Given the growing number of elderly persons in society and concerns about their health and well-being, the aim was to review the available literature on their death anxiety, and to explore features of this experience among a small sample of older men and women in care facilities. In both the review and empirical parts of this study, components and correlates of death anxiety were investigated. The review revealed limited research focus on death anxiety among the elderly, particularly among those in institutions, but suggested both components and correlates for inclusion in our empirical study. Results showed that, among our elderly participants in an assisted living facility (N = 49; age range: 60-96 years), there were higher levels of fear for others and of the dying process than for fear of the unknown. Notably, among the correlates identified, fear for significant others was associated with poor physical health; fear of the dying process was related to low self-esteem, little purpose in life, and poor mental well-being. Gender differences in death anxiety were found: women showed greater fear for the death of loved ones and for the consequences of their own death on these loved ones, than did men. These patterns are discussed in the light of concerns about the welfare of elderly persons; scientific implications are also considered.

Aims Some, but not all, studies have shown that patient‐reported health status, including symptoms, functioning, and health‐related quality of life, provides additional information to traditional clinical factors in predicting prognosis in heart failure patients. To evaluate the overall evidence, the association of disease‐specific health status on mortality in heart failure was examined through a systematic review and meta‐analysis. Methods and results Prospective cohort studies that assessed the independent association of disease‐specific health status with mortality in heart failure were selected. Searching PubMed (until March 2013) resulted in 17 articles in the systematic review and 17 studies in the meta‐analysis. About half of the studies reported a significant relationship between disease‐specific health status and mortality in heart failure, while the remainder found no association. A larger sample size increased the chance of identification of a significant association. The results of the meta‐analysis (including studies using a dichotomized heart failure‐specific health status variable as predictor) showed that heart failure patients reporting poor disease‐specific health status had a 39% increased risk of dying [hazard ratio 1.39 (1.25–1.54)] when compared with patients experiencing moderate or good disease‐specific health status. Conclusion Patient‐reported health status was an independent risk indicator for mortality in heart failure patients and may facilitate the identification of patients at high risk for poor prognosis above and beyond traditional risk variables. These findings suggest that patient‐reported health status should be routinely assessed in determining prognosis, as this information cannot be captured from patients' medical records.

The first clinical results from the Evaluation of Factors Impacting Clinical Outcome and Cost Effectiveness of the subcutaneous implantable cardioverter defibrillator (EFFORTLESS S-ICD) Registry on the entirely S-ICD system are promising, but the impact of the S-ICD system on patients' quality of life (QoL) is not known. We evaluated the QoL of patients with an S-ICD against an unrelated cohort with a transvenous (TV)-ICD system during 6 months of follow-up. Consecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system on a priori selected variables including baseline QoL. QoL was measured with the Short-Form Health Survey at baseline, 3, and 6 months after implant and compared using multivariable modeling with repeated measures. Patients with an S-ICD (n = 167) versus a TV-ICD system (n = 167) did not differ significantly on physical (p = 0.8157) and mental QoL scores (p = 0.9080) across baseline, 3, and 6 months after implantation in adjusted analyses. The evolution in physical (p = 0.0503) and mental scores (p = 0.3772) during follow-up was similar for both cohorts, as indicated by the nonsignificant interaction effect for ICD system by time. Both patients with an S-ICD system and a TV-ICD system experienced significant improvements in physical and mental QoL between time of implant and 3 months (both p's <0.0001) and between time of implant and 6 months (both p's <0.0001) but not between 3 and 6 months (both p's >0.05). In conclusion, these first results show that the QoL of patients with an S-ICD versus TV-ICD system is similar and that patients with either system experience improvements in QoL on the short term.

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