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

J Am Geriatr Soc. 2020 Jun;68(6):1202-1209. doi: 10.1111/jgs.16392. Epub 2020 Feb 29.


Objectives: The wish to die may be different in geriatric patients than in younger terminally ill patients. This study aimed to develop and validate instruments for assessing the wish to die in geriatric patients.

Design: Cross-sectional study.

Setting: Geriatric rehabilitation unit of a university hospital.

Participants: Patients (N = 101) aged 65 years or older with a Mini-Mental State Examination score of 20 or higher, admitted consecutively over a 5-month period.

Measurements: The Schedule of Attitudes Toward Hastened Death (SAHD) was adapted to the older population (SAHD-Senior). A second tool was developed based on qualitative literature, the Categories of Attitudes Toward Death Occurrence (CADO). After cognitive pretesting, these instruments were validated in a sample of patients admitted to a geriatric rehabilitation unit.

Results: The SAHD-Senior showed good psychometric properties and a unifactorial structure. In the studied sample, 12.9% had a SAHD-Senior score of 10 or higher, suggesting a significant wish to die. Associations were observed between high levels of the SAHD-Senior and advanced age, high levels of depressive symptoms, lower quality of life, and lower cognitive function. The CADO allowed for passive death wishes to be distinguished from wishes to actively hasten death. According to the CADO, 14.9% of the sample had a wish to die. The two instruments showed a concordance rate of 90.1%.

Conclusion: The wish to die in older patients admitted to rehabilitation can be validly assessed with two novel instruments. The considerable proportion with a wish to die warrants investigation into concept, determinants, and management of the wish to die. J Am Geriatr Soc 68:1202-1209, 2020.

Keywords: desire for hastened death; evaluation tools; older persons; palliative care; wish to die.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Attitude to Death*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Psychometrics / statistics & numerical data*
  • Quality of Life / psychology*
  • Rehabilitation*
  • Reproducibility of Results
  • Surveys and Questionnaires / standards*