Philippine Journal of Nursing Manuscript

7/28/2019 Philippine Journal of Nursing Manuscript

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Running Head: A VOYAGE TO THE TWILIGHT 1

A Voyage to the Twilight: Exploring Death Preparation among the Elderly

Carlo Paul C. Sana

Saint Louis University / Virgen Milagrosa University Foundation


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Author Information:

Carlo Paul Castro Sana is a faculty of Saint Louis University School of Nursing, Baguio City.

He holds the degree, Master of Arts in Nursing major in Administration of Nursing Service. This

research article has won several awards including a Platinum Award for having been the Best

Research Paper and the Best in Multimedia Presentation during the 10th

Dr. Martin P. Posadas

Memorial Research Forum and it has been presented during the 2nd

International Research

Forum vested by the Research and Educational Development Training Institute.

Contact Number: +63927-795-98-83; (075) 532-34-23

E-mail Address: [email protected]

Authors Photo:

This is to certify that all data presented in this manuscript are true, and that the research entitled,

A Voyage to the Twilight: Exploring Death Preparation among the E lderly embodies the result

of original and scholarly work carried out by the undersigned. This research article does not

contain words or ideas taken from published sources or written works that have been accepted as

basis for the award of a degree from any higher education institution, except where proper

referencing and acknowledgment were made.

Carlo Paul C. Sana, RN, MAN


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Abstract

Death and aging are inevitable. Everyone will pass through this stage with its

accompanying changes and transitions. However, since investigations usually assume that death

unanimously provokes anxiety, death is often termed the last taboo, which makes it painful for

most people to talk about, think about, or even plan for it. The study was conducted to determine

the philosophies and attitudes of the elderly in accordance with their ethnicities in relation to the

physical, psychosocial, and spiritual aspects of death preparation. It also sought for the

importance of having a support system as the elderly persons faced or are facing near-death

experiences and/or terminal illnesses. The study is qualitative in nature, and it has utilized

phenomenology as its research design. Informants of this study were from the different cities and

municipalities of Pangasinan. Eight informants were chosen through purposive sampling. Four of

them are pure Ilocanos, and the other four are pure Pangasinenses. There was no preset number

of informants. Instead, data was exhausted until saturation point was reached. All of them have

been involved in a near-death experience and/or are in a dying state. Data was gathered in the

form of a semi-structured interview. The study found out that the elderly persons have

acknowledged death as inescapable, and it serves as a way in entering their Creators kingdom.

In addition, the informants have gone through six stages of the grieving process, which included

the following in order: Denial, Anger, Realization of the Causes and Effects of their illnesses,

Bargaining, Depression, and finally, Acceptance. Moreover, both elderly Ilocanos and

Pangasinenses have the following philosophies and attitudes regarding death preparations: They

are dependent to their significant others in terms of death preparation; they also are family

oriented; and lastly, they believe that God extends life. Separately, elderly Ilocanos are optimistic

regarding their near-death experiences. Elderly Pangasinenses on the other hand, are peace-


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seeking individuals. Finally, the study also reconnoitered further on the effects of having a

support system with the informants, and they said that it makes them feel more recovered, and it

strengthens their family ties even more. These findings suggested that their own concept of

death, the grieving process, their cultivated philosophies, and support system played major roles

in helping the elderly people prepare for their death.

Keywords

Death, Dying, Death and Dying, Death Preparation, Elderly, Geriatrics

Text

Introduction:

What will you do if the angel of death came by your door to fetch you? He is very

impatient, and he does not like to wait. So the biggest question is ARE YOU PREPARED?

By understanding the content of this study, one will be able to discern how the elderly

persons perceive death, the stages that they undergo whenever they experience a loss (in their

cases, loss of wellness), their attitudes and philosophies in accordance to their ethnicities (either

being a Pangasinense or an Ilocano) in relation to the Physical, Psycho-social, and Spiritual

Aspects of death preparation, and lastly, the effects of having a support system to an elderly who

faces death. Physical aspect includes will, advanced health directive & power of attorney,

instructions to caregivers, settling unfinished businesses, and funeral Wishes (Len, 2007). Suit or

dress, interment motifs, type and style of remain container are also considered. Psycho-social

aspects include saying good-byes, making peace, talking about dying, asking doctors for all the

facts (Rantzen & Feinman, 2006). Spiritual aspect includes strengthening of faith, clarifying


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doubt in religious belief, resolving anger and guilt with ones Supreme Being and further

dependence on ones belief(Edinberg, 1990).

Humans are programmed to undergo the stage of being an elderly without the influence

of any opposing factors such as terminal illness at an early age, mishaps, suicide, etc., which may

hinder them from going through late adulthood. It is through late adulthood, where one

experiences degeneration, which makes a person susceptible to various life-threatening disorders,

and accidents. By this time, many notions may frolic into ones mind this is when the game of

what ifs starts. In this game, no one loses, but definitely, no one equally wins. One will be

stuck up in a labyrinth, styled with indefinite patterns. He will keep on seeking for the mazes

end, but he seem to have gone astray beneath the blank tracks of his imagination. However, these

soul-breaking philosophies of what ifs can be shunned by an adequate preparation for every

circumstance that he may encounter.

Moreover, this article will serve as a ticket for you to experience a free ride as you

expedite through the elderly persons nearing twilights.

