Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

BACKGROUND

Older adults are at risk of assisted and self-initiated suicide. The links between prior attempts and assisted suicide in the elderly have not been investigated. Hence, we aimed to investigate and describe the occurrence, timing and determinants of suicide attempts prior to assisted and self-initiated suicide.

METHODS

We developed a retrospective study of all assisted and self-initiated suicides among people over 65 years in the canton of Geneva, Switzerland, for a 10-year period (2010-2019). Cases were identified by cross-referencing hospitals' routinely collected electronic data and a forensic report database. Cases were characterised in terms of sociodemographic factors, mental health disorders, main comorbidities, temporal sequence, methods of injury, medical complications and disclosure rates of previous attempts. The study used descriptive statistics.

RESULTS

A total of 26 of 497 (5.2%) and 20 of 149 (13.4%) older adults had made previous attempts before assisted and self-initiated suicide, respectively. More than half of them had made a single attempt, mostly by medication poisoning, sometimes more than 10 years before dying. Individuals who made two attempts were significantly more represented among the assisted suicide decedents. One self-initiated suicide decedent and half of the assisted suicide cases had disclosed that they had considered suicide. Individual characteristics were similar, except for assisted suicide decedents, who were eight years older than self-initiated suicide decedents. Almost all the individuals had mental disorders. Depression, anxiety and chronic pain were particularly prevalent among decedents of assisted suicide. The substantial representation of women in both groups may be an indication of their vulnerability, possibly related to chronic pain and life stressors.

CONCLUSIONS

Our results show commonalities between older assisted and self-initiated suicide decedents who made an attempt (s) before suicide. Further research is needed to demonstrate the overlap between the determinants of assisted suicide and other forms of suicidality and to support a suicide prevention strategy applicable to both types of suicide.

Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study

OBJECTIVES

The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents.

DESIGN

Multisite cross-sectional observational study.

SETTING AND PARTICIPANTS

31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment.

METHODS

Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed.

RESULTS

From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66).

CONCLUSIONS AND IMPLICATIONS

The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.

Dimensions of end-of-life preferences in the Swiss general population aged 55+

BACKGROUND

understanding end-of-life preferences in the general population and how they are structured in people's minds is essential to inform how to better shape healthcare services in accordance with population expectations for their end of life and optimise communication on end-of-life care issues.

OBJECTIVE

explore key dimensions underlying end-of-life preferences in a nationally representative sample of adults aged 55 and over in Switzerland.

METHODS

respondents (n = 2,514) to the Swiss version of the Survey of Health, Ageing and Retirement in Europe assessed the importance of 23 end-of-life items on a 4-point Likert scale. The factorial structure of the underlying end-of-life preferences was examined using exploratory structural equation modelling.

RESULTS

four dimensions underlying end-of-life preferences were identified: a medical dimension including aspects related to pain management and the maintenance of physical and cognitive abilities; a psychosocial dimension encompassing aspects related to social and spiritual support; a control dimension addressing the need to achieve some control and to put things in order before death; and a burden dimension reflecting wishes not to be a burden to others and to feel useful to others.

CONCLUSION

highlighting the multi-dimensionality of end-of-life preferences, our results reaffirm the importance of a holistic and comprehensive approach to the end of life. Our results also provide a general framework that may guide the development of information and awareness campaigns on end-of-life care issues in the general population, informational materials and guidelines to support healthy individuals in end-of-life thinking and planning, and advance directive templates appropriate for healthy individuals.

The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019

This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.