Intergenerational conversations on death and dying during the COVID-19 pandemic: A pedagogical approach

ABSTRACT

This exploratory study examined how twenty-two undergraduate students and fifty-six older adults experienced discussing dying, death, and the COVID-19 pandemic with one another, using the book Tuesdays with Morrie as a conversational guide. The timing of these conversations is significant as discussions took place in March 2021, one year into the COVID-19 pandemic. Thematic analysis of students’ and older adult’s reflections on the discussion was employed and three themes were identified: the inevitability of death, gaining and giving perspective, and the importance of relationships. The pandemic was especially influential within two of the three themes. The findings highlight the benefits of bringing previously unknown people together to engage in conversations about dying and death during the pandemic using contemporary literature. This study also presents a pedagogical technique for educators to use to help students engage in discussions about death and dying.

KEYWORDS:

• Intergenerational communication
• death education
• COVID-19
• generativity
• college students

”We have much to learn from each other.”

Discussions about dying and death can be difficult for people of all ages. This may be true during times like the COVID-19 pandemic when deaths are sudden and unexpected (Pyszczynski, Lockett, Greenberg, & Solomon, 2021) as people are faced with their own mortality (Spitzenstätter & Schnell, 2022). The uncertainty of COVID-19 coupled with isolation measures put in place to protect those most vulnerable (older adults and the immunocompromised) necessitated physical isolation among the young and old alike. The pandemic propelled people of all ages to engage in conversations about life and living and dying and death, resulting in more intentional reflections about one’s mortality during a time of great insecurity (Lapid & Peisah, 2021; Pyszczynski, Lockett, Greenberg, & Solomon, 2021).

For gerontology educators, the pandemic offered an opportunity for students to engage in specific conversations about dying and death with older adults who were at higher risk of dying from COVID-19. Discussing death and dying is of pedagogical value to students, especially those who plan to work with older adults and their families in health care or related fields (Miller, Jezewski, Harlow, & Potter, 2021). The ability to openly talk about dying and death is especially relevant during times like the COVID-19 pandemic when mortality rates are high at a global level (McAfee et al., 2022). Knowing how to better prepare students to engage in conversations about dying and death is valuable for instructors and mentors who guide students through their educational journey (Hallberg, 2003; Juvet, Bornet, Debiens, Tapp, & Roos, 2021). The use of contemporary literature in the classroom to model conversations on dying and death is one practical way to better equip students. Therefore, the purpose of this study was to understand the pedagogical benefits of having college students and older adults discuss death and dying, particularly during a global pandemic, using the book Tuesdays with Morrie as a conversational guide.

Earlier studies on conversations between people from different generations highlight the benefits of these conversations for older adults and those with limited experience interacting with them (June & Andreoletti, 2018). There is also support for finding ways to encourage older adults to think more deeply about death (Hallberg, 2003) as they face the prospect of their own end-of-life in general (Stončikaitė, 2021) and the risk of increased mortality during a global pandemic (McKinlay, Fancourt, & Burton, 2021).

The possibility of dying during the COVID-19 pandemic was a distinct reality for older adults on a global scale. Older adults’ concerns about dying in isolation (Nelson-Becker & Victor, 2020), along with end-of-life care issues (McKinlay, Fancourt, & Burton, 2021) highlights the need for open discussions about their fears and hopes for the future. Similarly, the stress of the pandemic on college students (Farris, Kibbey, Fedorenko, & DiBello, 2021) also underscores young adults’ need to connect and engage in meaningful conversations with older adults who may model resilience during the pandemic because of their longer life experiences (Finlay et al., 2021; McAfee et al., 2022; McKinlay, Fancourt, & Burton, 2021).

Intergenerational interactions are dependent on older adults’ willingness to share their experiences (Lee, Jarrott, & Juckett, 2020; Underwood & Dorfman, 2006; Zucchero, 2010). Sharing their experiences and perspectives with others allows older adults to give back to the community and gives them a sense of generativity (Andreoletti & Howard, 2018; Ehlman, Ligon, & Moriello, 2014). It is worth noting there is limited research focused on the views of older adults (June & Andreoletti, 2018; Lee, Jarrott & Juckett, 12020; Obhi & Woodhead, 2016). We hope to further contribute to the literature by examining how students and older adults experienced intergenerational conversations about death and dying during a global pandemic.