Methods:

This study is qualitative in nature, and it has utilized phenomenology as its research

design. The province of Pangasinan was purposively selected as the locale of the study, and from

Pangasinan, four cities/municipalities were again purposively selected namely: San Carlos City,

Dagupan City, Urdaneta City, and Villasis. Eight informants of the study were chosen through

purposive sampling. One strategy of purposive sampling, which helped the researcher in

determining his informants, is through Extreme Case Sampling, which focuses on cases that are

rich in information because they are unusual or special in some way (Patton, 1990). Extreme


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case sampling included the selection of informants within the following criteria: must either be a

male or a female resident of Pangasinan, 60 years old and above, must possess a sound mind,

must have had a near death experience before or is presently having a terminal illness during the

time of the interview, must be a pure Pangasinense or a pure Ilocano, and they must be living

with others. Four of the informants are pure Ilocanos and the other four are pure Pangasinenses.

There was no preset number of informants. Instead, data was exhausted until saturation point was

reached. This was a point in data gathering where no new data was obtained.

The researcher studied the way of living of each informant before they were interviewed.

He made use of social integration (being one with the people) as a strategy to do this by being

one with the people he wished to deal with (in this case, his informants). This was done to build

rapport in order for the informants to feel more comfortable with the researcher, thus meaningful

and accurate data would be yielded from their responses. After building rapport, interview proper

was initiated. Data was gathered in the form of a semi-structured interview by utilizing

standardized open-ended questions. All responses of the informants were audiotaped in an

audiotape recorder. The audiotaped facts gathered from the informants were transcribed,

compared from other informants responses and were presented in narrative form. The

informants names were replaced with planet names to provide confidentiality on their parts.

Brief descriptions of the informants are as follows:

Venus, 86 year old female is an Ilocano and is a resident of Villasis, Pangasinan. She is a

retired teacher. She lives with her son, and grandchildren. She has been hit by a tricycle on 2005,

which led to her loss of consciousness.

Mars, 82 years old female is an Ilocano and is a resident of Villasis, Pangasinan. She is a

plain housewife. She lives with her daughter, and her daughters family (inclusive of husband


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and children). She was confined to the hospital because of difficulty of breathing. She mentioned

that she felt like drowning whenever she is lying. The medical team found out that she has a

pleural effusion.

Jupiter, 68 years old male, is an Ilocano, and is a resident of Urdaneta City, Pangasinan.

He lives with his eldest daughter, son-in-law, and his grandchildren. He usually stays in their

small store, and watches over the saleable basic items. Whenever someone buys, he attends to it.

Jupiter was hospitalized due to uncontrolled coughing. Eventually he had difficulty of breathing

which led him to seek for consult and confinement on 2009.

Neptune, 70 years old male, is an Ilocano, and is a resident of Urdaneta City, Pangasinan.

Neptune lives with his wife. He is a faith healer. Upon entering Neptunes house, various

religious icons would welcome you, as his altar where the religious icons are placed, is situated

right in front of his door. He had a heat stroke on 2004.

Earth, 85 years old female, is a Pangasinense, and is a resident of San Carlos City,

Pangasinan. She is a retired teacher. She lives with her two granddaughters, and her husband

who happens to be bedridden due to Parkinsons disease. Earth had a heart attack on 1975.

Another near-death experience that she had was when she had an internal bleeding during her

operation with her second child. She said that it was crucial since it is either her or her child will

die. Eventually both survived.

Mercury, 88 years old female, is a Pangasinense. She lives with her granddaughters in

Dagupan City, Pangasinan. Mercury had a stroke. She has lost her consciousness, and eventually

regained it when she was brought to the nearest hospital. She became dependent to her

significant others for quite some time. But now, she has recuperated. The only problem she has

during the interview is her blurring vision.


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Saturn, 65 years old male, is a Pangasinense who lives in San Carlos City, Pangasinan.

He stays with his wife, and his son. Saturn is a farmer who had a stroke on 2011. He stayed in

the Intensive Care Unit for almost a week, and in the long run, surpassed the disease.

Pluto, 73 years old male, is a resident of Dagupan City, Pangasinan. He is a Pangasinense

who lives with his diabetic wife, and bedridden son. Pluto was diagnosed with Chronic

Obstructive Pulmonary Disease, and is already in the terminal stage of the disease. Pluto can no

longer do his usual activities of daily living for a prolonged period of time, but is still conversant.

An oxygen tank is placed on his bedside. Plutos legs were already edematous. His wife is the

one responsible for Plutos home health and palliative care, since Pluto is a dying patient.

The data was presented in an emic perspective. Emic perspective refers to the manner the

members of the group envision their way of living, practices, and culture from their jurisdiction.

Responses of the informants obtained during the interview were compared between all other

informants to discriminate resemblances and alterations between their responses. The aim of

constant comparative method for this study is to generate a theory from the saturation of

responses, which would describe the lived experiences of the informants. The method of analysis

of data used in this study depended on the literatures during transcription.

Moreover, non-verbal responses of the informants were noted to and were written in the

interview protocol sheet. These non-verbal responses were associated to the transcribed

statements of the informants during the coding, recoding, and reduction process.

Reduction process included condensing all salient statements until the researcher has

come out with themes and sub-themes. Themes and sub-themes of the study were derived from

careful analysis of statements by the researcher, and no software(s) or digital application(s) were

used during the scrutiny of such assemblages. The themes and sub-themes were objective in


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nature, because they have been derived in accordance to the researchers insight of the

informants statements.

The audiotaped information was destroyed by the researcher after painstakingly

reviewing them to ensure confidentiality.

