the family and increasing
crisis of the near death subject.
Hence, it can be concluded saying that easing the discomfort caused by pain, agony
and other form of trauma triggered and revoked by reflections on life – can lead to better
comprehension of life lives as a whole, with the understanding of its meanings and finding if
not happiness but a peaceful satisfaction in the same. The social framework needs to be
strengthened and it is often seen that the family members of the dying person breaks down as
he or she is not prepared for the death of the old or elderly person. Providing physical, mental
and emotional comfort is very crucial and important as well.

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