A Psychosocial Aspect of Terminal Care: Anticipatory Grief

Death in contemporary society is increasingly an experience of the aged. Of the 2 million persons who will die in the United States this year, almost two-thirds of them (62 percent) will be 65 years of age or over, although this age group represents only 9 percent of the total population. Children under the age of 15, on the other hand, account for 29 percent of the total United States population but only 5.5 percent of the total deaths.' This is in sharp contrast to the mortality statistics in 1900, for instance, when proportionally, far more children died. At that time, children under the age of 15 accounted for 34 percent of the population-approximately the same proportion as today-but this age group accounted for 53 percent of the total deaths. In the same year, persons age 65 and over accounted for 4 percent of the total population, and 17 percent of all death^.^ These changes in mortality statistics are further reflected in life-expectancy figures. A person born in 1900 had a life-expectancy of 47.3 years, whereas a person born in 1967 could expect to live 70.5 years.4 The context in which dying and death are experienced in the United States has also undergone a significant change. Of the two million deaths estimated for 1970, almost two-thirds (64 percent) will take place outside the home in either a hospital or a nursing home.' The number of persons who will go to such a setting eventually to die can be expected to increase with the prospect of Medicare, more sophisticated medical technology, and the progressive segregation of the aged from families. Medical science, with its associated public health programs, has reduced the mortality rate and prolonged the life-expectancy of millions of our citizens. The extension and bureaucratization of medical health services, therefore, not only has changed the age at which a person can expect to die, but, in addition, has changed the time and place of his death.