Ethical considerations included the deference of informant autonomy by reiterating that

any one of them can withdraw from the study at any given time they wish to have. The

researcher also had the informants sign an informed consent to ensure autonomy. The researcher

made use of the name of the planets as aliases for the informants to preserve their confidentiality

and anonymity. Along with this is the reiteration of the researcher that none of the informants

personal backgrounds will be divulged. The principle of beneficence was also observed by the

researcher shows good intentions to the informants because one of the significances of this study

is to help the elderly group prepare with an upcoming death. In addition, the principle of non-

maleficence was also observed by not doing any harm to the informants during the entire course

of the study. Finally, the principle of justice was observed by giving due credits to the authors

whom the researcher of the study has referred to.

F indings and Discussion:

Presented in this section are the findings and analysis of the elderly informants

statements regarding death and death preparation highlighting the four major themes, with their

respective sub-themes in accordance to the emic perspective that the informants have had. The

major themes included The Meaning of Death, The Sequence of Living in a State of Dying, The

Philosophies of an Elderlys Living Soul, and Significances of a Support System.

I. The Meaning of Death


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Death may be defined in various ways. Many views may transpire when one is asked about

it. Others may delineate death with their experiences, while some may define it by means of

amalgamated thoughts and ideas. However, as for the informants who have been involved in a

near-death experience, death is defined in two ways: That is an inevitable event in ones life, and

it is a portal to the Creators realm.

a. I nevitable eventThe informants thought of death as an inescapable occurrence in ones life. Death

is a part of life; no one is exempted and no one can definitely escape from it. They have

verbalized that they cannot do anything about its approach into their lives.

Venus: Kung yan ang gusto ng panginoon na mamatay na ako, walanaman akong magagawa. (If the will of God is for me to die, I cannot do

anything)

Mercury: Nu alaen to ak la (refers to the Supreme Being), antoynagawaan mo ey? (If He will get me [refers to the Supreme Being], what

can I do?)

The informants viewed death as unavoidable and compulsory, knowing that it is

the bodys biologic function to cease one day. By analyzing the statements of the

informants, they have one phrase in common which may convey the thought of the

inevitability of death in their lives. The phrase I cannot do anything entails the

paramount surrender of their hopes that they too, will face death as a conclusion of their

being. Nesbitt (2009), Slaughter (2009), and Finlayson (2011) Have supported this claim

of the informants. Nesbitt said that death is inevitable. Slaughter also expressed the

inevitability of death through his poem. He described death as unstoppable, obstinate and

inescapable on the first stanzas of his poem. Finlayson also said that death is an inevitable


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part of life and very brief, holding on to dear about death is achieving nothing and

causing you struggle in the here and now.

b.Portal to the Creators Realm

Death can be associated to a door, which opens to another world, another domain,

or another dimension.

Pluto: Wow! That is a good question. Death for me is a sign of God,

because you cant go to heaven if you will not die. Papaano ka

makakapunta ng langit kung buhay ka? Kaya mamatay ka muna bago kapumuntang heaven. (Wow! That is a good question. Death for me is a

sign of God, because you cannot go to heaven if you will not die. How will

you go to heaven if you are still alive? That is why you still need to diebefore entering heaven.)

Earth: Ooohh.. (Amazed by the question, What is death for you?) Thatis second life. Ang alam ko sa death, ay paradise. My dream, my wish, and

my prayer is to go with the Lord. Yan ang iniisip ko. Ayoko yung eternal

fire. (Ooohh..[Amazed by the question, What is death for you?] That

is second life. Death is a paradise. My dream, my wish, and my prayer isto go with the Lord. That is what I think of. I do not want the eternal

fire.)

Anando (2005) made an investigation on whether consciousness continues after

death, and he concluded that consciousness is something separate from the physical brain

and body. This claim supports the existence of having other dimensions in the after-life.

II. The Sequence of Living in a State of DyingThis sequence has been adopted from Elisabeth Kubler-Ross Stages of Grieving Process,

which is initiated by Denial, followed by Anger, Bargaining, Depression, and Acceptance.

However, the researcher has found another phase, which can be included in the process as he

scrupulously deliberated every statement of the informants. The researcher has determined

Realization as a part of the grieving process, and it is manifested before the stage of Bargaining.


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The Grieving Process is a progression of stages that a person undergoes as he / she perceives a

loss. This loss may indicate various things such as the loss of a loved one, loss of a job, loss of an

important object and even a perceived loss of self. All persons who undertake the grieving

process have one thing in commonloss of a valued possession. As for the informants points of

view, they have had perceived losses of selves and their health during their near-death

experiences. Videbeck (2006) have said that Elisabeth Kubler-Ross has established a basis for

understanding how loss affects human life.

a. DenialDenial is a defense mechanism used by an individual to escape from unwanted

thoughts, feelings, emotions, or situations. Denial is met as the informants doubt their

perceived losses of selves. Furthermore, as one doubts the presence of a perceived loss, it

may result to not wanting to talk about it.

Jupiter: Hindi ko alam ang kamatayan kasi hindi ko pa nasubukan.

(Laughs) (I do not know what death is, because I have not experienced

dying yet. [laughs])

Neptune: Sa akin walang kamatayan. Ayan oh (points at his altar filled

with religious icons), Sila ang gumamot sa akin. (As for me, there is nodeath. Look, [points at his altar filled with religious icons], they were the

ones who treated me.)

Mars: Hindi ko pa nakausap ang mga kamag-anak ko kung sakaling

mamatay ako. Wala pa kasi sa isip ko ang mamatay. Hindi ko pa naiisip

ang preparasyon sa aking kamatayan kasi wala naman akong sakit.

