The Development of a Buddhist-Integrated Activity Model for Mindful Preparation before Death in Older Adults

Abstract

This research article pursued three objectives: (1) to design and develop a Buddhist-Integrated activity model for mindful preparation before death in older adults; (2) to implement the developed model with a group of older adults; and (3) to evaluate the impact of the model on the mindful
readiness for death of participants. The study employed a Research and
Development (R&D) methodology with a Mixed Methods approach, comprising 3 phases: (R1) knowledge synthesis according to Buddhist scriptures and related
literatures; (D1) program development and quality validation; and (R2-D2) field implementation and evaluation using a One-Group Pretest–Posttest experimental design with in-depth interviews; and refinement to produce the final activity model.
The findings indicated that key Buddhist principles suitable for program development were the Three Characteristics of Existence (Tilakkhaṇa), the
Law of Karma, the Four Foundations of Mindfulness (Satipaṭṭhāna),
Mindfulness of Death (Maraṇāsati), and the Threefold Training (Tisikkhā), which
were structured into a causal framework with the Threefold Training as its
central axis, leading to the development of the BUDDHA-END Model. This model
was subsequently developed into an integrated Buddhist activity-based
program synthesizing Buddhist philosophy with modern science such as
contemporary medical and psychological sciences, comprising five sequential activities:
(1) mindfulness cultivation through the Four Foundations of Mindfulness;
(2) Dhamma talk on “death as a natural phenomenon” and guided mindfulness of death; (3) preparation in terms of body, mind, and unfinished business before death based on medical and psychological perspectives; (4) letter writing for apology, forgiveness, or final farewell; and (5) a death simulation exercise.
The trial results with 32 older adult participants yielded statistically
significant improvements (p < .05) in tranquility of mind, death acceptance, and letting go. These quantitative findings were consistent with qualitative data revealing participants’ experiences of “mental lightness”. The mechanism of transformation followed a sequential pattern: mindfulness and insight into impermanence helped reduce attachment and foster acceptance and letting go. The most significant contribution of this study lies in the mindful dimension, demonstrating that the Buddhist-integrated activity model based on the BUDDHA-END Model constitutes a systematic process of mindful development. It enables older adults to meaningfully apply to prepare body, mind, and unfinished business before death. These findings align with the holistic care principles, addressing physical, psychological, social, and spiritual dimensions.