Wishes to Die in Older People

Abstract

Background: Death thoughts and wishes occur frequently among older people. In different European countries estimates of 10%–20% have been found. Aims: To determine the prevalence and associated factors of death thoughts and wishes among older people in The Netherlands. Methods: In The Netherlands 1794 people (58–98 years) were interviewed in 2005/2006 (Longitudinal Aging Study Amsterdam). Results: 81.3% reported never having death thoughts/wishes; 15.3% reported having had such thoughts/wishes; 3.4% reported currently having a wish to die and/or a weakened wish to continue living. Of those with a current wish to die, 67% had depressive symptoms (vs. 32% of people with death thoughts/wishes ever and 9% of people who never had had death thoughts/wishes), and 20% suffered from a depressive disorder (vs. 5% if death thoughts/wishes ever; 0.3% if never death thoughts/wishes). In a multivariate analysis, a current wish to die was associated with having depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment. Conclusions: Practical implications for health-care professionals are that they should be aware that in certain situations older people are more likely to develop a wish to die, and that a wish to die does not necessarily mean that someone has a depressive disorder. Nevertheless, it should serve as a trigger to investigate and to treat depression if present.

Full text

M.L.Rurup et al.: Wishes to Die in Older PeopleCrisis2011;Vol. 32(4):194–203© 2011HogrefePublishing
Research Trends
Wishes to Die in Older People
A Quantitative Study of
Prevalence and Associated Factors
M. L. Rurup1,2,D.J.H.Deeg
2,3, J. L. Poppelaars2,4,
A. J. F. M. Kerkhof2,5, and B. D. Onwuteaka-Philipsen1,2
1VU University Medical Center, Department of Public and Occupational Health, Amsterdam, The
Netherlands, 2VU University Medical Center, EMGO Institute for Health and Care Research,
Amsterdam, The Netherlands, 3VU University, Department of Psychiatry, Amsterdam, The Netherlands,
4VU University, Department of Sociology, Amsterdam, The Netherlands, 5VU University, Department of
Clinical Psychology, Amsterdam, The Netherlands
Abstract. Background: Death thoughts and wishes occur frequently among older people. In different European countries estimates of
10%–20% have been found. Aims: To determine the prevalence and associated factors of death thoughts and wishes among older people
in The Netherlands. Methods: In The Netherlands 1794 people (58–98 years) were interviewed in 2005/2006 (Longitudinal Aging Study
Amsterdam). Results: 81.3% reported never having death thoughts/wishes; 15.3% reported having had such thoughts/wishes; 3.4%
reported currently having a wish to die and/or a weakened wish to continue living. Of those with a current wish to die, 67% had depressive
symptoms (vs. 32% of people with death thoughts/wishes ever and 9% of people who never had had death thoughts/wishes), and 20%
suffered from a depressive disorder (vs. 5% if death thoughts/wishes ever; 0.3% if never death thoughts/wishes). In a multivariate analysis,
a current wish to die was associated with having depressive symptoms, a depressive disorder, lower perceived mastery, financial problems,
loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment. Conclusions: Practical implications
for health-care professionals are that they should be aware that in certain situations older people are more likely to develop a wish to die,
and that a wish to die does not necessarily mean that someone has a depressive disorder. Nevertheless, it should serve as a trigger to
investigate and to treat depression if present.
Keywords: wish to die, death thoughts, depression, mastery, loneliness
Introduction
Death thoughts and wishes occur frequently among older
people: 10–20% of older people in different European
countries (Sweden, Italy, the UK, and Germany) reported
having had death thoughts or wishes (Barnow & Linden,
2000; Forsell, Jorm, & Winblad, 1997; Rao, Dening,
Brayne, & Huppert, 1997; Scocco & De Leo, 2002; Skoog
et al., 1996). The most recent European study was done in
the UK and revealed a lower prevalence in a younger age
group (Dennis et al., 2007). A study in China showed a
lower prevalence than in the European studies: 6% of peo-
ple older than 60 had had death thoughts or death wishes;
however, this study excluded people living in a home or in
institutions, who in the European studies had a higher prev-
alence of death thoughts and wishes (Yip et al., 2003).
All these studies found an association between death
thoughts or wishes and depressive symptoms. Some au-
thors claim to have found that people with a wish to die
almost always have a depression or a psychiatric illness,
while others say that, although depressive symptoms oc-
cur more frequently, only a minority of people with a
wish to die qualified for a diagnosis of depressive disor-
der (Barnow & Linden, 2000; Callahan, Hendrie, Nien-
aber, & Tierney, 1996; Jorm et al., 1995). Some studies
focused only on the relationship of death thoughts or
wishes to depression or other psychiatric illnesses, while
studies that also included other factors consistently found
other associations as well, even after correcting for de-
pressive symptoms, namely:
– Increased disability in daily living (Dennis et al., 2007;
Forsell et al., 1997; Jorm et al., 1995),
– Institutionalization/residential care (Forsell et al., 1997;
Jorm et al., 1995),
– Visual/hearing impairment (Forsell et al., 1997; Jorm et
al., 1995; Yip et al., 2003),
– Poor self-rated health (Dennis et al., 2007; Jorm et al.,
1995),
– Being widowed/not married (Dennis et al., 2007; Jorm
et al., 1995).
DOI: 10.1027/0227-5910/a000079
Crisis 2011; Vol. 32(4):194–203 © 2011 Hogrefe Publishing