Ayokong pag-usapan pa yan. (I have not talked to my relatives yet if everI would die. Dying is not yet in my thoughts. I have not thought of any

preparations regarding my death yet, because I have no illness. I dont

want to talk about it yet.)

b. AngerAnger can be a normal and healthy reaction when situations or circumstances are

unfair or unjust, personal rights are not respected, or realistic expectations are not met. If


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a person can express his or her anger assertively, problem solving or conflict resolution is

possible. Anger becomes negative when the person denies it, suppresses it, or expresses it

inappropriately (Videbeck, 2006).

Pluto: Im suffering from my sins. Pag sinumpong yan (points at his

chest, referring to his lungs), hindi ko talaga alam kung anong susunod na

mangyayari. Kaya kung minsan, nakakapagsabi ako sa Panginoon naParang hindi nyo ako anak. Bakit hanggang ngayon, wala parin akong

nararamdamang kahit na pagbabago? Nung una, I doubted God, pero

nabasa ko sa bible, na ang nagbigay sa akin ng sakit ay ang demonyo. Kasi

ang Diyos hindi nagbibigay ng sakit yan eh. Nagpapagaling. (I amsuffering from my sins. When this flares up, (points at his chest, referring

to his lungs) I usually am not knowledgeable of what will happen next.

That is why sometimes, I question the Lord, It is as if I am not your child.Why is it that until now, I am not feeling any change at all? At first, I

doubted God, but when I have read the bible, it said that the devil is

responsible for my giving me my disease.)

c. RealizationThe researcher has found another stage in the grieving process, which is

realization. Realization is met after anger, and the informants have undergone either one

of the two known compositions of this stage: first is the realization of the Causes of the

illness / near death experience. The second is the realization of the Effects of having the

illness / near death experience.

Following this, are statements, which talk about the realization of the causes of

the illness / near death experience according to the informants:

Pluto: Siguro, sa dami ng kasalanan ko, ito ako ngayon; nagsusuffer. Atang suffering na ito excuse me(Coughs) alam mo, ahhhmm

pahinga muna ako sandali. Hinihingal ako kapag napapagod (deep

breathes for 3 seconds, and resumed talking) dadalhin ako sakamatayan. (Maybe, because of the many sins that I have committed, thisis what I am now; suffering. And this suffering excuse me [coughs]

you know ahhhmm I will rest for a while. I easily gasp when I get

tired (deep breathes for 3 seconds, and resumed talking) will bring meto death.)


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Jupiter: Magaling akong manigarilyo noon. Pinagbawal na ng doktor na

manigarilyo ako, kasi yun daw ang ikakamatay ko, kaya hininto ko na kasigusto ko pang mabuhay. (I am good at smoking before. The doctor

prohibited me to smoke, because it will be the cause of my death, that is

why I have stopped it because I still want to live.)

Realization of the cause(s) of the illness or near death experience is a way of

determining factors, which led to the existing problem. Regret is a salient point in this

sub-genre of the realization stage. It is through regret, where one thinks of change to

counteract the illness that they once had or are having in the present.

Following this, are statements, which talk about the realization of the effects of

the illness / near death experience according to the informant:

Earth: When I had those near death experiences (heart attack and internalbleeding during an operation), naisip ko yung mga children ko. Kung

mawawala ako, paano na sila, kasi wala na silang guidance. Hindi

masyado sa lalaki ang ganun (referring to her husband) (When I had

those near death experiences [heart attack and internal bleeding duringan operation], I have thought of my children. If I will die, how will they

be, because I can no longer guide them? This is not usual among males

[referring to her husband].)

Realization of the effect(s) of the illness or near death experience is a way of

determining various possibilities which might have been caused by the existing problem.

Conceptualization is a salient point in this subgenre of the realization stage. It is through

conceptualization, where one makes an advanced planning of how one wants things to be

in the future.

d. BargainingAfter the realization stage, bargaining follows and it is the stage where a person

asks God or in some other cases those whom he / she think are superior (such as doctors

in the medical field) for more time to postpone the foreseeable loss.


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Mars: Kung kukunin na ako ng Diyos, di handa na ako. Pero kung maaari

sana hindi pa. Kayat ko pay ti ag-biag. (laughs while talking) (If Godwould get me, then I would be prepared. However, if possible, he would

not get me yet. I still want to live.)

Mercury: Mikakasi ak labat la ya amay makmaksil su laman ko agew,

labi. Mikakasi ak lanlanang ya sayay matak et makanengneng labat

anggano daiset kwanko. (I pray that I would still be having a strong

body, day and night. I always pray that my eyes could see even just alittle.)

Pluto: Ang ginagawa kong devotion ngayon, humihingi ako ng tawad sa

Panginoon, nagbabagong buhay (voice trembles, and eyes became teary)(pauses at intervals). Na sana patawarin ako. Bigyan pa Niya (refers to

God) sana ako ng konting panahon kasi mga apo ko, maliliit pa eh. Gusto

ko pa silang makitang lumaki (The devotion that I am doing today, is thatI ask God for forgiveness, I am trying to change my life for the better

[voice trembles, and eyes became teary][pauses at intervals]. I hope He

would forgive me. I hope He [Refers to God] would give me a little moretime because my grandchildren are still small. I still want to see them

grow.)

Saturn: Mandadasal ak ya lanang ya kumon unabig ak tapyan napabalegko ni iray apok (I always pray for me to recover so that I could still

guide my grandchildren as they grow.)

