Factors determining the balance between the wish to die and the wish to live in older adults

Bonnewyn, Anke; Shah, Ajit; Bruffærts, Ronny; Demyttenaere, Koen

doi:10.1002/gps.4511

Cited by 15 publications

(11 citation statements)

References 34 publications

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“…This observation is in accordance with that of a prior study, which revealed that depression and pessimism were related to WTD in medically ill elderly inpatients [5]. Likewise, other studies support our finding: the status of living was associated with suicide in the elderly [18]; perceived sense of belonging, substantial support, self-esteem, and chronic interpersonal problems were correlated with SI [49]; the factors related to WTD in the elderly were depression [50], hopelessness [51], social support, and subjective well-being [52]. The significant association between WTD and three variables in our study, i.e., living alone, negative feeling, and feelings of being accepted/respected suggest medical staff take proper measure in time; that is, when elderly inpatients are found to live alone before admission, or to present with negative feelings, such as hopelessness or a sense of being abandoned, they should be evaluated for the presence of WTD.…”

Section: Discussionsupporting

confidence: 83%

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Liao

Liu

et al. 2018

BMC Psychiatry

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BackgroundWorldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.MethodsA total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.ResultsSI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56–2.98), item 4 (inferiority) (OR = 1.62, 1.23–2.13), item 5 (insomnia) (OR = 1.52, 1.13–2.05), and physical domain of WHOQOL (OR = 0.84, 0.72–0.99). QOL15 (mobility) (OR = 0.64, 0.46–0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44–0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24–15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15–0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20–0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.ConclusionTo provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

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Section: Discussionsupporting

confidence: 83%

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Liao

Liu

et al. 2018

BMC Psychiatry

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“…Our study indicated that even more important factors were perceptions of a change in thought processes (slower thinking, forgetfulness, repetitive thoughts), and general loss of interest in life. Social isolation and loneliness were less frequently mentioned by our interviewees as reasons for a WTD, but might nevertheless have played an important role as indicated by other studies [9][30][49]. We can only hypothesize that for elderly persons, this is a difficult topic to talk about, which makes it an aspect to be aware of in assessing a WTD in frail elderly people.…”

Section: Discussionmentioning

confidence: 66%

“…In elderly patients, the WTD is associated with being female, not being in a partnership, greater frequency of depressive symptoms, loss of autonomy and controll, financial problems, restricted social network, urinary incontinence, a negative perception of one’s own physical health, polymorbidity, higher levels of stress and sleep problems, and living in a nursing home [30][45][46][47][48][49][50]. In the elderly, loneliness and social disconnectedness in particular play an important role in WTD, while the presence of social support can effectively counteract a WTD [9][49][51][52]. Untreated or undertreated depression might cause a WTD, and while most authors agree that underdiagnosed depression in the elderly is a problem, clinical depression is not always present in elderly people with a WTD.…”

Section: Overview Of the Literaturementioning

confidence: 99%

“…A WTD does not always contain a wish to hasten death [5][6][1]. It is not uncommon for patients’ wishes with regard to living or dying to change from WTD (and even wishes to hasten death) into wishes to live and also the other way around, even in the final weeks of life [7][8][9][10]. All this might suggest that for many patients, thoughts of dying and even wishes to die, transient or not, might be part of a process of coming to terms with their situation at the end of life, of facing loss, suffering and finitude.…”

Section: Introductionmentioning

confidence: 99%

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Wishes to die at the end of life and subjective experience of four different typical dying trajectories. A qualitative interview study

et al. 2019

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Research aimsThe motivations that lead to wishes to die (WTD) in palliative care patients with cancer are relatively well studied. But little is known about WTD in other pathologies and the relation between subjective understandings of dying trajectories and a WTD. We investigated the WTD of palliative patients in four different dying trajectories: neurological diseases, organ failure, frailty due to age, and cancer.Study population62 palliative cancer (n = 30) and non-cancer (n = 32) patients (10 neurological disease; 11 organ failure; 11 frailty), their families and health professionals in different palliative care settings (248 interviews).Study design and methodsQualitative semi-structured interviews. Data analysis through Interpretive Phenomenological Analysis and Grounded Theory.ResultsIn addition to personal motivations, we found that people dealing with similar trajectories were often confronted with similar questions and concerns due to similar challenges. For four trajectories we show typical patterns, similarities and differences that should be considered when talking with patients about their WTD. These illness-related considerations do not explain the WTD completely, but give important information on the challenges for particular patient groups that might experience a WTD. In all patient groups, there were clear moments that triggered a WTD: for neurological patients it was experiencing breathlessness, high-dependency care, or when considering tube feeding or respiratory support; for persons with organ failure it was an acute burdensome crisis; for patients with cancer after the initial diagnosis, it was the first relapse or the move into advanced palliative care; for elderly frail persons it was the move into care facilities, or the loss of important relationships or capabilities. The feeling of being a burden to others was reported in all patient groups.InterpretationWTD can be triggered within disease trajectories by specific conditions and transitional points that affect agency and self-understanding. A better understanding of the concerns and challenges of a particular dying trajectory as well as its characteristic trigger points can facilitate early and comprehensive communication about patients’ WTD, and the underlying motivations and protective factors.

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“…Fall-related injuries may be fatal or non-fatal though most are non-fatal [18]. Frequent falling is a vital cause for morbidity and mortality in the elderly population and it indicates deprived physical and cognitive status [13,15]. Fall has many etiology like muscle weakness, arthritis, use of more than three prescribed medications, depressions, use of an assistive device, impairments in gait, balance, vision, cognition, and activities of daily living [28].…”

Section: Introductionmentioning

confidence: 99%

Comparing the effect of pool therapy and land therapy on balance in elderly population

Vadivelan¹,

Shravanthi²

2021

JIMRHS

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Balance is defined as the dynamic process by which the position of the body is maintained in equilibrium. As age increases balance decreases that lead to falls. To improve the balance, land, and pool therapies are used. Studies have shown that land-based exercises improve joint flexibility, muscle strength, balance, and reaction time in an older population. The physical properties of water are an effective rehabilitation program. Water-based exercises provide a viable alternative for the elderly who are unable to participate in land-based exercise programs as water exercise has reduced the risk of falls. The objective of the study is to compare the effect of pool therapy and land therapy on balance in the elderly population. The Study methodology: Quasi-experimental study.30 elderly people between 60-75 years (both male and female) were included in the study based on inclusion and exclusion criteria. Tinetti falls efficacy scale questionnaire was given to the subjects and they were asked to fill it and then a timed up and go test was done before and after the exercise protocol. The 30 individuals were divided into 2 groups of 15 members each (Group A and Group B). Group A was given pool therapy and Group B was given land-based therapy for 6 weeks. The results of statistical analysis showed a significant difference between land therapy and pool therapy. This study concludes that pool therapy is more effective in improving balance in the elderly population.

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Factors determining the balance between the wish to die and the wish to live in older adults

Cited by 15 publications

References 34 publications

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Wishes to die at the end of life and subjective experience of four different typical dying trajectories. A qualitative interview study

Comparing the effect of pool therapy and land therapy on balance in elderly population

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