Paul T. P. Wong, Ph.D.
President, INPM

I can never forget the angry reaction from a number of seniors right after the key- note address on successful aging at a major gerontological society convention. The speaker was a prominent authority on the topic, yet his message was met with disapproval and even anger from a small group of seniors standing close to me. These protestors included three or four women, a clergyman and a lanky, tall white-haired man leaning on a cane. We were standing at the door because there were no empty seats left inside the lecture hall. One advantage of being outside was that people could freely express their opinions without embarrassing the speaker.

The tall elderly gentleman with a cane was visibly angry to the proposition that successful agers were relatively free from disease and disability. "How about those on wheelchairs or using a walker! That would make us failures!" he said, shaking his head. Those with him were in total agreement with him. Their main complaint was that the speaker almost exclusively emphasized successful agers’ physical health and physical activities with no mention of their spiritual and existential dimensions.

This incident caused me to rethink the meaning of successful aging: Have the experts on successful aging missed something important to the aging population? The same question resurfaced a few years later when I read Rowe and Kahn’s (1995) report on the MacArthurs Successful Aging Project. They defined successful aging as ". . . the ability to maintain three key behaviors or characteristics: (1) Low risk of disease and disease-related disability, (2) high mental and physical functions and (3) active engagement with life" (p. 38). By active engagement, they meant such "happy activities" as relating to others and continuing productive activities. (p. 45)

It is worth-noting that happy activities are not necessarily productive as defined by Rowe and Kahn (1995): they "count as productive all activities, paid or unpaid, that create goods or services of values." (p. 47). They seem to imply that only activities contributing to the gross national product are considered productive. But how about spiritual and existential activities, such as prayer and meditation? How about activities of experiencing and appreciating nature? Are these activities productive?

In Rowe and Kahn’s (1995) expanded definition of successful aging, there was also no reference to spirituality and existential wisdom as contributors to successful aging. This omission is not surprising, since none of the 16 researchers of the MacArthurs Foundation Research Network on Successful Aging have done authoritative research on the spiritual and existential aspects of aging.

The Hidden Dimension of Successful Aging

During the past decade, I have consistently emphasized the importance of meeting the existential and spiritual needs of seniors (Wong, 1989, 1994, 1998; Wong & Watt, 1993). I have proposed that personal meaning is the hidden dimension of successful aging (Wong, 1989), because having a positive meaning and purpose in life will not only add years to one’s life, but also add life to one’s years. Without a clear sense of meaning and purpose in the face of physical decline, longevity may prove to be an unbearable burden. People need to develop a positive attitude towards life in order to maintain life satisfaction in the midst of losses and illness. I have presented a more detailed argument (Wong, 1989):

When many of the major sources of meaning, such as work, social status, and activity are threatened or diminished, as in the case of advancing age, the question ‘Why survive?’ becomes urgent. One’s health and life satisfaction importantly depends on whether this existential need is met. The main thesis of the present paper is that discovery/creation of meaning through inner and spiritual resources is a promising way of transcending personal losses and despair in old age. (p. 516)

No one would question the benefits of trying to prolong years of vitality and to compress the time of poor health to a minimum period (Fries & Crapo, 1981). The problem with this approach is that it "devalues" those who, for various reasons, cannot achieve this ideal. Furthermore, even the healthiest may succumb to chronic disabilities. Is life still worth living in these cases? In a nutshell, this is the question was probably behind the grumbling of some the seniors at the gerontological meeting. Cole (1984) has offered a similar critique of the Western culture, which values vitality and productivity and devalues the frail and sick. He has correctly pointed out that increase in longevity as a result of medical progress has been accompanied "by widespread spiritual malaise . . . and confusion over the meaning and purpose of life" (p. 329). The following quote points to the futility of emphasizing physical vitality without any reference to existential needs:

While many do live through their old age with personal vigor and integrity, many more suffer from segregation, desolation, and loss of self in a culture that does not value the end of life. Today’s ‘enlightened’ view of aging, which encourages older people to remain healthy, active, independent, etc., has yet to confront this crucial issue and therefore harbours potentially pernicious effects . . . . Unless the attack on ageism is applied to address the existential challenges and tasks of physical decline and the end of life, we will perpetuate a profound failure of meaning. (p. 333)

In his best selling book Successful Aging, Novak (1985) has made much the same point: "There is no secret, no magic formula. A good old age doesn’t come about from some special talent or as a secret gift. It comes about when, given a basic income, reasonable health, good self-esteem and a little energy, a person sets out to discover a meaningful life for him- or herself." (p. 273). He then goes on to say that merely focussing on physical activities, such as playing golf or travelling, may have the unexpected negative effect of covering up "the void of old age and keep people from coming to grips with the challenge of living beyond middle age. Meaningless action can short-circuit the chance to discover a good age" (p. 297).

