Incidence and Causes of the
Near-Death Experience and Life Review Among the Elderly and Non-Elderly, by
Benjamin M. Linzmeier
Incidence and Causes of the Near-Death Experience and Life Review Among the
Elderly and Non-Elderly
Benjamin M. Linzmeier
University of Wisconsin-Eau Claire
One-hundred and seven elderly and non-elderly participants were recruited from the university setting and the senior setting. Questionnaires were filled out which examined the near-death experience (NDE) and life review. A Fisher exact test indicated no significant differences in the incidence of the NDE between the elderly and non-elderly. A small sample size did not allow for a statistical analysis of the incidence of the life review and the rate of onset of the NDE among the elderly and non-elderly. However, tentative speculation was made about the eight reported NDEs. In future research, either a recruiting method should be employed or a larger sample should be drawn.
Proposal for Incidence and Causes of the Near-Death Experience and Life Review among the Elderly and Non-Elderly
The near-death experience (NDE) has been around for centuries. Famous figures such as St. Paul and Gregory the Great have captured the public�s attention with accounts of what it is like on the other side (Zaleski, 1987). Much of the recent interest in the NDE began following Raymond Moody�s (1975) book, Life After Life, which described the phenomenon that people frequently experience when coming close to dying based on about fifty people who were interviewed in great detail. Through these case studies, Moody found anecdotal evidence that humans survive bodily death (Moody, 1975).
Soon, other researchers wanted to validate Moody�s work with more scientific approaches. One such researcher was Kenneth Ring. Describing many of the same stages that Moody did, he described the �core experience� of the NDE in five stages including peace and a sense of well-being, body separation, entering the darkness, seeing the light, and entering the light (Ring, 1980). However, not all NDEs follow that exact pattern. Some NDEs skip stages and certain aspects can be quite distinct from the typical NDE (Serdahely, 1989; 1995). Additionally, the core experiences do not occur with equal frequency. In one study, sixty percent experienced the �peace� stage while only ten percent �entered the light� (Ring, 1980). Other characteristics of the NDE include a sense of timelessness, a sense of death, and ineffability when trying to describe it (Sabom, 1982).
The NDE is defined as: �An altered state of consciousness occurring during an episode of unconsciousness resulting from severe trauma or other life-threatening condition, in which a series of well-defined characteristics are present. It is identified by self-report on a questionnaire using standard questions and by content analysis of anecdotal data using the Near-Death Experience Scale (NDES) (Greyson, 1983b) with a score of seven as an indication of a near-death experience� (Olson & Dulaney, 1993).
The life review is defined as: �a naturally occurring reminiscence; may be formalized into an intervention designed to assist the elderly to achieve ego integrity or may occur in other contexts, such as a near-death experience� (Olson & Dulaney, 1993). One question from the NDES, �Did scenes from your past come back to you?� was used to determine if a life review was present. If the participant indicated that they had remembered many past events or their past had flashed before them, out of their control, they were considered to have had a life review.
Ring (1980) found the life review to be a relatively common phenomenon that occurred in about twenty-five percent of his sample. Other studies have found this percentage to be as low as three percent (Sabom, 1982) and as high as over fifty percent (Atwater, 1994).
Life review in a non-NDE context has been found to be therapeutic. For example, people who reminisce have a better self-concept of themselves and their past (Lewis, 1971). Those who reminisce have also been shown to have higher morale than those who don�t (Coleman, 1986).
Erik Erikson�s final stage in human development is ego integrity vs. despair. In it, the integration of self becomes a goal for those in their final stage of life (Erikson, 1950).
The life review occurs more in the aged during life because of an older person�s actual nearness to death, because an older person is retired and has more time for self-reflection, and �the customary defensive operation provided by work has been removed� (Butler, 1963).
Two common theories of the NDE are a psychological explanation and a physiological explanation. Proponents of the psychological explanation believe that the threat of imminent death is so great that the NDEer is forced to depersonalize and create a story as a defense mechanism to help them cope with the trauma of nearly dying (Noyes & Kletti, 1977). Adherents of the physiological explanation maintain that the phenomena reported by NDEers is a result of a dying brain.
There are some aspects of the NDE that cannot be readily explained by these theories, however. Some people who were apparently �unconscious� at the time of their death report extremely detailed descriptions of doctors in the operating room, what surgery was being done to them, how the surgery was being done and what the doctors were saying (Sabom, 1982). It is common for a NDEer to find himself or herself hovering above their body, a calm bystander who often has little desire to reenter the physical body. Some people even have NDEs while being subjected to an autopsy and remember what was being done to them (Atwater, 1994).