Neptune: Nung nagkasakit ako, hindi naman ako nagalit sa Kanya

(Refers to God). Sa halip, nagdasal ako, God, sana tulungan mo pa akong

mabuhay ng matagal kasi gusto ko pang makita ang apo ko kasi nasa

malayo pa siya noon eh. (When I got sick, I neverreally got mad at Him[Refers to God]. Instead, I prayed, God, I hope You would help me to

live longer because I still want to see my grandchild. My grandchild was

far away from me that time.)

Venus: Maganda naman ang pananalig ko sa Diyos. Nung hindi pa ako

matanda, lagi akong nagsisimba. Member ako sa church noon. Ngayon

naman, nagdadasal ako sa Apo na sana tulungan nya akong mabuhay papara makita ko pa ang mga anak kong nasa malayo at sana may pension pa

sila hanggang ngayon. (My faith with theLord is good. When I was not

that old yet, I always attend Chruch masses. I was a member of the churchback then. Now, I am praying to God that He would help me to live longerso that I may still be able to see my children from afar, and I hope that

they are still receiving their pensions today.)


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The informants of the study have stated that they are prepared to die, however,

when possible, they still want to live longer. In accordance to the informants responses,

bargaining is then associated to pleading God for a longer life in lieu of their various

requests.

e. DepressionWhen a person gives up his / her constant aggression for saving what was lost, then he

/she is in a state of depression. According to Kubler-Ross, depression results when

awareness of the loss becomes acute (Videbeck, 2006).

Emotional despondency may affect the persons physical being. Analysis of the

informants statements will prove this allegation in relation to this stage of the grieving

process:

Saturn: Nu unya ak lanlamang ay (referring to when he was stillimmobile and dependent due to stroke attack), gabay ko ni lanlamang su

umpatey kwanko. Nu talagan kapalaran ko, kapalaran kon talaga.

Maminsan agak makaugip. (I told myself: If this is how it is really

supposed to be [referring to when he was still immobile and dependentdue to stroke attack], I would rather choose to die. If it is really my fate,

then be it. Sometimes I find it hard to sleep.)

Pluto: So Im keeping myself busy to be close to God. Yun ang ginagawa

ko ngayon. Nights and days; kulang pa nga ako ng tulog eh. Tignan mo

tong mata ko, malalim na (points at eyes. Eyes were noted to be sunkenand have black circles around them). Insomniac na ako. Complicated na

ang lahat. Lumaki na yungpuso ko eh. Yun na ang last choice ko. (So I

am keeping myself busy to be close to God. That is what I am doing today.

Nights and days; As a matter of fact, I still am lacking some sleep. Look atmy eyes, they are already deep [Points at eyes. Eyes were noted to be

sunken, and have black circles around them]. I am an insomniac.

Everything now is complicated. My heart is already enlarged. That is mylast choice.)

Saturn and Pluto have had sleep deprivations because of depression. Time keeps a

person develop more thoughts about his problems as it is prolonged. In this stage of the


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grieving process, it is but normal for a person to have collected thoughts about his / her

illness, because of the protracted span of time that he / she underwent during the first four

stages of this process, thus depression is really an expected outcome.

Aside from disturbed sleeping patterns, sadness is another evident manifestation

of depression. The person usually cries to express his / her negative feelings about the

loss. Crying is a normal response to depression in order for the affected person to be

freed from the locked bars of contained emotions.

f . AcceptanceWhen a person no longer has the burden of contained emotions, acceptance of the

loss follows. This is the last stage of the grieving process, where the affected person may

say that he could combat the illness, or might as well just prepare for it instead.

Preparedness is met when choice is no longer an option. In this study, the researcher has

found out that acceptance goes with two factors:

First, acceptance according to Venus and Pluto is met because they no longer

have any choice since it is Gods willpower to give them such trials.

Venus: Oo, handa na akong mamatay. Wala na akong magagawa kung

iyon ang gusto ng Apo. (Yes, I am ready to die. I cannot do anything if

it is Gods will.)

Pluto: So whether you like it or not, you must have to accept what God

will give you. (So whether you like it or not, you must have to accept

what God will give you.)

And second, acceptance according to Saturn is met because of a mission met in his life.

Saturn felt it easy to accept death in him because his children are already grown-ups.

Saturn: Nu kapalaran ko, umpatey ak la; talagan untay bilay kwanko.

Tinanggap ko la. Ta ankabaleg la ray anako (If it is my fate, then Iwould die; that is life, I said. Besides, my children are already grown-

ups.)


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III. The Philosophies of an Elderlys Living SoulThis study aimed to determine the various attitudes of the elderly towards death preparation

in relation to their ethnicity. A soul is what makes a person. It is tantamount to the attitudes that

the informants of this study have developed over the process of their preparations toward death.

These attitudes define them as they live within the margins of their ethnicities.

Nan-Zhao and Teasdale (2004) have stated that the Philippines have developed into an

independent, democratic and modern nation, principles and values have emerged that are more

self-assertive but at the same time less exclusive of others.

The following subthemes were derived from scrupulous analysis of the informants

statements, and they make up the philosophies or attitudes of the elderly persons as they prepare

themselves for death in terms of the physical, psycho-social, and spiritual aspects:

a. PassivityThe informants of this study showed passivity over their death preparations as

they depend onto their significant others all the preparations and expenses when they die.