Thus, the challenge of successful aging is to discover positive meanings of life and death even when one’s physical health is failing. We need to address the needs of the frail, the disabled and the chronically ill; we should not view them as unsuccessful agers. We need to look deeper and discover what enables one to triumph over prolonged illness and disability. Yes, the secret to successful aging for the frail and the dying lies in discovering the transcendental meaning of life and death.

Numerous authorities on aging (i.e., Birren, 1964; Butler, 1963; Erikson, 1963) have concluded that the search for personal meaning and integrity becomes crucial for adaptation in old age. Schulz (1986) pointed out that personal meaning becomes a major source of life satisfaction and personal growth in old age. He maintained that existential acceptance may be more adaptive for the elderly than active striving for personal control.

The Ontario Project on Successful Aging

In our Ontario Project on Successful Aging*, we defined successful aging in terms of mental and physical health and adjustment as rated by an interviewer as well as a panel of psychologists or psychiatrists, a geriatric nurse and a gerontological recreational worker. The third criterion—adjustment—was based on the observation of how well they coped with stressful life situations. A number of the questions were designed to measure the respondent’s general attitudes towards life and aging.

On the basis of these ratings, we were able to select successful agers and less successful agers from both the residential community and institutions for the elderly. We provided a comprehensive study of various psychosocial factors contributing to resilience and vitality in old age. These factors include variables emphasized by Rowe and Kane (1995), such as Healthy Lifestyles and Social Resources. In addition, we also measured Religiosity, Personal Meaning, Optimism, Commitment and Coping. The Successful and Less Successful groups differed significantly in all of these measures. More importantly, regression analyses showed that personal meaning was the best predictor of happiness, perceived well being and the absence of psychopathology and depression. In short, these results suggest that successful aging is 80% attitude, and 20% everything else.

On the basis of open-ended interviews with participants in this project, Wong (1986) concluded that successful agers are more likely to report positive meanings of life and death as sources of happiness and life satisfaction. The following are a few examples:

I want to be of value in whatever days left to me. I want to do it with dignity . . . . When I take my last breath, I want to be remembered not for any property or valuable things in a monetary sense, but for what I was capable of doing and what I have done for others.

This newly retired man was very active in various seniors’ groups. He was trying to organize various seniors’ organizations under one umbrella and apply for government funding. He expressed a strong desire to be "needed, wanted and loved." He wanted to work hard to benefit others. To him, successful aging was not so much being engaged as keeping active for a worthy cause. Successful aging involved serving others and leaving a good legacy.

I still have certain ambitions. I would like to do something for my country, for the Peterborough area, and for the Province. We started a while ago back a project called POP—Preserve Ontario Pickerel. We are great fishermen and we say that the fishing was going down. So we started this project. We have now 20, 000 signatures. We also believe that there is the urgent need for a beautiful art centre. We have started a drive for membership. Third, the Constitution we have. It is good, but there is a lot that should and could be done to it. It is not a people’s constitution. So there are the kind of things I would be very glad to give the rest of my life to.

At 73 years old, the above successful ager was still fully engaged with life. His happy activities not only consisted of golfing, travelling and enjoying himself; he wanted to give all his energy and the rest of his life to projects that benefited humanity. His life goals of conservation and civil duties endowed his life with purpose and passion.

What happens when one becomes frail and institutionalized? What gives one a sense of meaning and purpose in a nursing home? One 92-year-old man derived real satisfaction from helping those who were worse off then he was. His eyes sparked and his voice quivered with excitement as he talked about the joy of helping others:

I help anyone. If I see a wheelchair waiting at the elevator or going around and they want a little help, even though I’m crippled myself, I can do without the walker as long as I can have the cane. If I see a wheelchair that wants help, I’ll go and help that wheelchair every time.

The common thread of these successful agers is that they have a zest for life and a clear sense of meaning and purpose. They consistently say "Yes" to life and all the trials of aging. For most of them, their happy activities can be considered purposeful and altruistic rather than leisurely or economically productive. They seem to derive energy and satisfaction from serving others and pursuing a meaningful goal that transcends self-interest.