Sometimes, this phenomenon is dispelled with claims that it is merely a hallucination, induced by drugs being administered at the time of death. There is good reason to doubt this. The NDE occurs even in the total absence of drugs. Additionally, many drugs result in a variety of experiences that are rarely similar to NDEs (Audain, 1999), although a few drugs, such as ketamine and DMT, have produced NDE-like phenomena. Indeed, NDEers who have also experienced hallucinations consider their NDE to be �more real� than ordinary reality which, in turn is �more real� than hallucinations they have experienced (Greyson, 2000).
The veridicality of some observations made by people during a NDE also creates greater doubt of the physiological and psychological explanations. Kenneth Ring and Sharon Cooper examined near-death experiences in blind people. Fifteen out of the twenty-three blind NDEers were able to see during their NDE. The verdicality of some of these visions were corroborated by others (Ring and Cooper, 1997).
Regardless of one�s personal philosophy regarding the explanation for NDEs, a closer examination of them is warranted. The NDE changes the lives and attitudes of these people drastically (Ring, 1980). Whatever the explanation is for the NDE, a better understanding of them is of importance to the scientific community.
In this study, I will attempt to determine whether a difference exists in the NDEs of the elderly and the non-elderly. Olson and Dulaney (1993) found that none of their elderly NDEers encountered a life review. This finding was surprising, as other research has shown that there appeared to be no distinct differences in the incidence of the NDE according to such categories as age, area of residence, size of home community, religious background, or frequency of church attendance (Sabom, 1982). Why should the incidence of the life review be any different?
Noyes and Kletti found that twenty-nine percent of their subjects had experienced a life review during life-threatening incidents. Those percentages become higher still when the near-death experience involved a near drowning (forty-three percent) or an auto accident (thirty-three percent) (Ring, 1980).
Ring speculated that a possible determinant of the incidence of a life review is the suddenness or unexpectedness of the near-death crisis. For instance, he found that the life review was reported by fifty-five percent of accident victims, while occurring in only sixteen percent of those in his other two categories, illness and suicide (Ring, 1980). Others have found the life review to be more common when the rate of onset is sudden rather than gradual (Stevenson & Cook, 1995). Could it be that the elderly, having already had time later in their life to reminisce, no longer need to review their life after they die? Could it also be that people who nearly die of illness have more time to review their life before they undergo a NDE? The elderly may undergo a NDE following an illness more frequently than the non-elderly who may experience more accidents or suicide attempts.
In order to determine possible causes of the absence or infrequency of the incidence of a life review in the elderly compared to the non-elderly, the rate of onset (sudden or gradual) of the NDE was examined. This may give some insight about whether the incidence of the life review within an NDE is a function of age or whether suddenness is also a determining factor. In order to remain consistent with Olson and Dulaney, the elderly are operationally defined as fifty-five or older. The non-elderly are thus younger than fifty-five.
In this study, the following questions will be addressed: Is the incidence of the NDE greater for the non-elderly than the elderly? Is the incidence of the life review greater for the non-elderly than the elderly? Does the rate of onset of a NDE correlate with the incidence of a life review?
Granted, even if a correlation would be found between the rate of onset of the NDE and the incidence of a life review, a causal relationship cannot be inferred. However, through future examination and different studies, this relationship can be more thoroughly understood.
Three hypotheses were developed. First, the incidence of the near-death experience would not be significantly greater for the non-elderly than for the elderly. Secondly, the incidence of the life review would be greater for the non-elderly than for the elderly. Finally, the rate of onset of the NDE would be correlated with the incidence of a life review.
The target population included one group of people aged fifty-five and older and another group of people below the age of fifty-five. A total of twenty-three elderly people were recruited from local nursing homes and a senior center in Eau Claire, Wisconsin. These participants ranged in age from sixty-two to one hundred. Their mean age was 77.1 with a standard deviation of 8.67. A total of eighty-four students were recruited from six classes at the University of Wisconsin-Eau Claire. These participants ranged in age from nineteen to fifty-one. Their mean age was 22.7 with a standard deviation of 5.6. Five of the classes consisted of traditional students. One class had a high percentage of non-traditional, older students. Participants from all settings were of the intended age for that group. In other words, all participants at nursing homes and the senior center were age fifty-five and older and all participants at the university were under fifty-five.
