Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study

Published:October 03, 2022DOI:



      The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents.


      Multisite cross-sectional observational study.

      Setting and participants

      31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment.


      Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed.


      From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66).

      Conclusions and implications

      The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Voumard R.
        • Rubli Truchard E.
        • Benaroyo L.
        • et al.
        Geriatric palliative care: a view of its concept, challenges and strategies.
        BMC Geriatr. 2018; 18: 220
        • Schroepfer T.A.
        Mind frames towards dying and factors motivating their adoption by terminally ill elders.
        J Gerontol B Psychol Sci Soc Sci. 2006; 61: S129-S139
        • Balaguer A.
        • Monforte-Royo C.
        • Porta-Sales J.
        • et al.
        An international consensus definition of the wish to hasten death and its related factors.
        PLoS One. 2016; 11: e0146184
        • Rodriguez-Prat A.
        • Balaguer A.
        • Booth A.
        • et al.
        Understanding patients' experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography.
        BMJ Open. 2017; 7: e016659
        • Kox R.M.K.
        • Pasman H.R.W.
        • Huisman M.
        • et al.
        Current wishes to die; characteristics of middle-aged and older Dutch adults who are ready to give up on life: a cross-sectional study.
        BMC Med Ethics. 2021; 22: 64
        • Briggs R.
        • Ward M.
        • Kenny R.A.
        The ‘Wish to Die' in later life: prevalence, longitudinal course and mortality. Data from TILDA.
        Age Ageing. 2021; 50: 1321-1328
        • Bornet M.A.
        • Rubli Truchard E.
        • Waeber G.
        • et al.
        Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward.
        BMC Geriatr. 2020; 20: 348
        • Rurup M.L.
        • Deeg D.J.
        • Poppelaars J.L.
        • et al.
        Wishes to die in older people: a quantitative study of prevalence and associated factors.
        Crisis. 2011; 32: 194-203
        • Ayalon L.
        The prevalence and predictors of passive death wishes in Europe: a 2-year follow-up of the Survey of Health, Ageing, and Retirement in Europe.
        Int J Geriatr Psychiatry. 2011; 26: 923-929
        • Pivodic L.
        • Pardon K.
        • Morin L.
        • et al.
        Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries.
        J Epidemiol Community Health. 2016; 70: 17-24
        • Dasch B.
        • Blum K.
        • Gude P.
        • et al.
        Place of death: trends over the course of a decade: a population-based study of death certificates from the years 2001 and 2011.
        Dtsch Arztebl Int. 2015; 112: 496-504
        • Hedinger D.
        • Braun J.
        • Zellweger U.
        • et al.
        Moving to and dying in a nursing home depends not only on health - an analysis of socio-demographic determinants of place of death in Switzerland.
        PLoS One. 2014; 9: e113236
        • Rurup M.L.
        • Muller M.T.
        • Onwuteaka-Philipsen B.D.
        • et al.
        Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: an interview study.
        Psychol Med. 2005; 35: 665-671
        • Durst A.V.
        • Spencer B.
        • Bula C.
        • et al.
        Wish to die in older patients: development and validation of two assessment instruments.
        J Am Geriatr Soc. 2020; 68: 1202-1209
        • Bonnewyn A.
        • Shah A.
        • Bruffaerts R.
        • et al.
        Are religiousness and death attitudes associated with the wish to die in older people?.
        Int Psychogeriatr. 2016; 28: 397-404
        • Edwards A.
        • Pang N.
        • Shiu V.
        • et al.
        The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research.
        Palliat Med. 2010; 24: 753-770
        • Piderman K.M.
        • Lapid M.I.
        • Stevens S.R.
        • et al.
        Spiritual well-being and spiritual practices in elderly depressed psychiatric inpatients.
        J Pastoral Care Counsel. 2011; 65: 1-11
        • Monod S.
        • Martin E.
        • Spencer B.
        • et al.
        Validation of the Spiritual Distress Assessment Tool in older hospitalized patients.
        BMC Geriatr. 2012; 12: 13
        • SDA-Keystone
        Swiss organisation reports over 1,200 assisted suicides last year.
        • Vilpert S.
        • Borrat-Besson C.
        • Borasio G.D.
        • et al.
        Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland.
        PLoS One. 2020; 15: e0232109
        • Morris J.N.
        • Fries B.E.
        • Mehr D.R.
        • et al.
        MDS cognitive performance scale.
        J Gerontol. 1994; 49: M174-M182
        • Monod S.M.
        • Rochat E.
        • Bula C.J.
        • et al.
        The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons.
        BMC Geriatr. 2010; 10: 88
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • et al.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Kissane D.W.
        • Clarke D.M.
        • Street A.F.
        Demoralization syndrome--a relevant psychiatric diagnosis for palliative care.
        J Palliat Care. 2001; 17: 12-21
        • Morris J.N.
        • Hawes C.
        • Fries B.E.
        • et al.
        Designing the national resident assessment instrument for nursing homes.
        Gerontologist. 1990; 30: 293-307
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms.
        Psychosom Med. 2002; 64: 258-266
        • Salvi F.
        • Miller M.D.
        • Grilli A.
        • et al.
        A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients.
        J Am Geriatr Soc. 2008; 56: 1926-1931
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        mice: multivariate imputation by chained equations in R.
        J Stat Softw. 2011; 45
      1. Belar A, Martinez M, Centeno C, et al. Wish to die and hasten death in palliative care: a cross-sectional study factor analysis. BMJ Support Palliat Care. Published online October 14, 2021.

