Wish to die in nursing homes residents: comparison of the three linguistic regions in Switzerland
E. Rubli Truchard1, S. Monod1, R. J. Jox1 (1Lausanne)
In aging societies, there is a growing concern about the living conditions of very old people in nursing homes, particularly near the end of their lives. In countries with liberal end-of-life laws like Switzerland, the numbers of assisted suicides by elderly people with chronic illnesses beyond the terminal phase increases.
As part of a study funded by the Swiss National Science Foundation in the context of a national program “End of Life” (NRP 67), we aimed to obtain lacking data regarding (i) the prevalence of wishes to die (WTD) in nursing home residents above the age of 75, (ii) the determinants of WTD, and (iii) differences between the three linguistic and cultural regions of Switzerland.
We conducted a multi-site, cross-sectional study among nursing home residents in the French-, Italian- and German-speaking Swiss cantons of Vaud, Ticino and St. Gallen. Residents were included if they were over the age of 75 years, possessed decisional capacity and had been admitted to nursing homes 3-10 months before. Participants completed validated scales and semiquantitative questionnaires concerning WTD as well as physical, psychosocial and spiritual distress.
Among 769 residents screened, 336 were eligible and 280 participated in the study (107 in Vaud, 117 in Ticino, 56 in St Gallen). Their median age was 87.5 years, 73% were female, and 61% were widowed. Depending on the assessment instrument, 11-16% of the participants expressed a WTD, with almost all being passive wishes for death to occur naturally. In bivariate regression analysis, the main determinants of WTD were depression, demoralization, anxiety, symptom burden, some specific domains of spiritual distress, higher age, the feeling to be a burden to others, and antipsychotic medication. Residents who had higher degrees of cognitive impairment tended to have lower WTD. In multivariate regression, the remaining predictors for WTD were higher age, demoralization, symptom burden and antipsychotic medication. The WTD was higher in the French-speaking region and lower in the Italian-speaking and German-speaking regions
A considerable minority of elderly nursing home residents have passive death wishes with a multifactorial origin. The influence of culture confirms international data among other population groups.