The spring semester of 2021 seemed an ideal time for students enrolled in the first author’s Death and Dying class to engage in conversations about dying and death with previously unknown older adults. Wanting to offer a meaningful experience during a challenging time, the first author created a book partner assignment where students enrolled in her course and older adults shared their perspectives on dying and death using the book Tuesdays with Morrie as a conversational guide. The goal of this assignment was to help students, particularly those pursuing a career in gerontology and health related fields, become comfortable with having conversations about dying and death with unfamiliar individuals. Additionally, the first author hoped that taking part in the book partner assignment would be meaningful for older adults, allowing them to share their insights with a younger person, especially as they thought about the pandemic from their unique perspective.

While there are many books chronicling the experiences of a dying person (e.g., The Last Lecture, When Breath Becomes Air, etc.), the book, Tuesdays with Morrie, is a rich and in-depth exploration of Morrie Schwartz’s journey with a life-limiting illness. The book, Tuesdays with Morrie, is based on the relationship between Morrie, a retired professor living with the effects of Amyotrophic Lateral Sclerosis (ALS), and Mitch Albom, a former student who lost contact with his beloved teacher and mentor (Albom, 1997). Albom’s chance viewing of his former professor on Ted Koppel’s Nightline program led to the rekindling of their relationship, which flourished at the end of Morrie’s life (Just, 1995). For college students there is an inherent familiarity with this connection, making this book relatable to their own college experience.

The book offers the reader insight into Mitch and Morrie’s conversations about life and living during their regular Tuesday meetings. The appeal of this book is its longstanding presence on the New York Times Bestsellers list, as well as its debut as a television movie in 1999 (Detroit Historical Society, n.d.). The popularity of the book also resonates with teachers at the high school (Davis & Sokan, 2019), college (Masters, 2003), and post-secondary levels (Ring & Reilly, 2003) to introduce discussions about end-of-life. Additionally, Tuesdays with Morrie provides a glimpse into the aging process and is used in adult development courses focused on engaging younger individuals with older adults (Atkins, 2018). Reading Tuesdays with Morrie may also encourage older adults to think about and discuss aging and end-of-life issues with others (Mattes, 2005; Stončikaitė, 2021).

The assignment

With eighty students enrolled in the course, the first author sought eighty older adults to serve as the students’ book partners. In total, eighty-three older adults agreed to take part. Per the University’s COVID-19 regulations at that time, the first author did not allow face-to-face meetings between students and their book partners. Older adults had to be able to use either Zoom, FaceTime, or the phone to converse with students. Individuals living in nursing facilities or memory support units were not eligible to participate as book partners as they may not have had access or the ability to use this technology. The first author was also sensitive to the potential vulnerability of persons living with physical and cognitive issues (Patino & Ferreira, 2018). Prospective book partners shared background including education, professional career, and interests to aid in pairing students with book partners. When possible, students and book partners were paired based on similar interests or backgrounds. For example, she paired a pre-medical student with a retired physician, a business major with a retired business owner, and a nursing major with a retired nurse.

Prior to agreeing to take part in the discussion, the first author informed older adults they would be talking about dying and death with an undergraduate student. Discussion questions were provided in advance so they would be fully aware of the nature of the conversation. The first author supplied the older adults with the book upon request, although many already had a copy. In addition, she provided book partners with a YouTube link to the Koppel interviews. Reading the book and viewing the interviews was a pre-meeting requirement. By supplying these details, the first author believed that the book partners were equally prepared for the discussion

While the goal of the assignment was to give students the opportunity to discuss dying and death with older adults, knowing how both parties experienced this conversation is valuable. By understanding how these students and older adults experienced the project, we hope to better inform educators on how the use of popular literature, such as Tuesdays with Morrie, may encourage and facilitate conversations about dying and death between students and older adults during times of both historical significance and times of relative normalcy.