They have demonstrated the bahala na system with this matter. The bahala na system

which is a Filipino philosophy, also meant come what may. This may be an attitude of

leaving all things up to God, or to those significant to them.

Financial constraint is the main reason for having this philosophy among the

informants. If only they have enough money, then dependence over their significant

others may be disregarded.

Venus: Hindi ko pa sila nakakausap tungkol sa aking kamatayan. Sila na

lang bahala sa akin kung mamamatay na ako. (I have not talked to them[referring to the relatives] yet regarding my death. I will just have to leave

it all up to them when I die.)


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Mars: Mga kamag-anak ko na ang bahala. Nakapasok naman ako saSenior Citizen Association. Kasi pag namatay ako, may ibibigay ang

Senior Citizen. (It will all be up to my relatives. I am a member of the

Senior Citizen Association. If I die, the association will help out.)

Neptune: Kung lote lang na paglilibingan sa akin ang pinag-uusapan,

meron na doon sa byenan ko. Ang panggastos lang ang wala pa sa ngayon.

Kapag namatay ako, bahala na yung mga maiiwan. Pero si misis, meronsiyang mahuhugot sa buwan buwan niyang binabayaran sa insurance. (If

you were to ask me about the lot where I would want to be buried, then it

is not a problem. I already have one which was the lot used by my late

mother-in-law. When I die, it will all be up to the one who is left. Howevermy wife will have something to spend coming from the monthly insurances

that she is paying.

Mercury: Anggapo ni ginawak ya preparasyon ed ipatey ko. Saray agik

lay akauley ed siak. Sikaray pikakasian ko,syempre anggapoy pakayariandaray anako. Imbagak ed sika ra, bukot-bukoten ta kila nu umpatey ak.

Say kwanda, ay agyo ibabaga tan nanang ta anggapoy mangipunpon ed

sikayo nu inatey kami met la (Informant laughs while stating the last

sentence.) (I have not done any preparations yet regarding my death. Itwill all be up to my siblings when I die. I always plead them, because of

course, my children have nothing to spend too when I die. I told them that

I would haunt them when I die, and they told me that I should not because

no one would take charge of my burial if they die too. [Informant laughswhile stating the last sentence.])

Earth: Sabi naming mag-asawa dati, kung sino ang mauuna, yungmaiiwan ang bahala sa pagpapalibing and all. (Laughs) Besides, may lote

na kami sa public cemetery, dun sa mother ko. I will also get some

benefits from a life plan when I die because I have been availaing fromtheir promos. (My husband and I have decided that whoever from us

dies first, the one left will be responsible for the burial and all [laughs].

Besides, we already have a lot in the public cemetery, where my late

mother is buried too. I will also get some benefits from a life plan when Idie because I have been availing from their promos.)

Venus, Mars, and Neptune are Ilocanos, while Mercury and Earth are

Pangasinenses. This means that both elderly Ilocanos and Pangasinenses are passive /

dependent with their significant others in terms of death preparation.

b. Family-oriented


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Like any other typical Filipinos, the elderly informants have showed how much

they value their families with their statements. As much as possible, they still wanted to

live longer so that they could still be with their families, to see them grow more, and to

guide them in all the things that they do. Attachment is the salient point in this elderly

philosophy, which makes them ask for more days to spend with the members of their

families.

Jupiter: Ipinagdarasal ko na sana humaba pa ang buhay ko para makita kopa ang mga apo ko, pag mag-aasawa na sila, ganun. (I always pray for a

longer life, so that I could still see my grandchildren until they get

married.)

Neptune: Nung nagkasakit ako, hindi naman ako nagalit sa kanya. Sa

halip nagdasal ako, God, sana tulungan mo pa akong mabuhay ngmatagal kasi gusto ko pang makita ang apo ko kasi nasa malayo pa siya

noon eh. (When I got sick, I never really got mad at Him [Refers to

God]. Instead, I prayed, God, I hope You would help me to live longer

because I still want to see my grandchild. My grandchild was far awayfrom me that time.)

Pluto: Bigyan pa Niya (refers to God) sana ako ng konting panahon kasimga apo ko, maliliit pa eh. Gusto ko pa silang makitang lumaki. (I hopeHe [Refers to God] would give me a little more time because my

grandchildren are still small. I still want to see them grow.)

Saturn: Mandadasal ak ya lanang ya kumon unabig ak tapyan napabaleg

ko ni iray apok (I always pray for me to recover so that I could still

guide my grandchildren as they grow.)

Earth: When I had those near death experiences (heart attack and internal

bleeding during an operation), naisip ko yung mga children ko. Kung

mawawala ako, paano na sila, kasi wala na silang guidance. Hindimasyado sa lalaki ang ganun (referring to her husband) (When I had

those near death experiences [heart attack and internal bleeding during

an operation], I have thought of my children. If I will die, how will theybe, because I can no longer guide them? This is not usual among males[referring to herhusband].)


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Jupiter and Neptune are Ilocanos, while Pluto, Saturn, and Earth are

Pangasinenses. This means that both Ilocanos and Pangasinenses are Family-oriented

individuals.

c. Belief that God Extends L if eThe informants of the study are known to be very devotional. They believe in the

existence of a Creator, and they believe that the Creator that they call God has the power

to make them live longer through divine healing.

God according to the elderly informants is a healer, thus when they become closer to

Him through prayers, He would heal them physically and make them live longer; he is

believed to extend their lives.

Mars: Mabuti naman ang pagdarasal ko ngayon. Mas malapit ako sa

Diyos ngayon kasi gusto kong mabuhay pa. (My devotion is fine. Ibecame closer to God now because I still want to live.)

