Analysis of the Current Status and Influencing Factors of Death Attitudes Among Older Adults in Five Elderly Care Institutions in Hefei

Objective To explore the current attitudes towards death among elderly individuals in senior care institutions in Hefei City and the influencing factors, providing support for the implementation of life meaning education and end-of-life care for the elderly. Methods A convenience sampling method was employed to conduct a questionnaire survey of 206 elderly individuals in five senior care institutions in Hefei City from July to August 2023. The survey instruments included: (1) a general demographic questionnaire; (2) a questionnaire on quality of life and family support; and (3) the Chinese version of the Death Attitude Profile-Revised. Descriptive analysis, t-tests, variance analysis, and multiple linear regression analysis were performed using SPSS 21.0 software. Results The scores of the dimensions of death attitudes among elderly individuals in senior care institutions in Hefei City ranked from high to low as follows: Natural Acceptance (4.19±0.58), Death Avoidance (3.26±0.89), Escape Acceptance (2.91±0.89), Approach Acceptance (2.32±0.78), and Fear of Death (2.17±0.69). Multiple linear regression analysis showed that: Fear of Death was significantly lower in those aged 90 and above compared to the 60-69 age group (B = -0.439, P = 0.010). Regarding education level, Natural Acceptance scores were significantly higher in those with junior high school education compared to those with primary school education or below (B = 0.312, P = 0.008); simultaneously, Approach Acceptance scores were significantly lower in those with junior high school education or above compared to those with primary school education or below (Junior high school: B = -0.342, P = 0.014; senior high school/technical secondary school: B = -0.449, P = 0.001; college and above: B = -0.450, P < 0.001). Religious belief also significantly influenced death attitudes, with believers showing higher Approach Acceptance (B = 0.765, P < 0.001). Family visitation frequency was important, with those receiving visits at least once per month having significantly lower Approach Acceptance scores compared to those visited less frequently (B = -0.260, P = 0.017). Interaction analysis revealed a significant interaction between religious belief and visitation frequency on approach acceptance (B=0.794, P=0.014), suggesting that religious belief amplifies the positive influence of family visitation on approach acceptance. Conclusion Elderly residents in senior care institutions in Hefei City generally showed positive attitudes toward death, with a relatively high level of Natural Acceptance. Attitudes toward death were influenced by age, educational level, religious belief, and family visitation frequency, and a significant interaction between religious belief and family visitation frequency was found in the dimension of Approach Acceptance. These findings suggest that senior care institutions should provide targeted death education and psychological support according to the elderly individuals’ age, educational level, and family support status, with particular attention to younger elderly residents, those with lower educational levels, and those with insufficient family support, while also addressing the spiritual care needs of elderly individuals with religious beliefs.