SynthesisBMC geriatrics2026
Attitudes toward death and associated factors among older adults in China: a systematic review and meta-analysis.
Synthesis in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundPopulation aging has intensified global attention to issues surrounding death and dying. Attitudes toward death are associated with older adults' mental health, quality of life, and engagement in end-of-life care planning. However, in China, cultural taboos and limited death education may hinder the development of adaptive and accepting death attitudes. This study systematically reviewed the current status of attitudes toward death and associated factors among older adults in China.
methodsThis review followed PRISMA 2020 guidelines. Seven databases were searched from inception to July 2025, including PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), and Wanfang Data. We included cross-sectional studies that used either the Death Attitude Profile-Revised (DAP-R) or the Elderly Death Attitude Scale. The quality was evaluated using Agency for Healthcare Research and Quality (AHRQ) criteria. We used Stata 17.0 to perform a meta-analysis of scores across the scale dimensions, and conducted subgroup, meta-regression, and descriptive analyses to explore sources of heterogeneity and associated factors.
resultsA total of 2431 records were initially identified, from which 15 studies (4098 participants) were ultimately included. Quality assessment scores for these studies ranged from 5 to 7, indicating moderate overall quality. Meta-analysis suggested that neutral acceptance of death had the highest pooled mean score. However, between-study heterogeneity was extremely high across all dimensions (I
conclusionsNeutral acceptance may represent a relatively higher-scoring dimension of death attitudes among Chinese older adults. Health-related factors, death-related experiences, and cultural factors appear to be relevant factors associated with death attitudes. Based on these preliminary findings, exploratory interventions, including death education and psychosocial support, could be considered for older adults with poor health. These findings should be interpreted cautiously, given that all included studies were cross-sectional and based on self-reported data, which limits causal inference.
trial registrationPROSPERO(CRD420251090654).
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