A five-page survey was distributed in addition to a cover letter. The first part contained an initial page that all participants filled out in order to get demographic information and to determine which participants might have had a near-death experience. Writing utensils were administered when needed. By answering yes to two questions, participants were asked to proceed in filling out form one. On form one, Greyson�s NDES (Near Death Experience Scale) (1983b) was used to asses the incidence of an near-death experience. The NDES has high internal consistency, split-half reliability and test-retest reliability Greyson (1983b). A score of seven or over indicated a near-death experience. A score of lower than seven did not necessarily mean that certain aspects typical of the near-death experience did not occur. It meant that there was not enough evidence to label the experience as a near-death experience. If participants did not indicate that they might have had a near-death experience, they filled out form two which consisted of questions about their knowledge and beliefs about near-death experiences, but was not be used in this particular study. One reason for this form was so participants who indicated that they might have had a NDE would not feel isolated when filling out form one.
Most participants filled out the questionnaires in a group setting. Six participants filled out the questionnaires at their leisure after picking them up from a stack of questionnaires that was left for a week and a half period. At the university, the questionnaires were filled out at the beginning of class. First, a general explanation of the study was provided for them. They were informed that they did not have to participate and could stop at any time. Then, they were given the questionnaires and instructed to read and tear off the cover letter before proceeding. If they indicated on the first page of the questionnaire that they had a �close call with death� and had an unusual experience during this �close call� (Olson & Dulaney, 1993), they were directed to fill out form one. If they did not indicate both of these, they were directed to fill out form two. Participants were instructed to wait until everyone else had finished, although this did not always happen and was irrelevant in one of the senior settings in which everyone was waiting for a meal.
Although a standardized procedure was intended in order to prevent extraneous variables from affecting the results, this was not always possible. In the L. E. Phillips Senior Center, questionnaires were distributed to seniors who were waiting for a meal. The setting was informal and the seniors were approached one table at a time. Time constraints restricted a standardized introduction to the study. At one nursing home, the questionnaires were dropped off and seniors were able to fill them out at their leisure if they desired. Six questionnaires were obtained this way.
The seniors sometimes required assistance in filling out their packets. If they did not understand a certain question and asked for help or if they were taking an inordinate amount of time, assistance was provided. This was done by re-reading particular questions or telling them which packet they were supposed to fill out as indicated by their previous answers. Almost all university students had no problems in filling out the survey.
When participants were finished, their questionnaires were retrieved. In the case of the University of Wisconsin-Eau Claire classes, teachers were allowed to present their students with extra credit for completing they questionnaires if they so desired.
An analysis of 107 participants from the university and senior settings was performed in order to better understand certain features of the NDE, specifically the incidence of the NDE, the incidence of a life review and the rate of onset. Of the 107 respondents who had adequately filled out the questionnaire, 90 (84.1%) were female, 16 (15%) were male and 1 (0.9%) neglected to select a gender. Of the 84 non-elderly participants, 72 (85.7%) were female and 12 (14.3%) were male. Of the 23 elderly participants, 18 (78.3%) were female and 4 (17.4%) were male. The elderly population (M=77.1, SD=8.7) was much older than the non-elderly population (M=22.7, SD=5.6). It was hypothesized that the incidence of the near-death experience would not be more common in the elderly, life review would be more common in the non-elderly and incidence of life review and rate of onset of NDE would be correlated.
Of all respondents, (10.3%) indicated that they had had a close call with death and that they had an unusual experience at that time. Of these 11, 8 (7.5%) had a NDE as indicated by a score of 7 or more on the NDES (M=11.1, SD=3.1). In the elderly sample, 4 of 23 respondents (17.4%) had had a NDE. Two of the elderly did not respond as to when they had had their NDE. Of the two that did respond, one had their NDE 62 years ago at the age of 19. The other�s NDE occurred 39 years ago at the age of 34. In the non-elderly sample, 4 of 84 respondents (4.7%) had had a NDE. For the non-elderly, the average of 2 years had elapsed since their NDE. A Fisher exact test supported the null hypothesis that incidence of the near-death experience was not more common in the elderly than the non-elderly (p > .05, p = .063). Of the 8 NDEers, 5 (62.5%) experienced a life review. Of the 4 non-elderly NDEers, 3 (75%) had a life review. Of the 4 elderly NDEers, 2 (50%) had a life review. All 8 NDEers had a sudden rate of onset (100%). This data is presented in figure 1. The small number of NDEers prevented any specific statistical analysis to be done among that particular group. Tentative speculation about this population will be mentioned later.
An overall NDE incidence of 7.5% is consistent with previous findings. A 17% incidence of the NDE in the elderly and a 4.7% incidence in the non-elderly might seem like a great discrepancy, but due to the few NDEers, a more powerful statistic was used which did not result in a statistically significant difference. Maybe a larger study from which a greater number on NDEers could be obtained which would provide better insight as to whether or not differences exist between the two groups.
