To Örebro University

Background: The COVID-19 pandemic has underscored older adults' vulnerability to severe illness or death. Increased public awareness of mortality, with daily reminders of preventive measures, spurred interest in understanding the impact on death-related thoughts. This systematic review analyses existing literature on death attitudes among individuals aged 50 and older during the COVID-19 pandemic and focuses on associated factors.

Methods: A systematic literature search was conducted using the WHO COVID database without any language limit, up until April 2023. The review protocol was registered in PROSPERO and PRISMA guidelines were followed. Included studies were systematically analysed and summarized using a predefined data extraction sheet.

Results: Of the 2297 studies identified, 9 met inclusion criteria. The review showed moderate to high levels of death anxiety during the pandemic, linked to direct health risks from COVID-19 rather than mitigation measures. The impact of health and personal factors on older people's death anxiety was complex, with a range of health and personal factors such as chronic conditions, loss of capacity, loneliness, occupation, and resilience associated with it, suggesting potential intervention avenues.

Conclusion: The systematic review shows a significant link between COVID-19 and heightened death anxiety among individuals aged 50 and above. Negative attitudes to death can harm physical and mental health, diminish life satisfaction, increase avoidance behaviour, impair coping mechanism and undermine end-of-life decision making. Findings underscore the need for further research into risk and protective factors (personal, health, and environmental) and the importance of standardized data collection to guide interventions and public health strategies aimed at mitigating death anxiety.