Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

Abstract

OBJECTIVES The wish to die may be different in geriatric patients than in younger terminally ill patients. This study aimed to develop and validate instruments for assessing the wish to die in geriatric patients. DESIGN Cross‐sectional study. SETTING Geriatric rehabilitation unit of a university hospital. PARTICIPANTS Patients (N = 101) aged 65 years or older with a Mini‐Mental State Examination score of 20 or higher, admitted consecutively over a 5‐month period. MEASUREMENTS The Schedule of Attitudes Toward Hastened Death (SAHD) was adapted to the older population (SAHD‐Senior). A second tool was developed based on qualitative literature, the Categories of Attitudes Toward Death Occurrence (CADO). After cognitive pretesting, these instruments were validated in a sample of patients admitted to a geriatric rehabilitation unit. RESULTS The SAHD‐Senior showed good psychometric properties and a unifactorial structure. In the studied sample, 12.9% had a SAHD‐Senior score of 10 or higher, suggesting a significant wish to die. Associations were observed between high levels of the SAHD‐Senior and advanced age, high levels of depressive symptoms, lower quality of life, and lower cognitive function. The CADO allowed for passive death wishes to be distinguished from wishes to actively hasten death. According to the CADO, 14.9% of the sample had a wish to die. The two instruments showed a concordance rate of 90.1%. CONCLUSION The wish to die in older patients admitted to rehabilitation can be validly assessed with two novel instruments. The considerable proportion with a wish to die warrants investigation into concept, determinants, and management of the wish to die. J Am Geriatr Soc 68:1202–1209, 2020.

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

“…This variability between WTD instruments has been noted previously [30]. The authors of a previous validation article found lower variation between the SAHD-senior and the CADO [3], perhaps because of the non-acute context, where patients present with more chronic symptomatology. Overall, our results suggest that WTD prevalence is low but highly relevant for clinical practice in an acute care setting, and that the two WTD instruments do not capture the WTD in the same individuals.…”

“…As WTD instruments vary [3], we assessed WTD using two validated instruments to ensure that the construct was adequately measured in this large sample. We considered patients to show a WTD if responses on either or both instruments were positive.…”

“…The French version of the Schedule of Attitudes toward Hastened Death-senior (SAHD-senior) assesses the intensity of the WTD in elderly persons by evaluating attitudes to death, the wish to die/live, and the fear of physical/psychological suffering [3]. It is a modified version of the SAHD, which was originally validated for young terminal stage patients [16].…”

“…The French version of the Categories of Attitudes toward Death Occurrence (CADO) measures quality of the WTD [3]. It is based on a qualitative study conducted by Schroepfer [17] and contains six categories (1: neither ready nor accepting; 2: not ready but accepting; 3: ready and accepting; 4: ready, accepting, and wishing death would come; 5: considering a hastened death but having no specific plan; and 6: considering a hastened death with a specific plan).…”

“…Wish to die defined as either a SAHD-senior score ≥ 10 or a CADO category ≥4. Between-group comparisons performed using Student's t-test or Mann-Whitney test ( a ) for continuous variables and chi-square for categorical variables prevalence of 8.9-14.9% (using either or both instruments) in geriatric rehabilitation inpatients [3], and 4.0-22.1% (using either or both instruments) in nursing homes [4]. WTD prevalence in this study was also lower than for palliative care patients in a previous study using the SAHD, which found a prevalence of between 3.9 and 28% (4.6 to 17% using the same cutoff as in the present study) [30].…”