The ‘Wish to Die’ in later life: prevalence, longitudinal course and mortality. Data from TILDA

Abstract

Background ‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead. Objective To examine the prevalence, longitudinal course and mortality-risk of WTD in community-dwelling older people. Design Observational study with 6-year follow-up. Setting The Irish Longitudinal Study on Ageing, a nationally representative cohort of older adults. Subjects In total, 8,174 community-dwelling adults aged ≥50 years. Methods To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’ Depressive symptoms were measured using the CES-D. Mortality data were compiled by linking administrative death records to individual-level survey data from the study. Results At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD. Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up. Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up. Conclusions WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness. An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic.

Exploring the reciprocal relationship between activities of daily living disability and depressive symptoms among middle-aged and older Chinese people: a four-wave, cross-lagged model

“…The presence of depressive symptoms in the middle-aged and older population is closely associated with “Wish to Die” [ 47 ] and significantly increases the risk of death [ 48 ]. Identifying potential depressive symptoms in older people is vital for early prevention and treatment.…”

Physical multimorbidity and wish to die among adults aged ≥65 years: A cross-sectional analysis of the Irish Longitudinal Study on Ageing

“…As in previous publications using the same dataset (Briggs et al, 2021;Ragab et al, 2021), WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead? "…”

“…The potential mediators in the association between multimorbidity and WTD were selected based on previous literature that suggest that they can be the result of multimorbidity, while they can also potentially be the cause of WTD. Specifically, potential mediators included sleep problems, pain, depression, anxiety, loneliness, perceived stress, and disability (Briggs et al, 2021;Lapierre et al, 2012). A composite sleep score (range 0-7 with higher scores representing more sleep problems) was created based on three questions on the likelihood of dozing off or falling asleep during the day, frequency of trouble falling asleep, and trouble with waking up too early and not being able to fall asleep again (Scarlett et al, 2021).…”

How do trained palliative care providers experience open desire to die-conversations? An explorative thematic analysis

“…Confronted with approaching death due to serious, life-limiting disease or geriatric multimorbidity, patients frequently express a desire to die (Monforte-Royo et al, 2012;Bellido-Pérez et al, 2018;Bornet et al, 2020;Briggs et al, 2021). Recent public discussions tend to see these desires to die only through the narrow lens of (ethically) adequate reactions toward requests for medical aid in dying (MAiD) (Wright et al, 2017).…”