Running Head: A VOYAGE TO THE TWILIGHT

A Voyage to the Twilight: Exploring Death Preparation among the Elderly Carlo Paul C. Sana Saint Louis University / Virgen Milagrosa University Foundation

Running Head: A VOYAGE TO THE TWILIGHT 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 Elderly 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

Running Head: A VOYAGE TO THE TWILIGHT 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 nonmaleficence 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.

Findings 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. Inevitable event The 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, wala naman 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), antoy nagawaan 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 ka pumuntang 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 die before entering heaven.) Earth: Ooohh.. (Amazed by the question, What is death for you?) That is 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 is to 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 Dying

This 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 common loss 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. Denial Denial 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 no death. 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 ever I 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. Anger Anger 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 na Parang 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 am suffering 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. Realization The 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. At ang 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 sa kamatayan. (Maybe, because of the many sins that I have committed, this is 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 me to death.)

Running Head: A VOYAGE TO THE TWILIGHT Jupiter: Magaling akong manigarilyo noon. Pinagbawal na ng doktor na manigarilyo ako, kasi yun daw ang ikakamatay ko, kaya hininto ko na kasi gusto 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.)

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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 internal bleeding 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 during an 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. Bargaining After 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.

Running Head: A VOYAGE TO THE TWILIGHT 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 God would 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 a little.) 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 that I 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 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.) 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 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 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 pa para makita ko pa ang mga anak kong nasa malayo at sana may pension pa sila hanggang ngayon. (My faith with the Lord is good. When I was not that old yet, I always attend Chruch masses. I was a member of the church back then. Now, I am praying to God that He would help me to live longer so 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. Depression When 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 still immobile 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 dependent due 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 sunken and have black circles around them). Insomniac na ako. Complicated na ang lahat. Lumaki na yung puso 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 at my 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 my last 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. Acceptance When 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 I would die; that is life, I said. Besides, my children are already grownups.)

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III.

The Philosophies of an Elderlys Living Soul

This 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. Passivity The 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.)

Running Head: A VOYAGE TO THE TWILIGHT Mars: Mga kamag-anak ko na ang bahala. Nakapasok naman ako sa Senior 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, meron siyang 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. However my 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 pakayarian daray 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. It will 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 laughs while stating the last sentence.]) Earth: Sabi naming mag-asawa dati, kung sino ang mauuna, yung maiiwan 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 from their 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 I die because I have been availing from their promos.)

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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 ko pa 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 ng matagal 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 away from me that time.) Pluto: Bigyan pa Niya (refers to God) sana ako ng konting panahon kasi mga apo ko, maliliit pa eh. Gusto ko pa silang makitang lumaki. (I hope He [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. Hindi masyado 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 they be, because I can no longer guide them? This is not usual among males [referring to her husband].)

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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 Life The 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. I became closer to God now because I still want to live.) Mercury: Mas imasingger ak lalaingen ed Diyos natan ya tinmakken ak tapian 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 ginagawa ko 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 the ones 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-seeker To 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. Pero sinasabi 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 kapabayaan ng 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 someone loses 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 financial conflicts 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, because money 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 na kasi 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 talked to 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 two grandchildren 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. Of course, I am already old. I want to die without carrying any grudges. I want 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 System Another 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 Cure Upon 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 mga pangangailangan 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 I and 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 da ed 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 my death. 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 be talking 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 Family 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 sa mundo 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 even closer with each other because of how she cares for me.) Neptune: Mas matibay ang relasyon naming mag-asawa ngayong tumanda 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 na kami katanda, naghoholding hands pa kami. Kami-kami narin ang nagaalaga 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

Running Head: A VOYAGE TO THE TWILIGHT 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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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

Running Head: A VOYAGE TO THE TWILIGHT 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-ofDeath&id=6062136

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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.