Methodology

Data collection procedures

Conversations between students and older adults occurred during March of 2021. As part of their course requirements, all eighty students turned in a small reflection paper on the experience after the conversations had concluded. After receiving approval from the Institutional Review Board of our granting institution (IRB# 0910-21-EX), older adults and students received an e-mail inviting them to complete an anonymous, open-ended survey about their experiences with their book partner. We sent these e-mails approximately one month after the discussions occurred and after the first author had posted students’ reflection paper grades to ensure that students did not feel their grade was contingent on completing the survey (Bartholomay & Sifers, 2016). To reach a higher response rate, we sent a reminder to both students and older adults around two weeks after the first e-mail invitation.

Participant demographics

Fifty-six of the eighty-three older adult book partners completed the survey for a 67% response rate. Forty-six (79.3%) of the survey respondents were female and 12 (20.7%) were male. Forty-six of the survey respondents were between the ages of 65 to 84. More than half of the older adult survey respondents (51.7%) were married or had a domestic partner and around twenty percent were widowed. Twenty-two undergraduate students completed the survey for a 28% response rate. Nineteen were female and all were between the ages of 19 and 24 and single.

Data collection instrument

To understand how students and older adults experienced discussing the book Tuesdays with Morrie, we employed a qualitative method. A qualitative method allows researchers to examine a topic or phenomena in an open and exploratory manner (Creswell & Poth, 2017) and privileges the voices and perspectives of participants, supplying a more in-depth understanding of that topic or phenomena (Creswell & Poth, 2017). While semi-structured interviewing is a hallmark of qualitative research, questionnaires with open-ended questions can also capture rich, in-depth data in participants’ own words (Charmaz, 2014). Given the University’s COVID-19 restrictions toward in-person meetings, we believed a questionnaire with open-ended questions distributed via an online survey platform (Qualtrics) was the safest form of data collection that would provide us with in-depth, detailed information. In addition to a few demographic questions, our questionnaire consisted of five open-ended questions, found in Appendix A. We instructed respondents to not include any identifying information in their responses.

Data analysis

We analyzed written responses of students and older adults using Braun and Clarke’s (2006) phased approach to thematic analysis. To begin, the second author downloaded all responses from Qualtrics into a Word document and read the responses several times to familiarize herself with the data. She then assigned initial codes to the entire data set. Upon completion of this step, the authors met and discussed the first round of coding, amending the codes if needed. After this meeting, the second author formulated themes by sorting, comparing, and contrasting the codes, cross-checking her emergent themes against the codes to ensure that the themes stayed close to the data. Figure 1 illustrates the coding tree used to develop themess

Figure 1. Coding Tree.

After the second author created a preliminary list of themes, replete with supporting data, the authors and research assistant met again to discuss the themes. During this meeting, themes were evaluated, critiqued, and reconceptualized, if needed. The second author then refined some of the themes and presented her coauthors with the updates. At this third meeting all authors felt the analysis process to be complete.

Justifiability of interpretation is a standard of evaluation consistent with the assumptions of qualitative research (Auerbach & Silverstein, 2003). To demonstrate the justifiability of our interpretations, we have been transparent with our data analysis procedures and our results are communicable, meaning that other researchers or the research participants themselves can explain and understand our themes. Our themes are also coherent, fitting together to tell a coherent story or narrative (Auerbach & Silverstein, 2003). Finally, while developing the themes, the second author looked for disconfirming evidence (Creswell & Poth 2018) by searching for any data instances that appeared contrary to the emergent theme. This process ensures that we captured a wholistic and realistic portrait of participant experiences.

Results

Conversations between students and older adults occurred during the spring 2021 semester, at the height of the COVID-19 pandemic. The assignment’s discussion questions (see Appendix A) asked students and older adults to reflect on the possible wisdom and insight Morrie might supply toward the pandemic. The written responses of both students and older adults revealed a mutual understanding that death was inevitable (theme # 1- the inevitability of death), that each learned a great deal from the other (theme # 2- gaining and giving new perspectives) and that both knew the value of friends and family (theme # 3- importance of relationships).

Theme # 1: the inevitability of death

For both students and older adults, COVID-19 underscored their experience of the book and the discussion. When responding to the question “How does Morrie’s approach to dying and death provide guidance during a global pandemic?” one older adult wrote:

Simply put, Morrie was determined to live mindfully until death arrived. He had normal fears. The pandemic has brought everyone’s own mortality into focus. Reading how MORRIE (sic) faced his death provided witness as to how we should all be living our lives (Older Adult # 10).