Mercury: Mas imasingger ak lalaingen ed Diyos natan ya tinmakken aktapian mikasi ka ak andukey ni bilay ko. (I was brought closer to God,especially now that I grew older, so that I could ask for a longer life.)

Pluto: So Im keeping myself busy to be close to God. Yun ang ginagawako ngayon. (So I am keeping myself busy to be close to God. That is what

I do today.)

Saturn: Mas naging malapit ak ed Diyos natan ya nansakit ak, ta sikato

labat su makatambal basta mikasi ka ed sikato. (I became closer to God

when I got ill, because He is the only one who could cure me for as long

as I keep my faith on Him.)

Mars is an Ilocano, while Mercury, Pluto and Saturn are Pangasinenses. This

implicates that both Ilocanos and Pangasinenses are devotional, and they believe that

when they become close to God, He would make them live longer.

d. Optimistic


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Optimism is a rational approach that construes unwanted circumstances and

happenings as being preeminent (boosted). The notion is normally prolonged to contain

the attitude of hope. Hope is the salient point for this philosophy, and it keeps them

fueled even if problems exist.

The following statements were taken from Neptune and Mars who are both

Ilocanos:

Neptune: Sa akin, maski anong oras talagang mamamatay ang isang tao.Pero sa akin, matagal pa. Para sa akin naman, sila (Points to his altar) ang

gumagabay sa akin. (For my opinion, a person may die anytime. But my

time here will still be longer. For me,They [points to his altar] are theones guiding me.)

Mars: Nung nagkasakit ako, alam ko gagaling din ako sa awa ng Apo.(When I got sick, I knew that I will be better, through Gods mercy.)

This implicates that Ilocanos are very optimistic in a way that they believe in

living longer because of Gods providence.

e. Peace-seekerTo forgive and to ask for forgiveness are two of the attitudes which make up a

being who seeks for peace before he / she dies. A person wants to die without carrying a

heavy load of burden in his / her heart. This is the primary reason for asking for

forgiveness, and at the same time forgiving those who have hurt him / her before.

Being sorry is the salient point in this philosophy of the elderly because it

characterizes them as persons of amity and concord. Being sorry does not only refer to

those he / she has had conflict with, but it also includes God. They believe that whenever

a person does something wrong to another person, then they are doing the same

wrongfulness to God.


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The researcher of the study has called his informants Peace-seekers. The

informants, Pluto and Earth are Pangasinenses, which implicates that Pangasinenses are

Peace-seeking individuals.

Pluto: Marami akong nakaalitan dati. Hindi pa ako nakikipagbati sa

kanila, kasi nasa malalayong lugar na sila ngayon. Mga karibal-karibal;

minsan suntukan, yung iba naman kapag natalo, talagang mananakit. Perosinasabi ko na sa Panginoon, You just have to forgive me. Pinagsisihan

ko na, Huwag padalos-dalos. Yun ang talaga ang gusto ng Panginoon.

Magpatawad ka dahil tao ka lang. Kung Siya (referring to God)

nagpapatawad, nagsakripisyo Siya ng buhay Niya para sa mga kapabayaanng tao. Why cant we? (I have a lot of conflicts with people before. I

have not made peace with them yet because they are far from me now.

Rivalries; sometimes we even knock each other out, and when someoneloses he would definitely hurt the other. But I told God, You just have to

forgive me. I am now repenting; I should not be a helter-skelter. That is

what God really wants. Forgive because you are just a person. He[Referring to God.] forgives and sacrifices His life for mans neglects.

Why cant we?)

Earth: Masama ang loob ko sa isang anak ko, because of financialconflicts before. She never talked to me since then. (Voice trembles and

eyes are teary). Humiram siya sa akin ng 5000 dati, pero hindi na niya

ibinalik. As for me, what was borrowed should be returned, becausemoney isnt easy, especially ngayon na kami lang ng asawa ko dito sa

bahay with our two grandchildren. Yung asawa ko pa, bedridden na. Ako

ang nagsusupport sa family. We havent talked yet, but if given the chance

to be at peace with her, I would grab that opportunity. Nasa malayo nakasi siya ngayon. Siyempre, matanda na ako. I want to die na walang

iniintinding sama ng loob. I want to face God clean. (I have resentment

with my other child because of financial conflicts before. She never talkedto me since then. [Voice trembles and eyes are teary]. She borrowed five

thousand pesos to me before, but she never returned it anymore. As for

me, what was borrowed should be returned, because money is not easy,

especially now that it is just me and my husband along with our twograndchildren here in the house. And my husband is even bedridden. I

support the family. We havent talked yet, but if given the chance to be at

peace with her, I would grab that opportunity.She is far from me now. Ofcourse, I am already old. I want to die without carrying any grudges. Iwant to face God clean.)

Even if the informants were not able to actually say sorry to those people whom

they have had conflict with, they have still provided a space in their hearts for them.


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Constraints of not being able to ask for forgiveness included the physical distance that

both parties had. However, they have stated that they were longing to be at peace with

those people they had conflict with in the past. Praying to God and asking Him for

forgiveness were also noted during the analysis, which justifies the previous statement on

being sorry not only to the mortals they have had conflict with, but also to the Creator.

IV. Significances of a Support SystemAnother aim of this study is to determine the effects of having a support system in the

lives of the elderly persons as they face their illness / near death experience. Support system may

be in the form of having a significant other with them, in the form of financial support, in the

form of moral support, and the like.