Another common theme was that the successful agers had a positive attitude towards life. "Be cheerful and try to be as happy as you can," advised a 74-year-old senior. "Well, get out and smile and the world smiles. There is no use grouching about it," mused an 81-year-old lady.

The following quote was from a 73-year-old man who brimmed with zest for life. There was an eager anticipation for each day and each season. He had a profound appreciation for what life had to offer. This kind of positive attitude towards life does not allow much room for death anxiety. Here are his words:

I look forward to tomorrow and all the days to come. You know, tomorrow is the first day of the rest of your life, so you just take what comes and enjoy it. I look forward to summer, I look forward to fall, I look forward to winter and I look forward to next spring when everything starts bursting out.

A 77-year-old mentioned the importance of being positive and grateful. He had this to say:

Be thankful for what you have and get the most out of everyday. Keep a healthy, happy attitude. If you start thinking about tomorrow and tomorrow’s illness, which is liable to creep up on you or anyone, then you’re going to spoil today. Be thankful for what you have today.

Another successful ager summed it up this way:

Your attitude is the biggest part. If you want to go around with a chip on your shoulder all the time, you’re going to have health problems—you’re going to think this is wrong with me or that is wrong with me. But, if you have the right attitude, and think, well, gee whiz, is this aging or what is it?

Successful agers also demonstrated a positive attitude towards death and dying. For most of this cohort, the positive meaning of death was often derived from their religious beliefs. Here is a quote from a 76-year old man:

What I really look forward to is to see the culmination of all the experiences of life is when the Lord comes and we go to be with Him. Then, we are out of this scene. I am not afraid to die, because I am ready. Life is sweet even at that. When it comes, I am satisfied that that is it. The Lord knows best, and I’ll leave that up to him.

Another successful ager talked about how his Christian faith and his positive attitude helped him face present difficulties as well as the prospect of dying:

If we have sufficient faith in God, who is always with us and we are in his hands, I don’t think anyone has any need to fear the future. We need to come to grips with the fact that it’s only a problem, if you allow it to be a problem. If you can accept the fact of our diminishing activities, whatever they might be, you would realize that there is still life ahead of you.

The untold story of successful aging is about positive attitudes towards life and death, about the spiritual and existential quest, and about personal growth in wisdom and spirituality. From this spiritual, existential perspective, successful aging is attainable for everyone with positive meanings, regardless of his or her physical condition.

In the remaining sections of this chapter, I will discuss (1) the relationship between meaning of life and meaning of death, and (2) the implications of death attitudes for successful aging.

The Relationship between Meaning of Life and Meaning of Death

Life teaches us how to survive, while death teaches us how to live. Life is a taskmaster, while death is a master teacher. We cannot learn how to appreciate the preciousness of life without coming to grips with the reality of death. When people spend so much time in trivial and self-destructive activities, it is often because they have denied the reality of personal mortality. Firestone (1994) observes: "Much of people’s destructiveness toward themselves and others can be attributed to the fact that people conspire with one another to create cultural imperatives and institutions that deny the fact of mortality" (p. 221). On the other hand, there also those who are motivated to make something of their lives before death puts an end to their aspirations. Thus, how we react to personal death has considerable impact on how we live.

Tomer (1994) reviews several philosophical approaches towards death. Each of these philosophies has implications for the meaning of life. For example, Martin Heidegger's position is that since death is a threat of non-existence, it provides the precondition for fuller understanding of life, thereby freeing us from anxiety. For Sartre, death reduces one’s being to nothingness; therefore, to reflect on death is to realize the meaninglessness of existence. However, Neimeyer and Chapman (1980) derive a more positive view of life from Sartre’s notion of nothingness; they propose that death anxiety can be reduced through self-actualization. In other words, those who have realized their central life goals are less likely to experience death anxiety than those who have not completed their life tasks are.

Wong, Reker and Gesser (1994) provide a broader conceptual framework for death attitudes, which include fear of death, death avoidance, approach acceptance, neutral acceptance and escape acceptance. Fear of death can be considered the most powerful and universal death attitude; the other four attitudes may be considered as the various human attempts to cope with death anxiety.

There are many reasons for fear of death. Some of the common reasons are fear of the pain of dying, fear of separation, fear of the unknown, fear of divine judgement. According to Goodman (1981), "The existential fear of death, the fear of not existing, is the hardest to conquer. Most defensive structures, such as the denial of reality, rationalization, insulation, erected to ward off religiously conditioned and separation-abandonment fears do not lend themselves readily as protective barriers against the existential fear of death" (p. 5). Another type of the existential fear is that death comes before one has lived a meaningful life. Butler (1963) even suggests that people are more afraid of a meaningless existence than of death.

