[Implication of near-death experience for the elderly in terminal care]

Near-death experience (NDE) was studied in a series of 48 consecutive patients who were admitted to hospital in a deep coma (level III on the III-3 coma scale) due to cardiac arrest, pulmonary failure, cerebrovascular accident, and/or other life-threatening disease. When the patients recovered from coma without complications such as aphasia, dementia or mental disturbance, they were interviewed by the same physician following the same protocol consisting of 25 questions about their experience during the period of deep coma. Of 48 patients interviewed, 14 (37%) had a vivid and undeniably personal experience during their unconscious state. Factors attributable to the NDE were assessed by the following three methods. First, the frequency and odds ratio were examined in terms of gender, age, underlying disease, occupation, religion, education, site of accident, duration of comatose state, drugs and treatment for resuscitation, and drugs being taken at the time of interview. There were no specific factors significantly related to the NDE. Next, background factors were compared between the NDE positive and negative groups to detect a particular factor related to the NDE. However, there were no factors that showed significant frequency in the NDE-positive group. Finally, discriminatory analysis was performed to detect discriminatory factors in the occurrence of NDE by selecting NDE as an objective variable and background factors as explanatory variables. However, the discriminatory equation gained was not significant. Thus, there were no background factors that could explain the occurrence of NDE. Among the NDE reported, there were such elements as flying in a dark void space with dim light ahead, encountering dead relatives or friends, standing at the boundary of brook, river or pond, and returning to the world in response to a voice calling from behind. These elements are common to those reported by investigators abroad, except for the lack of a tunnel experience. As for the influence of the NDE on life subsequent to the experience, the majority of patients who had had a NDE stated that they became more sincere to towards every aspect of life and held spiritual values in high esteem than before. This was quite a contrast to the attitudes in the non-NDE patients who looked upon the comatose episode as arising from an underlying disease and considered it a health problem only. Most of the NDE patients considered that death was neither fearful nor difficult, but calm and peaceful if it occurs in a manner similar to that in their NDE. From this study, a picture can be down of the dying process, based on empirical information, it can also be seen that a NDE causes the individual to develop a sincere introspective depth. It is possible that these findings may be applicable to elderly patients in terminal care.