Likewise, a student saw parallels between Morrie’s story, the inevitability of death, and the pandemic, writing:

I think there are many themes that can be taken away from what Morrie teaches us that apply to COVID-19. One of the takeaways that my partner had that I had not thought of was to be prepared. She stated that whether it be to be prepared that you may catch this virus or that everyone will die at some point, and you don’t know when, it is important to know this is coming and be ready for it (Student # 4).

Just as Morrie acknowledged the realities and difficulties of his disease while still trying to live to the fullest, students and older adults believed that they too needed to confront the realities of the pandemic and make the best of the situation. One older adult wrote:

Morrie had to adjust to his diagnosis and what the disease was doing to his body. He embraced depending on people and accepted and adjusted to his situation … we need to accept the situation right now and make adjustments in our lives to try to make the best of the situation (Older Adult # 40).

Likewise, a student wrote, “I remember taking a tip from Morrie when I was in quarantine. I kept a small plant in a patch of sun on my desk and looked at it every day for joy and encouragement” (Student # 1).

Although there was an age gap between book partners, both the older adults and students were surprised to discover they held similar viewpoints and perspectives. One older adult wrote, “Surprisingly, she [student book partner] had most of the same views as I did. There is much to learn from interacting with a variety of age groups” (Older Adult # 16). Likewise, a student enjoyed discovering the similarities and differences in perspectives they had with their older book partner:

Overall, reading the book Tuesdays with Morrie and speaking with my partner was a very rewarding experience. It was so interesting to see the different things that each of us took away from the book that the other had not thought of, and also the similarities that we each took away from the book (Student # 4).

In addition to discovering they had shared perspectives about death, dying, and the importance of living fully, both older adults and students wrote that they enjoyed learning about their partner’s perspectives, while having the opportunity to share their own, which is the essence of our second theme, Gaining and Giving Perspective.

Theme # 2: gaining and giving perspective

Respondents wrote that they found the perspectives of their book partner to be valuable and insightful. When asked what they learned from their book partner, one student wrote:

I gained a lot of insight about life not only from Morrie, but also from my book partner … . She gave me many new perspectives to consider and think about that had not been brought to my attention before (Student # 2).

Older adults enjoyed sharing their perspectives with a younger person and learning from them as well. As one older adult succinctly wrote “We have much to learn from each other” (Older Adult # 51). Another wrote, “I learned that youth can be sensitive to Morrie and his ideals … . I learned that I am never too old to learn, to absorb new ideas, to change myself for the better” (Older Adult # 50).

Learning from one another were meaningful points of connection and understanding between book partners. Older adults and students also found connection from their mutual beliefs that relationships are of utmost importance, which is our final theme.

Theme # 3: the importance of relationships

Spending time with loved ones and recognizing the importance of people (and the unimportance of material possessions) was significant for students and older adults. One older adult wrote, “We talked about the importance of each day for it is a gift. We discussed the importance of loving and caring about others” (Older Adult # 43). Another wrote, “I think it [the conversation] gave both of us the opportunity to be reminded about both the briefness and preciousness of life as well as what finally matters and what doesn’t” (Older Adult # 42). Students also recognized the importance of love, relationships, and caring as what matters most. For instance, one student wrote “I drew that life is very important and to not waste it on the non-important things. Family and friends are everything” (Student # 2).

Students also emphasized how the pandemic influenced their thinking toward relationships and caring for others. For instance, one student wrote that individuals who did not get the COVID vaccine were not upholding Morrie’s teaching that loving others is of utmost importance: “Morrie’s approach to death showed us to love our neighbor more than anything else. I think this is very applicable to the many people not getting vaccines and not thinking about anyone but themselves” (Student # 3). Another student connected Mitch Albom’s regret at not seeing Morrie for sixteen years to the current pandemic, suggesting that COVID might be a wake-up call to spend time with loved ones before it is too late:

Mitch mentions throughout the book that he does not know why he did not visit Morrie between the 16 years when he graduated and heard of Morrie’s disease and state, and that he wishes he had. I related this to COVID-19 because I think now that people are becoming more isolated and are actually not able to spend as much time with the people they care about, there is a realization that comes where people are asking themselves why they did not see other people in their lives when they had the chance before Covid became an issue (Student # 4).

