Abstract
Objectives
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.
Design
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.
Methods
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.
Results
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.
Keywords
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Article info
Publication history
Published online: October 03, 2022
Footnotes
The authors declare no conflicts of interest.
This work was funded by the Swiss National Science Foundation (NRP 67 on End of Life, No. 406740_139362).
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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