To Plan or Not to Plan? Experiences and Challenges of Older Swiss Adults Facing End-of-Life Decisions.

End-of-life (EoL) planning and the drafting of advance care directives (ACD) are challenging for older adults. As part of a mixed study, the content of 18 semi-structured interviews with Swiss community-dwelling older adults was analyzed to investigate contextual and interactional aspects that might influence their choice to complete ACD. Results show that EoL planning vary greatly. Three types of planners were highlighted: the solo planners, the collaborative planners, and the delegators. Each represents a specific way of conceiving autonomy, the usefulness of ACD and of involving third parties in the decision-making process. Whereas for solo planners, ACD is a personal, rational affair, for collaborative planners and delegators, reflection and decisions on EoL issues are interactional and iterative processes. The results suggest that health and social care professionals would benefit from taking into consideration the various types of planning, in order to provide the best support to older adults for ACD completion.

A systematic review of psychosocial protective factors against suicide and suicidality among older adults.

BACKGROUND: Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. METHOD: First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. RESULTS: A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. CONCLUSION: Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Suicidal Ideation in Canadian Family Caregivers for a Person with Dementia: A Portrait of the Situation.

This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.

Character Strengths and Resilience in Older Adults during the COVID-19 Pandemic.

During the pandemic, older adults were perceived as a vulnerable group without considering their various strengths. This study explored the associations between character strengths and resilience, and verified if some of these could predict resilience during the COVID-19 pandemic. A sample of 92 participants (women = 79.1%), ≥ 70 years of age (mean = 75.6 years), completed an online version of the Values in Action Inventory of Strengths - Positively keyed (VIA-IS-P) to assess 24 character strengths (grouped under six virtues) and the Connor and Davidson Resilience Scale. Results showed that 20 of the 24 strengths correlated positively and significantly with resilience. A multiple regression analysis revealed that the virtues of courage and transcendence, as well as attitudes toward aging, uniquely predicted the level of resilience. Interventions should be developed to improve certain strengths (e.g., creativity, zest, hope, humor, and curiosity), while reducing ageism, in order to promote resilience.

Perception of Medical Assistance in Dying Among Asian Buddhists Living in Montreal, Canada.

In the Western world including Canada, grievous and irredeemable health conditions, which cause unbearable suffering, has given support to the legalization of medical aid in dying (MAiD). It is unknown how Asian Buddhists who are in contact with the Western culture perceive MAiD. In this qualitative study, 16 Asian Buddhists living in Montreal took part in a semi-structured interview. Contrary to general findings in the literature, religious affiliation do not always determine moral stances and practical decisions when it comes to MAiD. Some participants were willing to take some freedom with the doctrine and based their approval of MAiD on the right to self-determination. Those who disapproved the use of MAiD perceived it as causing unnatural death, creating bad karma, and interfering with a conscious death. End-of-life (EoL) care providers have to remain sensitive to each patient's spiritual principles and beliefs to understand their needs and choices for EoL care.

Perception of death and preference for end-of-life care among Asian Buddhists living in Montreal, Canada.

Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.

Will they let me die? Perspectives of older Swiss adults on end-of-life issues.

This article contributes to scientific discussion with regard to the interplay of individual and social factors on end-of-life decisions. Semi-directed interviews (N = 18) with people over 65 years highlighted two different but articulated fears in relation to end-of-life care: on one hand, older adults fear not being allowed to die and being subjected to therapeutic obstinacy; on the other, they fear not being cared for properly, due to their age and a lack of financial resources in the health and social care system. Recommendations are given to assist professionals in discussing these fears with the people concerned and their families.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study.

PURPOSE: The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time. METHODS: The sample was made up of 44 participants (19 men and 25 women) aged 65-85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to ("why" and "how") optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later. RESULTS: Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants' sleep along with their sleep efficacy also increased significantly during the same period. CONCLUSION: A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.

The Experience of Adults Bereaved by the Suicide of a Close Elderly Relative: A Qualitative Pilot Study.

