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

Area of Science:

• Gerontology
• Psychiatry
• Clinical Psychology

Background:

• The wish to die may differ in geriatric patients compared to younger terminally ill individuals.
• Assessing the wish to die in older adults requires specialized instruments due to unique psychological and physiological factors.

Purpose of the Study:

• To develop and validate instruments for assessing the wish to die specifically in geriatric patients.
• To differentiate between passive and active wishes to hasten death in the elderly population.

Main Methods:

• Cross-sectional study involving 101 geriatric patients (age ≥ 65) with Mini-Mental State Examination score ≥ 20.
• Adaptation of the Schedule of Attitudes Toward Hastened Death (SAHD) for older adults (SAHD-Senior) and development of the Categories of Attitudes Toward Death Occurrence (CADO).
• Cognitive pretesting and validation of both instruments in a geriatric rehabilitation unit.

Main Results:

• The SAHD-Senior demonstrated good psychometric properties and a unifactorial structure.
• 12.9% of patients scored high on SAHD-Senior, indicating a significant wish to die, associated with advanced age, depression, lower quality of life, and cognitive function.
• The CADO distinguished passive from active death wishes; 14.9% expressed a wish to die, with 90.1% concordance between the two instruments.

Conclusions:

• Two novel instruments, SAHD-Senior and CADO, can reliably assess the wish to die in older patients in rehabilitation settings.
• The substantial prevalence of a wish to die among geriatric patients necessitates further investigation into its underlying concepts, determinants, and management strategies.