Title: Attitudes to Death and Dying in the Context of Healthy Ageing

Background Despite increased global attention to Healthy Ageing, the critical dimensions of death and dying are notably absent from its framework. This gap undermines efforts to create a holistic understanding of ageing that addresses life’s final stages. The thesis explores how personal, health, and environmental factors shape attitudes toward death and dying in adults aged 50 and older, contextualized within the World Health Organization’s Healthy Ageing framework and the COVID-19 pandemic.

Methods This thesis comprises two studies: (1) a scoping review mapping the literature on factors associated with death and dying attitudes among older adults, using PRISMA guidelines, and (2) a systematic review analyzing death attitudes during the COVID-19 pandemic among adults aged 50 and older, with data drawn from the WHO COVID database and synthesized through a structured extraction and analysis process.

Results The scoping review identified 74 studies, revealing significant gaps, including an overemphasis on negative attitudes and a lack of attention to environmental factors. The systematic review, encompassing nine studies, highlighted moderate to high levels of death anxiety during the pandemic, with associations linked to chronic illness, loss of capacity, loneliness, and resilience. Protective factors included spiritual well-being and perceptions of death as distant.

Conclusion This thesis bridges Healthy Ageing and death studies, emphasizing the need to integrate death and dying into frameworks for ageing. It identifies modifiable factors influencing death attitudes and underscores their implications for public health strategies, mental health interventions, and end-of-life care. These findings lay the groundwork for comprehensive, culturally sensitive approaches to ageing that support individuals to live—and die—aligned with their values and preferences.