Suicide in older persons is a serious issue in many countries. The act of intentionally causing one's own death is often associated with lack of social support, thwarted belongingness, or chronic interpersonal difficulties. Therefore, suicide has a significant interpersonal dimension that can influence those left behind. However, studies that have investigated the impact of older adults' suicide on their family are scarce. The objective of this pilot study was to assess the feasibility of a qualitative research on the psychosocial experience of adults bereaved by the suicide of an elderly relative. This research could recruit three participants (daughter, grand-son, and grand-niece) who had lost to suicide a close family member aged between 75 and 90. The analysis of the content of the semi-structured interviews revealed seven main themes: (1) finding an explanation to the suicide, (2) give meaning to the loss, (3) the emotional processes of mourning, (4) the repercussions of the suicide on the individual and the family, (5) looking for support, (6) the taboo and secrecy of suicide, and (7) perceptions of aging and the end of life. To explain the suicide of their loved one, the bereaved mentioned various factors related to aging, such as loss of autonomy, illness, and fear of placement. Although the older relative was perceived to be approaching death because of his/her age, the suicide was still unexpected and shocking and led to various emotions (shock, anger, and guilt) and to family conflicts. Suicide remains a taboo subject, but the newly legalized medical assistance in dying is seen as a potential solution to suffering in old age. Further investigation is clearly needed on this topic and this pilot study indicates that the main difficulties will lie in the choice of selection criteria for participants and in the recruitment process.

Social Interactions among Older Adults Who Wish for Death.

Objectives: When the need for relatedness is frustrated, some older adults feel that life is not worth living and wish for death (WD). The aim of this study was to look at the perception of social interactions among older adults who express the WD.Methods: A probabilistic sample of 2787 French-speaking community-dwelling older adults aged 65 to 96 years (M = 73.8) took part in the Seniors Health Survey, a study on the prevalence of mental disorders which also collected information on various demographic and social variables.Results: Results showed that 5% of participants expressed WD. Participants who WD felt significantly more isolated and in conflict with their children than participants without WD. When sociodemographic variables, self-rated physical health, and depression were controlled, three social variables predicted WD in a logistic regression: being distant toward others, dissatisfaction with social life, and a lack of participation in organizations.Conclusions: Results of the present study support the interpersonal theory of suicide, which suggests that self-reported thwarted belongingness can foster WD.Clinical implications: Clinicians should consider social dissatisfaction and withdrawal as risk factors for WD and design interventions that foster social skills or meaningful connections.

Factors involved in sleep efficiency: a population-based study of community-dwelling elderly persons.

STUDY OBJECTIVES: Research indicates that sleep efficiency below 80% substantially increases mortality risk in elderly persons. The aim of this study was to identify factors that would best predict poor sleep efficiency in the elderly, and to determine whether associations between these factors and sleep efficiency were similar for men and women and for younger and older elderly persons. METHODS: A total of 2468 individuals aged 65-96 years (40.7% men) participated. They were recruited via random generation of telephone numbers according to a geographic sampling strategy. The participants agreed to have health professionals visit their home and to answer structured interview questions. Sleep efficiency was calculated based on interview responses. Descriptive statistics and logistic regressions were conducted. RESULTS: The factors most strongly associated with sleep efficiency below 80% were pain, nocturia, sleep medication use, and awakening from bad dreams. Some factors varied by sex: women aged 75 years and older or who had an anxiety disorder were more likely to have sleep efficiency below 80%, whereas being single or having painful illness raised the likelihood for men only. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly persons similarly. CONCLUSIONS: Poor sleep efficiency is prevalent among elderly persons. The results shed new light on factors associated with poor sleep efficiency, highlighting the presence of sex differences and that certain factors make no significant contribution, such as typically proscribed sleep hygiene behaviors, mood disorders, and illness in general.

Sleep Environment and Insomnia in Elderly Persons Living at Home.

