REVIEW article
Front. Psychol.
Sec. Psychology of Aging
Psychological And Behavioural Responses To Death Anxiety In Older Adults With Chronic Illnesses: A Systematic Integrative Review
Provisionally accepted
- 1University of Porto, Porto, Portugal
- 2RISE-Health, Competence Center for Active and Healthy Aging, Faculty of Pharmacy, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal, Universidade do Porto Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal
- 3RISE-Health, Competence Center for Active and Healthy Aging, Faculty of Pharmacy, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal, University of Porto, Porto, Portugal
- 4RISE-Health, Department of Behavioural Sciences, School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal, University of Porto, Porto, Portugal
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Background: Death anxiety has been identified as a relevant emotional response in older adults with chronic illness, but its role in shaping psychological and behavioural responses remains underexplored. Objective: This integrative review aimed to investigate how death anxiety influences the emotional and behavioural responses of older adults living with chronic conditions, and to identify theoretical and clinical implications. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO databases, using an integrative review framework. Nine studies met the inclusion criteria and were analysed using thematic synthesis and quality appraisal. Results: Death anxiety was associated with both negative and positive or adaptive outcomes, including emotional distress, avoidance behaviours, increased treatment adherence, and re-evaluation of personal values. Thematic analysis revealed five key domains: (1) psychological responses; (2) behavioural responses; (3) predictors and moderators; (4) spirituality as a buffer; and (5) assessment strategies. Conclusions: Death anxiety plays a central and context-dependent role in shaping health-related behaviours in later life. Its effects are moderated by factors such as spirituality, social support, disease burden, and emotional resilience. These findings support the development of integrative clinical models that combine existential and behavioural frameworks to improve adherence and well-being in older populations.
Keywords: Mortality salience, older adults, Chronic Disease, Treatment Adherence, Existential reflection
Received: 12 Aug 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Alcântara, Figueiredo, Midão, Costa and Paúl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Elisio Costa, emcosta@ff.up.pt
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