7/28/2019 Philippine Journal of Nursing Manuscript
1/28
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
7/28/2019 Philippine Journal of Nursing Manuscript
2/28
Running Head: A VOYAGE TO THE TWILIGHT 2
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
7/28/2019 Philippine Journal of Nursing Manuscript
3/28
Running Head: A VOYAGE TO THE TWILIGHT 3
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-
7/28/2019 Philippine Journal of Nursing Manuscript
4/28
Running Head: A VOYAGE TO THE TWILIGHT 4
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
7/28/2019 Philippine Journal of Nursing Manuscript
5/28
Running Head: A VOYAGE TO THE TWILIGHT 5
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
7/28/2019 Philippine Journal of Nursing Manuscript
6/28
Running Head: A VOYAGE TO THE TWILIGHT 6
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
7/28/2019 Philippine Journal of Nursing Manuscript
7/28
Running Head: A VOYAGE TO THE TWILIGHT 7
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.
7/28/2019 Philippine Journal of Nursing Manuscript
8/28
Running Head: A VOYAGE TO THE TWILIGHT 8
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
7/28/2019 Philippine Journal of Nursing Manuscript
9/28
Running Head: A VOYAGE TO THE TWILIGHT 9
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
7/28/2019 Philippine Journal of Nursing Manuscript
10/28
Running Head: A VOYAGE TO THE TWILIGHT 10
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
7/28/2019 Philippine Journal of Nursing Manuscript
11/28
Running Head: A VOYAGE TO THE TWILIGHT 11
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.
7/28/2019 Philippine Journal of Nursing Manuscript
12/28
Running Head: A VOYAGE TO THE TWILIGHT 12
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
7/28/2019 Philippine Journal of Nursing Manuscript
13/28
Running Head: A VOYAGE TO THE TWILIGHT 13
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.)
7/28/2019 Philippine Journal of Nursing Manuscript
14/28
Running Head: A VOYAGE TO THE TWILIGHT 14
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.
7/28/2019 Philippine Journal of Nursing Manuscript
15/28
Running Head: A VOYAGE TO THE TWILIGHT 15
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.)
7/28/2019 Philippine Journal of Nursing Manuscript
16/28
Running Head: A VOYAGE TO THE TWILIGHT 16
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
7/28/2019 Philippine Journal of Nursing Manuscript
17/28
Running Head: A VOYAGE TO THE TWILIGHT 17
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.)
7/28/2019 Philippine Journal of Nursing Manuscript
18/28
Running Head: A VOYAGE TO THE TWILIGHT 18
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.)
7/28/2019 Philippine Journal of Nursing Manuscript
19/28
Running Head: A VOYAGE TO THE TWILIGHT 19
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
7/28/2019 Philippine Journal of Nursing Manuscript
20/28
Running Head: A VOYAGE TO THE TWILIGHT 20
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].)
7/28/2019 Philippine Journal of Nursing Manuscript
21/28
Running Head: A VOYAGE TO THE TWILIGHT 21
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
7/28/2019 Philippine Journal of Nursing Manuscript
22/28
Running Head: A VOYAGE TO THE TWILIGHT 22
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.
7/28/2019 Philippine Journal of Nursing Manuscript
23/28
Running Head: A VOYAGE TO THE TWILIGHT 23
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.
7/28/2019 Philippine Journal of Nursing Manuscript
24/28
Running Head: A VOYAGE TO THE TWILIGHT 24
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.
7/28/2019 Philippine Journal of Nursing Manuscript
25/28
Running Head: A VOYAGE TO THE TWILIGHT 25
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
7/28/2019 Philippine Journal of Nursing Manuscript
26/28
Running Head: A VOYAGE TO THE TWILIGHT 26
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
7/28/2019 Philippine Journal of Nursing Manuscript
27/28
Running Head: A VOYAGE TO THE TWILIGHT 27
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.
References
Anando. (2005). Science and Consciousness. Retrieved August 14, 2012, from Life Trainings:
http://www.lifetrainings.com/Does-consciousness-continue-after-death.html
Edinberg. (1990).Death in the Family .vol.27. Canada.
Fajemilehin, B., & Odebiyi, A. (2011, July).International Journal of Sociology and
Anthropology, 3 (7), 245-252. Retrieved September 13, 2012
7/28/2019 Philippine Journal of Nursing Manuscript
28/28
Running Head: A VOYAGE TO THE TWILIGHT 28
Finlayson, A. (2011, March 10).Fear of the Inevitability of Death. Retrieved August 12, 2012,
from ezinearticles.com: http://ezinearticles.com/?Fear-of-the-Inevitability-of-
Death&id=6062136
Len. (2007, July 17). Retrieved December 03, 2011, from Hayagriva Buddhist Center:http://www.hayagriva.org.au/WheelofLifeHospiceService/Preparingforyourowndeath/tab
id/142/ctl/Details/mid/615/ItemID/44/Default.aspx
Nan-Zhao, Z., & Teasdale, B. (2004). Teaching Asia-Pacific Core Values of Peace and
Harmony: A Sourcebook for Teachers. Bangkok, Thailand: UNESCO Asia and Pacific
Regional Bureau for Education.
Nesbitt, W. (2009, July 15). Understading Death - The Inevitable. Retrieved August 08, 2012,
from Ezine Articles:
file:///C:/Users/carlolea/Desktop/Desktop%20Files/THESIS/RRL/Understanding%20Dea
th%20-%20The%20Inevitable.htm
Patton, M. (1990). Qualitative Evaluation and Research Methods (p.169). Beverly Hills, CA:
Sage
Rantzen, E., & Feinman, J. (2006, March).BBC. Retrieved December 03, 2011, from Planning a
Good Death: http://www.bbc.co.uk/health/support/includes/planning_a_good_death.pdf
Slaughter, M. (2009).Death, Inevitable Death. Retrieved August 09, 2012 from
poemhunter.com: http://www.poemhunter.com/poem/death-inevitable-death/.
Videbeck, S. L. (2006).Psychiatric Mental Health Nursing(3rd edition ed.). Philippines:
Lippincott Williams & Wilkins.
Top Related