The pandemic also influenced how older adults saw relationships; however, their responses suggest COVID limited them differently from their younger book partners. Older adults indicated that the pandemic physically limited them from spending time with others; student responses did not reflect this. For example, one older adult wrote that COVID restrictions reminded them of Morrie’s limitations, although they believed Morrie’s illness to be far more confining than the pandemic:

The importance Morrie attributed to connecting with people and maintaining relationships, the unimportance of things, and the appreciation for nature and day-to-day correspond to lessons I have taken from the isolation during the pandemic. Morrie was limited by his illness, which is way beyond what I experienced during COVID, so the timing of reading this provided good perspective (Older Adult # 29).

One older adult connected their loneliness and fear during the pandemic to Morrie preparing for the end of his life:

During this pandemic, I often felt lonely and vulnerable because I doubted that I would survive if I contracted COVID. I missed seeing family and friends and felt confined. It was a time to reflect on what is really important. Also, Morrie said we all need to be ready to die any day. That became more immediate during this time (Older Adult # 41).

For older adults, the pandemic put into perspective much of what Morrie believed and emphasized. However, the pandemic created a conundrum for older adults. While they knew how important relationships were, their fear of contracting COVID limited them from spending in-person time with those they loved and cared about

To summarize our findings, discussing Tuesdays with Morrie with a book partner appears to have been worthwhile for both students and older adults. Both understood the inevitability of death, the importance of friends and family, and living one’s life to the fullest. Finally, each was grateful for the opportunity to learn from one another and share their own perspective. Of course, not every book partner experienced these things to the same degree and two wrote the conversation was not what they had hoped.

Discussion

The unique nature of this assignment was connecting undergraduate students with older adults during a global pandemic. Both were sheltering in place and had limited in person contact with others. Students adapted to remote learning (Lischer, Safi, & Dickson, 2021) and older adults faced higher risks of both contracting and dying from COVID (Pyszczynski, Lockett, Greenberg, & Solomon, 2021).

Unlike the media’s portrayal of older adults as ill and frail during the pandemic (Allen & Ayalon, 2021), students interacted with older adults who lived independently, were interested in the views of their student book partners, and capable of engaging in conversations using technology. Students were given a glimpse of well older adults living independently in the community, an important benefit to this project.

Students and older adults indicated that conversing with someone from a different generation about dying and death was meaningful, especially during the pandemic, highlighting the first theme of “the inevitability of death.” Older adults felt that sharing their unique insight imparted a deeper understanding of life and death to their younger counterparts. As other researchers have found, intergenerational exchanges can contribute to a sense of generativity – for middle aged and older adults (Ehlman, Ligon, & Moriello, 2014). Older adults can model coping skills for younger people who are facing challenges by helping them acknowledge the reality of the situation (Finlay et al., 2021; McKinlay, Fancourt, & Burton, 2021). While we did not actively measure this, older adult’s responses suggest a sense of giving back and feeling good about talking with their student partner. Likewise, both groups wrote that discussing life, death, and dying during the pandemic was meaningful and timely, forcing them to be introspective about their mortality, priorities, and relationships, which is an essential element of death education (McAfee et al., 2021). This was clear in the second and third themes, gaining and giving perspective and the importance of relationships.

Interestingly, holding the discussion over Zoom may have created an environment where book partners felt they could be more open with each other. Rates of self-disclosure and personal sharing are often higher in computer mediated settings than in face-to-face encounters (Schouten, Valkenburg, & Peter, 2009) and reciprocated self-disclosures (e.g., mutual sharing) via technology can lead to more liking in both established relationships and unfamiliar interactions (Dai, Shin, Kashian, Jang, & Walther, 2016). Older adults use of technology to communicate also highlights the recent findings of Peng and Roth (2021) that older adults while physically isolated were not digitally isolated during the pandemic suggesting the importance of technology during restrictive time periods along with the acceptance of alternative methods of communication among older adults including Zoom, e-mail, and text messaging (Fuller & Huseth-Zosel, 2021).