The effects of fear of death are complex and pervasive. At one extreme, fear of death may lead to intentionally confronting death in extreme sports or on the battlefield—by staring death in the eye. Individuals may have the exhilarating feelings of being free from the iron grip of fear of death. At the other extreme, individuals may live very cautiously in a protected "bubble"—they are extremely safety conscious and don’t want to try anything. Such extreme reactions clearly do not contribute to successful aging.

Even less extreme forms of death anxiety are unhealthy. Preoccupation with mortality and worries about death and dying will rob one of the joys of living. In deed, we have found that fear of death as measured by the Death Attitude Profile - Revised (DAP-R) was negatively correlated with psychological well being as well as positive meanings of life and death, and positively correlated with depression. Positive meanings were measured by the semantic differential (SD) method with 7-point bipolar adjectives (e.g., meaningful-meaningless, satisfying-dissatisfying, pleasant-unpleasant, etc.). These bipolar scales were used to provide SD ratings for life and death.

Fear of death can lead to unconscious avoidance, which expresses itself in different ways: living in a drunken stupor, treating death as a taboo subject, refusing to even think about it, or living in the illusion of perpetual youth through cosmetic surgery. However, the most common manifestation of death avoidance is probably the pursuit of busy but trivial activities, as if life would go on forever.

At the heart of death avoidance is denial. Unfortunately, the psychological defense of denial and avoidance eventually fails in the face of mounting evidence of aging and dying. That is why, sooner or later, people need to come to some form of death acceptance in order to overcome the fear of death

We have identified three types of death acceptance: neutral acceptance, approach acceptance and escape acceptance (Gesser, Wong, & Reker, 1987; Wong, Reker, & Gesser, 1994). Escape acceptance is very different from other two types of acceptance because it is based on problems of life rather than fear of death. Even the prospect of hell after death seems more tolerable than the pain of earthly life. In other words, when one finds life unbearable, suicide seems a more attractive alternative.

There are many reasons why people say: "I see death as a relief from the burden of life." More often than not, their burden has to do with the crushing weight of meaninglessness rather than physical suffering. In such situations, suicide becomes a cry for meaning. In other situations, people contemplate suicide because they have a very low tolerance for suffering and do not know how to cope with it.

Neutral acceptance refers to coming to terms with the inevitable reality of personal mortality, no matter how uncomfortable one may feel. All living things must die. Death is just a natural cycle of life. One has to accept this fact as the cognitive level, and then gradually adjust to it as the affective level.

Neutral acceptance can have different effects on how one lives. Some may feel that since life is short, they indulge in hedonic pleasure—"let’s eat and be merry, because tomorrow we die." These individuals have accepted death only at the cognitive level, because deep down in their hearts they remain anxious about the finality of death and the termination of that they hold dear.

A more positive type of neutral acceptance is related to self-actualization. Given the brevity of life, some people may want to make to good use of their time and accomplish something worthwhile and significant. Both Kaufmann (1976) and Goodman (1981) have also proposed the idea of conquering the fear of death through self-actualization; being able to accomplish meaningful life goals leads to death acceptance. This idea has been eloquently expressed by Goodman (1981):

"I don’t think people are afraid of death. What they are afraid of is the incompleteness of their life," wrote Ted Rosenthal (1973), who at the age of thirty was told that he had acute leukemia and was going to die. This is one of the most positive statements made on the most fundamentally aversive human condition. It contains an implicit solution to the existential fear of death: completion of one’s life, attainment of self-fulfillment. (p. 3)

Goodman (1981) provides numerous illustrations of the above thesis based on his conversations with eminent artists and scientists. For example, in response to Goodman’s question: "Would you banish death if you could?" Dr. John Wheeler, a renowned physicist, gave the following answer:

We have no stronger way to mark our commitment to a great cause than to die for it. So long as there is any such thing as death, human beings can be great. Nobody can take away one’s possibility to die for a cause. So long as that measure of ultimate commitment is attainable, the world will be a live place to live in. Were death to be abolished, all that we call precious in the world would die (p. 81)

Dr. Wheeler has raised an interesting point—the nobleness of human beings lies in their ability to find a cause that is worth dying for. This ultimate commitment constitutes the highest criterion of a meaningful existence. Death becomes a friend rather than an enemy when it brings a natural conclusion to a completed life task. Goodman (1981) explains the psychological process that transforms fear of death into death acceptance:

To assert in the face of death, "I have fulfilled myself, I can die," certainly takes the sting out of that fateful final hour. But even more important, to know that one is doing all that one is equipped to do, to experience life as meaningful while one is still in the midst of it, may well take the sting of death and liberate us from the fear that inhibits most people to strive toward self-actualization in the first place. . . . There may be an optimal way in the lifelong process of approaching death: a way that would allow us to experience the human condition as meaningful rather than absurd; life as fulfilling and terminable rather than frustrating and incomplete; death as an ultimate goal, worth striving for, rather than lifelong threat to dash our hopes. (p. 157-158)

The main weakness with Goodman’s thesis is that creative energy does not end with the completion of one task. In fact, creative people are constantly searching for new challenges, but life is too short to complete all the exciting projects available. I can’t imagine that truly creative people would say: "I have completed my life task. Therefore, I’ll spend the rest of my life on a rocking chair waiting to die." It is more likely that as long as health permits, creative people will continue to pursue projects. When it is time for them to depart, they have the satisfaction that they have done all they can given the years they have, even though much remains to be done.

Furthermore, I do not agree with Goodman that self-actualization represents an optimal way to approach death. Some have to die prematurely, not able to complete their life tasks, let alone fulfilling all of their potential. There is also little hope beyond the grave if the significance of one’s existence rests on one’s performance.

Approach acceptance seems to be the most satisfying way to approach death, because it not only incorporates the completion of one’s mission in life, but also extends to a rewarding afterlife. The sting of death is removed by faith in resurrection and eternal life. After presenting evidence on the resurrection of Jesus Christ, Apostle Paul declares:

When the perishable has been clothed with the imperishable, and the moral with immortality, then the saying that is written will come true: "Death has been swallowed up in victory. Where, O death, is your victory? Where, O death, is your sting?" (Holy Bible, 1 Corinthians 15:55)

Many of our successful agers have expressed such faith. They looked forward to returning to their Heavenly Home, not on the merit of their own accomplishment, but on the basis of their faith in Christ. This type of approach acceptance is not only more attainable, but also more satisfying that self-actualization, provided that one believes in the after-life.

In her memoir of living and dying, Elisabeth Kübler-Ross (1997) epitomizes the triumphant spirit of a religiously based death acceptance:

When we have passed the tests we were sent to Earth to learn, we are allowed to graduate. We are allowed to shed our body, which imprisons our soul the way a cocoon encloses the future butterfly, and when the time is right we can let go of it. The we will be free of pain, free of fears and free of worries . . . free as a beautiful butterfly returning home to God . . . which is a place where we are never alone, where we continue to grow and to sing and to dance, where we are with those we loved, and where we are surrounded with more love than we can ever imagine (p. 284).

We have found that both neutral acceptance and approach acceptance are significantly correlated with positive meanings of life. However, approach acceptance was also positively correlated with positive meanings of death, providing evidence that approach acceptance is an optimal way to approach death.

Implications for Successful Aging

We have seen that those who endorse both neutral and approach acceptance are likely to have a sense of mission and derive meaning from pursuing their life tasks. Their commitment to meaningful living not only banishes the fear of death but also make life worth living whatever their circumstances. That is why Elisabeth Kübler-Ross (1997) is able to declare: "Dying is nothing to fear. It is the most wonderful experience of your life. It all depends on how you have lived." (p.286)

According to Frankl (1963, 1971), the prospect of death motivates individuals to assume responsibility and respond to the opportunities life has to offer. It also provides the challenges to transform the reality of death into new possibilities for meaning. Kovacs (1982) offer this useful insight on Frankl:

An apparent obstacle or a limitation in life may become a source for new personal meaning and self-realization. Thus, for Frankl, death is not the end but rather the beginning of the birth of meaning in human living. (p. 202)

In his edited book The Courage to Grow Old, Berman (1989) provides numerous examples of individuals who have faced old age and death with courage because of their abiding sense of meaning and unfailing faith. Leland Stowe (1989), one of the contributors in Berman’s volume, summarizes it well:

If it doesn’t take courage to grow old, what does it take? Faith in living, I believe, faith that its compensations will multiply with time. . . . It all adds up to this equation: Attitudes + Habits = Motivations; Motivations + Goals + Dreams = Character – all cindered into solid bricks for the passageway into growing old. (p. 303)

Indeed, attitude matters a great deal. It is attitude more than action that ultimately determines whether a person ages well and dies well. Many of the participants in the Ontario Project on Successful Aging have demonstrated this important truth over and over again. I believe that our existential and spiritual emphasis will bring hope to many seniors who are suffering from chronic illness or physical disability.

