As people approach the end of life, changes occur and special challenges arise. Growing older means confronting many psychological, emotional, and social issues that come with entering the last phase of life.

Increased Dependency

As people age, they become more dependent on others. Many elderly people need assistance in meeting daily needs as they age, and over time they may become dependent on caregivers such as family members, relatives, friends, health professionals, or employees of senior housing or nursing care. Many older adults spend their later years in assisted living facilities or nursing homes, which can have social and emotional impacts on their well-being. Older adults may struggle with feelings of guilt, shame, or depression because of their increased dependency, especially in societies where caring for the elderly is viewed as a burden. If an elderly person has to move away from friends, community, their home, or other familiar aspects of their life in order to enter a nursing home, they may experience isolation, depression, or loneliness.

Increased dependency can also put older adults at risk of elder abuse. This kind of abuse occurs when a caretaker intentionally deprives an older person of care or harms the person in their charge. The elderly may be subject to many different types of abuse, including physical, emotional, or psychological. Approximately one in ten older adults report being abused, and this number rises in the cases of dementia or physical limitations.

Despite the increasing physical challenges of old age, many new assistive devices made especially for the home have enabled more old people to care for themselves and accomplish activities of daily living (ADL). Some examples of devices are a medical alert and safety system, shower seat (preventing the person from getting tired in the shower and falling), bed cane (offering support to those with unsteadiness getting in and out of bed), and ADL cuff (used with eating utensils for people with paralysis or hand weakness). Advances in this kind of technology offer increasing options for the elderly to continue functioning independently later into their lives.

Loneliness and Connection

A central aspect of positive aging is believed to be social connectedness and social support. As we get older, socioemotional selectivity theory suggests that our social support and friendships dwindle in number, but remain as close as, if not closer than, in our earlier years (Carstensen, 1992). Many older adults contend with feelings of loneliness as their loves ones, partners, or friends pass away or as their children or other family members move away and live their own lives. Loneliness and isolation can have detrimental effects on health and psychological well-being. However, many adults counteract loneliness by having active social lives, living in retirement communities, or participating in positive hobbies. Staying active and involved in life counteracts loneliness and helps increase feelings of self-esteem and self-worth.

Social relationships in old age

Research has shown that social support is important as we age, especially as loss and death become more common.

Erikson: Integrity vs. Despair

As people enter the final stages of life, they have what Erik Erikson described as a crisis over integrity versus despair. In other words, they review the events of their lives and try to come to terms with the mark (or lack thereof) that they have made on the world. People who believe they have had a positive impact on the world through their contributions live the end of life with a sense of integrity. Those who feel they have not measured up to certain standards—either their own or others'—develop a sense of despair.

Confronting Death

People perceive death, whether their own or that of others, based on the values of their culture. People in the United States tend to have strong resistance to the idea of their own death and strong emotional reactions of loss to the death of loved ones. Viewing death as a loss, as opposed to a natural or tranquil transition, is often considered normal in the United States. Elisabeth Kübler-Ross (1969), who worked with the founders of hospice care, described in her theory of grief the process of an individual accepting their own death. She proposed five stages of grief in what became known as the Kübler-Ross model: denial, anger, bargaining, depression, and acceptance. 

• Denial: People believe there must be some mistake. They pretend death isn't happening, perhaps live life as if nothing is wrong, or even tell people things are fine. Underneath this facade, however, is a great deal of fear and other emotions.
• Anger: After people start to realize death is imminent, they become angry. They believe life is unfair and usually blame others (such as a higher power or doctors) for the state of being they are experiencing.
• Bargaining: Once anger subsides, fear sets in again. Now, however, people plead with life or a higher power to give them more time, to let them accomplish just one more goal, or for some other request.
• Depression: The realization that death is near sets in, and people become extremely sad. They may isolate themselves, contemplate suicide, or otherwise refuse to live life. Motivation is gone and the will to live disappears.
• Acceptance: People realize that all forms of life, including the self, come to an end, and they accept that life is ending. They make peace with others around them, and they make the most of the time they have remaining.

While most individuals experience these stages, not all people go through every stage. The stages are not necessarily linear, and may occur in different orders or reoccur throughout the grief process. Some psychologists believe that the more a dying person fights death, the more likely they are to remain stuck in the denial phase, making it difficult for the dying person to face death with dignity. However, other psychologists believe that not facing death until the very end is an adaptive coping mechanism for some people.

Whether due to illness or old age, not everyone facing death or the loss of a loved one experiences the negative emotions outlined in the Kübler-Ross model (Nolen-Hoeksema & Larson, 1999). For example, research suggests that people with religious or spiritual beliefs are better able to cope with death because of their belief in an afterlife and because of social support from religious or spiritual associations (Hood, Spilka, Hunsberger, & Corsuch, 1996; McIntosh, Silver, & Wortman, 1993; Paloutzian, 1996; Samarel, 1991; Wortman & Park, 2008).