Under circumstances in which a person has been lost and presumed dead or when family members were unable to attend a funeral, there can continue to be a lack of closure that makes it difficult to grieve and to learn to live with loss.

However, as can be seen in figure 10.4, there has been a decline in the number of people dying in hospital in the last decade (Hall, Levant, & DeFrances, 2013). This decline can be tied to two changes in the U.S. health care system:

while aging that occurs due to controllable factors, such as an unhealthy lifestyle including lack of physical exercise and poor diet, is called secondary aging (Busse, 1969).