Because more contemporary forms of communication, such as social networking sites and videoconferencing, can positively affect older individuals in terms of social support, social connectedness, and reducing social isolation (Chen & Schulz, 2016), computer mediated communication may be an added venue for holding meaningful conversations with older populations. This knowledge is especially relevant for pre-health students and others as they enter future careers requiring an ability to display compassion and understanding during difficult moments (Juvet, Bornet, Debiens, Tapp, & Roos, 2021).

Since its first printing, Tuesdays with Morrie has been translated into forty-five languages (mitchalbom.com). The opportunity for instructors in other countries to use this book and adjust the questions accordingly is clear. In addition to the COVID-19 pandemic, educators could use this book to structure intergenerational conversations about other issues and timely events (Ring & Reilly, 2003).

Limitations

While we gained insight from book partners’ responses there are limitations worth noting. Because the survey was anonymous, we were unable to compare the experiences between older adults and their assigned students. Older adults completed the survey at a much higher rate than the students. They clearly wanted to share their opinion about the experience. We attribute students’ low response rate to the fact that they had already responded to the questions once as part of their reflection paper assignment and other responsibilities took precedence. However, we do not believe that students’ low response rate meant they were uninterested in the project; rather, we were simply asking them to do one more thing during a time of competing demands. In the end we did gain insight from a smaller sample of students who completed the questionnaire. Like their older book partners, these students learned something.

Another limitation of our study is that the sample of both older adults and students who completed the questionnaire present an incomplete perspective. Most respondents identified as female and non-Hispanic white. Other more diverse groups may experience the assignment differently.

Student and book partner interactions were confined to Zoom, FaceTime, or in two instances, a telephone conversation. While it does not appear methods of discussion discouraged people from participating, there may have been others who could not take part because of limited access or knowledge of technology. In addition, the use of technology may have been difficult for those with hearing and/or vision deficiencies. Returning to in-person visits to discuss the book may address these deficits in the future. However, the use of technology for these types of exchanges is worth further exploration.

Future suggestions

While most book partners found the experience to be of value and did not suggest any changes, there were some who offered constructive feedback to improve the assignment in the future. Both older adults and students wanted more opportunities to get acquainted, believing that knowing one another better would facilitate deeper conversations around dying and death. For older adults, the opportunity to share their story and experiences with students was like the mentoring relationship between Morrie and Mitch.

Other suggestions included meeting face to face, but both groups understood the rationale for not meeting in person. In addition, some participants wanted less prepared questions, although others found the structure helpful. Both students and older adults wrote that they would do this project again. They found value in discussing the book with someone from a different generation and life experience. Finding ways to continue this exchange seems to be of value. Most importantly, the comments from both groups suggest they were able to learn much from each other. Continuing projects such as this one has value in sharing views from different generations about topics that may have far-reaching consequences for the future.

The COVID-19 pandemic has changed life for many people in unexpected ways. This was true for our sample of students and for older adults living in the community. The inevitability of dying and death is a reality, one that calls for self-reflection and discussions with others to find ways to cope with one’s mortality (Pyszczynski, Lockett, Greenberg, & Solomon, 2021). This study highlights the usefulness of a book partner project to address the difficulties of facing mortality while at the same time learning from someone of another generation about how to face life during a time of uncertainty. This pedagogical technique of incorporating the book Tuesdays with Morrie into a course on Death and Dying is one-way gerontological educators can bring two generations together to discuss dying and death in a manner that affords each an appreciation for the lived experiences of the other, especially during a time of great historical significance.

Acknowledgement

The authors would like to thank the book partners and the University of Nebraska-Lincoln undergraduate students who participated in this project along with persons in the community partaking in this project. We would also like to thank Taylor O’Brien, Champion of Aging – a program of Home Instead for her assistance and Anna Larsen, Gerontology Research Assistant for editing assistance. Finally, we would like to thank the editors and the anonymous reviewers for their thoughtful and insightful comments on improving this manuscript. This project was funded by the Terry Haney Chair of Gerontology research funds.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Terry Haney Chair of Gerontology funding [N/A].

Appendix A.

Discussion questions for students and book partners

1. Which themes discussed in the book apply to COVID-19?

2. What advice would Morrie have for addressing the unrest in our country in 2021?

3. How does Morrie’s approach to dying and death provide guidance during a global pandemic?

4. What did you both learn about life and living from Morrie?

5. Conclusion – what did you draw from this experience? What did you learn from your book partner?