        • EXIT
        Suizidhilfe in Heimen zunehmend ein Thema.
        • EXIT A.
        D.M.D. Suisse romande. Nombre d’assistances au suicide effectuées.
        Bulletin. 2016; 64: 9
        • George K.
        • Davison T.E.
        • McCabe M.
        • et al.
        Treatment of depression in low-level residential care facilities for the elderly.
        Int Psychogeriatr. 2007; 19: 1153-1160
        • Costanza A.
        • Vasileios C.
        • Ambrosetti J.
        • et al.
        Demoralization in suicide: a systematic review.
        J Psychosom Res. 2022; 157: 110788
        • Gan L.L.
        • Gong S.
        • Kissane D.W.
        Mental state of demoralisation across diverse clinical settings: a systematic review, meta-analysis and proposal for its use as a 'specifier' in mental illness.
        Aust N Z J Psychiatry. 2022; 56: 1104-1129
        • Shim E.J.
        • Hahm B.J.
        Anxiety, helplessness/hopelessness and 'desire for hastened death' in Korean cancer patients.
        Eur J Cancer Care (Engl). 2011; 20: 395-402
        • Kissling W.
        • Glue P.
        • Medori R.
        • et al.
        Long-term safety and efficacy of long-acting risperidone in elderly psychotic patients.
        Hum Psychopharmacol. 2007; 22: 505-513
        • Federal Office of Statistics
        Socio-medical institutions: number of clients according to age and gender.
        • Hulur G.
        • Wolf H.
        • Riese F.
        • et al.
        Cognitive change at the end of life in nursing home residents: differential trajectories of terminal decline.
        Gerontology. 2019; 65: 57-67
        • Houben C.H.
        • Spruit M.A.
        • Groenen M.T.
        • et al.
        Efficacy of advance care planning: a systematic review and meta-analysis.
        J Am Med Dir Assoc. 2014; 15: 477-489

      Related Podcast

      December 15, 2022

      December 2022: Deprescribing, infection control, osteoporosis treatment, and palliative care

      Host:  Karl Steinberg MD, HMDC, CMD

      Guests: Philip Sloane MD, MPH; Mallory Brown, MD 

      Recorded: December 12, 2022

      Loading ...