The aim of this study was to draw a portrait of the sleep environment of elderly persons living in private households and to determine its relationship with the presence of insomnia. A sample of 599 individuals aged 70 years and older responded to questions about the comfort of their pillow and mattress and the noise level and brightness of their bedroom at night and in the morning. They were also asked whether or not they shared their bed or bedroom with a sleep partner. The Insomnia Severity Index was used to assess insomnia severity. Over 40% of the study participants were using a pillow that was not very comfortable, and almost 30% said that their bedroom was not completely quiet. Binomial logistic regression results revealed that two variables were significantly associated with insomnia symptoms: a pillow rated as moderately comfortable to very uncomfortable and a bedroom that was not completely quiet. No other sleep environment characteristics considered in this study were associated with the risk of insomnia. These results indicate that a nonnegligible proportion of the elderly population endures a suboptimal sleep environment. Although it is difficult to predict the real impact of changes to the sleep environment, this study supports the proposal that simple, minor changes to the bedroom can promote sleep in the elderly.

A systematic review of physical illness, functional disability, and suicidal behaviour among older adults.

OBJECTIVES: To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. METHOD: Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. RESULTS: Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. CONCLUSION: Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.

A systematic review of social factors and suicidal behavior in older adulthood.

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND: Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS: With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS: Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION: Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.

Key considerations for preventing suicide in older adults: consensus opinions of an expert panel.

BACKGROUND: The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide. AIMS: To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS: An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS: A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations. CONCLUSIONS: The suggestions span a wide range and are offered for consideration by local groups preparing new interventions, as well as large scale public health care planning.

A systematic review of elderly suicide prevention programs.

BACKGROUND: Suicide rates are highest among the elderly, yet research on suicide prevention in old age remains a much-neglected area. AIMS: We carried out a systematic review to examine the results of interventions aimed at suicidal elderly persons and to identify successful strategies and areas needing further exploration. METHODS: Searches through various electronic databases yielded 19 studies with an empirical evaluation of a suicide prevention or intervention program designed especially for adults aged 60 years and older. RESULTS: Most studies were centered on the reduction of risk factors (depression screening and treatment, and decreasing isolation), but when gender was considered, programs were mostly efficient for women. The empirical evaluations of programs attending to the needs of high-risk older adults seemed positive; most studies showed a reduction in the level of suicidal ideation of patients or in the suicide rate of the participating communities. However, not all studies used measures of suicidality to evaluate the outcome of the intervention, and rarely did they aim at improving protective factors. CONCLUSIONS: Innovative strategies should improve resilience and positive aging, engage family and community gatekeepers, use telecommunications to reach vulnerable older adult, and evaluate the effects of means restriction and physicians education on elderly suicide.

[Relocation in a nursing home of a spouse with cognitive impairment: experience of wives]. / Le relogement en centre d'hébergement d'un conjoint atteint de problèmes cognitifs: l'expérience des epouses.

The goal of this phenomenological study was to describe the experience of wives during the relocation to a long-term care facility of their spouse with cognitive impairment. Four wives shared their experience four to six weeks after the relocation of their husband. The process involved four phases: decision making, a long waiting period before relocation, the adjustment to the living accommodation, and the new direction of their life. For the wives, the decision making was characterized by numerous disillusions involving a lack of support from their children and their social service providers. The waiting period to find a location is exhausting for the wives bringing them to intimidate the interveners ; hoping to accelerate the process of finding living accommodations. Once a location is found, the spouses are generally relieved and content with their new surroundings even though they remain concerned with the security of their spouse. In conclusion, the reorganization of their life is very difficult seeing as they experience a significant loss of revenue due to incurred living accommodation expenses and maintaining their responsibility for their husband.

Addressing suicidal ideations through the realization of meaningful personal goals.

A personal goal intervention program was offered to early retirees aged 50 to 65 years with the objective of increasing their subjective well-being. The program was aimed at helping the participants set, plan, pursue, and realize their personal goals. A subsample of 21 participants with suicidal ideas was identified from a larger sample (N = 354) of retirees living in the community who took part in the study to evaluate the program. The experimental (n = 10) and control (n = 11) groups were compared on their answers to 16 goal and psychological well-being questionnaires. By the end of the program, the experimental group had improved significantly more than the control group on hope, goal realization process, serenity, flexibility, and positive attitude toward retirement. The levels of depression and psychological distress significantly decreased. These gains were maintained 6 months later. The positive results obtained from this study could lead to an innovative way to help people with suicidal ideations.