Fortunately, it is within almost everyone’s reach to discover meaning and spirituality. Regardless of the extent of their physical limitations, people can always choose positive attitudes towards life. All that is required is a grateful heart, an open mind and a searching soul. We have initiated the International Network on Personal Meaning (http://www.meaning.twu.ca) to facilitate people’s existential and spiritual quests. Our Meaning of Life Forum is particularly relevant to those interested in meaning-oriented successful aging.

What happens when seniors are no longer able to do productive work? What happens when their health declines to the point that they require institutional care? Can they still achieve successful aging? The answer to these questions is a resounding "Yes." Elsewhere, I have discussed in details how to promote meaning and spirituality in successful aging (Wong, 1989, 1998). I believe that society and individuals can work together to making aging and death more meaningful.

To follow up on the incident reported at the beginning of this chapter, I was able to engage in a discussion with this group of disgruntled seniors. Almost instantly, they caught on to my message and agreed wholeheartedly that the medical and gerontological establishment should pay more attention to the existential and spiritual needs of seniors.

Psychologists and researchers all need to pay more attention to existential and spiritual issues. Neugarten (1997) had this recommendation:

Psychologists will probably gain enormously by focusing more attention upon the issues that are of major concern to the individual by focusing more attention upon issues that are of major concern to the individual—what the person selects as important in his past and his present, what he hopes to do in the future, what he predict will occur, what strategies he selects, and what meanings he attaches to time, life, and death. (pp. 639-640)

With respect to spiritual care, Cluff (1984) emphasized that "Spirituality must be accepted as a dimension of what it means to be human—to live and die, to suffer and rejoice, to succeed and to fail, to hope and despair" (p. 609). He suggested that when one is facing death,

. . . what is important is not whether the individual finds peace in God or attains a satisfactory answer to the questions of life’s meaning, although this may be desirable. What is important is whether the individual continues to question and seek out God, meaning, purpose, and value. (p. 610)

Thus, the quest for meaning and spirituality is an on going process, making the journey of life rewarding until the very end.

I am pleased that things are moving in the right direction. Both researchers and health care professionals are beginning to recognize the important role of meaning and spirituality (Wong & Fry, 1998). I hope this chapter will encourage more people to take seriously the existential approach to successful aging and death education.

Points to Remember

Rowe and Kane’s (1995) model of successful aging focuses on physical health, psychological functioning and active lifestyle. Some seniors, especially those with physical disability, feel that this model devalues them and treats them as failures.

Wong’s (1989, 1998) model of successful aging emphasizes the existential and spiritual needs of seniors. He proposes that successful aging is 80% attitude and 20% everything else; therefore, it is attainable even by those who are frail and chronically ill. Results from the Ontario Project on Successful Aging support Wong’s existential model.

According to Wong’s existential-spiritual model of aging, positive meanings of life and death provide the necessary motivation for pursuing a healthy life style as well as worthy life goals. Furthermore, the model allows for a high level of life satisfaction, even when physical health is failing.

Death anxiety and death avoidance can be replaced by neutral acceptance and approach acceptance. Individuals demonstrate the death attitude of neutral acceptance when they come to grips with the reality of their personal mortality and try to make the most of their lives. Individuals exhibit the death attitude of approach acceptance when they look forward to a rewarding afterlife after completing their mission in life.

Approach acceptance promises to be the optimal approach to living well and dying well. Therefore, gerontological care and death education should take into account the spiritual and existential needs of seniors.

* The Ontario Project on Successful Aging was conducted in corporation with Gary Reker and supported by a Strategic Research Grant from Canada’s Social Sciences and Humanities Research Council.

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Wong, P. T. P. (1995). The adaptive processes of reminiscence. In B. Haight & J. D. Webster (Eds.) Reminiscence: Theory, research methods, and applications (pp. 23-35). Washington, DC: Taylor & Francis.

Wong, P. T. P. (1998). Spirituality, meaning, and successful aging. In P. T. P. Wong & P. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications. (pp. 359-394). Mahwah, NJ: Lawrence Erlbaum Associates, Inc., Publishers.

Wong, P.T., & Stiller, C. (1999). Living with dignity and palliative care. In B. de Vries (Ed.), End of life issues: Interdisciplinary and multidimensional perspectives (pp. 77-94). New York: Springer. Wong, P. T. P., & Watt, L. (1991). What types of reminiscence are associated with successful aging? Psychology and Aging, 6, 272-279.