Due to few NDEs with which to analyze and because none of the seniors had had a NDE after the age of 55, it is difficult to speculate on differences between the NDE in the elderly and the non-elderly. However, insights can still be extracted from the data. Perhaps there are longitudinal effects among the different generations. One major factor that may play a role in the differences is that the NDE has only become more recognizable, if not more accepted in the general public in the past two decades.
An Australian sample of 173 respondents showed positive attitudes toward the NDE (Kellehear & Heaven, 1989). Perhaps younger people are more comfortable with their near-death experiences because they already heard about them before they experienced one themselves, or maybe they received support from people who understood what they had gone through. Perhaps the elderly people who had their NDE several decades ago were treated coldly by medics and loved ones when they told of their experience, causing them to either repress them or withhold from telling about them.
The data from the present study does not seem to indicate that the elderly have repressed memories of NDEs. The percentage of NDEs among the elderly (17.4) was actually much greater than the percentage of NDEs among the non-elderly (4.7).
One explanation for this finding is that the elderly people who had NDEs when they were much younger were not affected by any negative feedback if they in fact received any. A second explanation is that they have kept their experiences to themselves but were willing to relate them in an anonymous, relatively non-obtrusive format that the questionnaire provided. Yet another explanation is that these elderly people suppressed their memories of their NDEs, only to have them resurface after hearing about the phenomena following a resurgence in their popularity in recent times. A follow-up questioning of these people might inform this issue. Another obvious reason for the much greater incidence in NDEs among the elderly in this study is the greater number of years living that the elderly have had with which to experience a NDE.
Although the sample size was too small to be able to draw any conclusions from, a greater percentage of non-elderly people experienced a life review (75%) than non-elderly people (50%). This is in agreement with the hypothesis. Yet, it may be of even greater interest that two of the elderly NDEers did experience a life review. This runs contrary to the findings of Olson & Dulaney (1993) who found that none of the elderly NDEers had experienced a life review. They also indicated that through personal communication with them in 1986, NDE researcher Bruce Greyson also did not find the life review to be present among any of his elderly NDEers (Olson & Dulaney, 1993).
Although the two elderly participants indicated a life review by reporting that scenes from the past came back to them, they were not interviewed, which previous researchers of the life review have been able to do. An interview would help to confirm or disconfirm whether they had a life review.
A limitation of this study is that a non-random sample was used. Participants all lived or went to school in Eau Claire, Wisconsin. In addition, specific groups were selected in a non-random manner. However, generalization was increased by the selection of several different groups. Classes in different departments were selected and seniors were approached at three different senior settings. While the extremely high female percentage (84.1%) was somewhat representative of the populations being approached, it is quite unrepresentative of the general population. Reasons for such a high rate of female participation include the high percentage of females attending UW-Eau Claire, especially in library science classes, and the greater longevity of females in the senior setting.
Extraneous variables may have had an effect on this study. While the non-elderly all completed the questionnaire in a similar, classroom setting, the same cannot be said for the elderly. Where the questionnaires were completed was limited to the most convenient or practical place available. One group was approached table by table while they were waiting for a meal. Another group filled out questionnaires on an individual basis at their leisure by picking them up from a stack of questionnaires that was left at a nursing home for a week and a half.
Regrettably, an in depth analysis of the life review and the rate of onset of the NDE is impossible due to the small number of NDEers. This problem was complicated further in that all NDEers who responded reported a sudden onset. This finding is understandable considering that they all were non-elderly at the time of their NDE. This does not allow for any speculation as to possible correlation between the rate of onset and the incidence of a life review.
Future research is needed to determine what relationship exists between the rate of onset of NDEs and the incidence of life reviews. Perhaps in an interview setting, participants might be asked why they think they did or did not encounter a life review. Elderly NDEers could be asked whether or not they had gone through a reminiscence similar to that described by Lewis (1971) and Coleman (1986). If they had, it might be hypothesized that they would encounter life reviews less frequently than elderly who had not reminisced before their NDE.
A primary limitation of this study was the small sample size of NDEers. A detailed analysis of NDEers as well as adequate measures of incidence the NDE and life review are difficult to obtain simultaneously. In future research, one of two methods could be employed. Either NDEers could be recruited through various methods or much larger samples could be used. Recruiting NDEers would be easier to do, but the generalization of these samples would be less. Using larger samples would increase generalization, but such large samples may be impractical because of economic or time restraints.
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Figure 1. Number of participants reporting a life review and a sudden rate of onset of the NDE by age.