Fajemilehin and Odebiyi (2011) have concluded that living with spouse and type of

marriage (be it mono or polygynous) were relevant for positive health behaviours such as

utilization of health facilities, using their drugs as prescribed, eating and drinking on time in

clean and wholesome environment promote quality of life in old age.

The researcher of the study has found two significances of having a support system

(significant other). First, support system is known to be a cure, and the second is that it is known

to strengthen their family ties:

a. The CureUpon analysis of the informants statements, the presence of a support system was

said to have been one of the factors why they remain living as of the time of the interview

process. They were one of the reasons why they have survived the trial or why they still

are thriving.


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When the informants were ill, it was their significant others (support system) who

took charge with their needed care in order for them to survive. Without them, they

would be helpless and this might lead to deterioration of their health, thus hastening their

lives as well.

One of the informants even stated that financial support may be a good factor of

his living, however without the presence of a physical care, and then it would not be

possible for him to live.

Pluto: Itong asawa ko, siya lahat ang gumagawa dito sa bahay. At may

mga anak din ako na nasa abroad, tumutulong sila financially sa mgapangangailangan namin dito. Maganda ang epekto nila sa pagtanda ko.

Isipin mo kapag wala itong asawa ko. Paano na lang kami ng anak ko?

Baka matagal na kaming wala. Kahit pa may perang pang-sustento sa iyo,kung wala namang mag-aalaga, useless. My life was extended because of

her help. (My wife does all the chores in the house. I also have some

children abroad who help me financially with our needs here. They have a

good effect with my elderly life. Imagine life without my wife. How will Iand my son be? Maybe we have died for a long time already. Even if there

is money to support us, if there is no one to care, it is useless. My life was

extended because of her help.)

Saturn: Sikaray (Referring to his family members whom he is living

with) manaasikaso ed siyak nen mansasakit ak. Nu anggapo ira, umpano

agak la immabig, umpano sikato lay ipatey ko. Balbaleg su pakatulong daed impan-abig ko natan. (They [Referring to his family members whom he

is living with] are the ones taking care of me when I was ill. If they were

not around, maybe would not be healed, and will be the reason for mydeath. They are of big help to my healths improvement.)

Earth: The people around me play a big role kung bakit andito pa ako sa

mundo ngayon. Without their support and care, I might not be able to betalking to you right now. (The people around me play a big role, and they

are the reason why I am still in this world today. Without their support

and care, I might not be able to be talking to you right now.)

b. Strengthened Fami ly Ties


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Another significance of having a support is that it is known to strengthen family

relationships. This was a result of the scrutiny of statements from the elderly informants

as they face the trials of a near death experience.

The presence of a support system during the time of illness implicates a different

kind of bond among them. The bond becomes resilient as time passes by. As what was

stated previously, the significant others were responsible for the direct care of the

informants during the time of their illness (because of the continuation of care done at

home after discharge from the hospital). This created a better understanding of their

relationships, thus relationship ties were strengthened.

Earth: The people around me plays a big role kung bakit andito pa ako samundo ngayon. Without their support and care, I might not be able to be

talking to you right now. Lalo na yung isang apo ko. Talagang hindi niya

ako pinapabayaan. Minsan, tatabihan pa niya ako sa pagtulog sa gabi. Mas

naging malapit kami sa isat isa dahil narin sa pag-aalaga niya sa akin.(The people around me play a big role and they are the reason why I am

still in this world today. Without their support and care, I might not be

able to be talking to you right now. My other granddaughter never leaves

me behind. Sometimes, she sleeps with me at night. We became evencloser with each other because of how she cares for me.)

Neptune: Mas matibay ang relasyon naming mag-asawa ngayongtumanda na kami at kaming dalawa na lang sa bahay. Kung ano ang ayaw

ng asawa ko, hindi ko gagawin. Kung ano ang ayaw ko naman, hindi din

niya gagawin. Nirerespeto naming ang isat isa. Minsan kahit na ganito nakami katanda, naghoholding hands pa kami. Kami-kami narin ang nag-

aalaga sa isat isa ngayon. (My relationship with my wife strengthened

now that we are already old, and that it is just the two of us living together

now. I do not do what she do not like. She do not do what I do not like.We respect each other. Sometimes we even hold hands while we are

walking, even if we were this old. We take care of each other.)

Conclusions:

When thoughts of fear and uncertainty flourish during ones journey to an end, it

indicates a certain degree of unpreparedness. However, when a dying person who


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considers certain factors in helping himself/herself cope with the stress of dealing with

the previously-stated sentiments, then chances are, those gushes can be minimized or

even relinquished from his/her contemplations. Four factors were known to have helped

the informants in coping with the distress that they have gone through/been going

through. They include their own perceptions of death, the grieving process, their

cultivated philosophies and attitudes towards death preparation, and the presence of a

support system. These four factors made a huge impact on the preparedness of elderly as

they get near to the end of life. The researcher has categorized these four factors within

the lexis, imperative key.

The researcher of this study therefore concludes that the imperative key has made

an impact in the elderly persons lives as they face the changing temporalities of time.

The imperative key paved its approach to convey an influence change on the

informants view of death through a newly-formulated meaning of death according to

them, the sequence that they undergo during grief, the attitudes that make them up as an

elderly who have had near death experiences in relation to their ethnicity, and the effects

of having a support system with them as they face the challenges of the mutating time.

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Documents

Philippine Journal of Nursing Manuscript