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Desire to die among older people often transient, study finds

Original article featured in The Irish Times. Link to article is here.

Improving mental health care should form part of assisted dying talks, researcher says.

Researchers from Trinity College have found that the “wish to die” among older people living in the community is often “transient” and is strongly linked to depression and feelings of loneliness.

A survey of more than 8,100 people aged over 50 as part of the Irish Longitudinal Study on Ageing (Tilda) found that 4 per cent of people surveyed expressed a wish to die. However, almost three-quarters of those who initially expressed this desire did not feel the same when researchers revisited the issue with them two years later.

The Tilda research, which is a large-scale, nationally-representative study, found that 60 per cent of those who reported a wish to die had co-existing depressive symptoms while half of those who stated they wanted to die had been diagnosed with depression. This indicates a “high burden of undetected mental health problems” in the group, the authors said.

Almost three-quarters of those with a wish to die were also lonely, the study found. Those who subsequently said two years later that they no longer felt the wish to die reported that their symptoms of loneliness and depression had improved.

Some 15 per cent of those who expressed this wish actually died during the study’s six-year follow-up period, it added.

Mental Health Care

The report’s authors noted that their findings are particularly pertinent given the consideration of the Dying with Dignity Bill by the Oireachtas Committee on Justice and have called for an “enhanced focus on improving access to mental health care and addressing social isolation in older people” , particularly in the context of the Covid-19 pandemic.

Dr Robert Briggs, consultant geriatrician at St James’ Hospital and author of the study, said most older people with a wish to die and co-existing depression had not been formally diagnosed with depression nor had they received appropriate mental health treatment. “Less than one-tenth had received psychological counselling,” said Dr Briggs.

“An enhanced focus on improving access to mental health care should therefore form an important part of any discussion around assisted dying in later life.”

Prof Rose Anne Kenny, head of medical gerontology at Trinity College and consultant geriatrician, who was a senior author on the study, said the Tilda findings should help inform legislators and practitioners as they consider the complex issue of assisted dying.

She noted that almost two-thirds of participants who expressed a wish to die in the study had at least one chronic illness which meets the criteria for a terminal illness as proposed in the Bill..

Remediable factors

“This study demonstrates that a wish to die in later life is often transient but is closely linked with remediable factors such as loneliness and social isolation, the burden of which is likely to increase significantly during the Covid-19 pandemic,” said Prof Kenny.

The Dying with Dignity Bill tabled by People Before Profit TD Gino Kenny last year, which seeks to legalise assisted dying, has attracted both support and condemnation from medical practitioners across Ireland.

A group of 100 doctors told the Oireachtas committee in its submission on the legislation last month that medically-assisted dying could be introduced in a “safe and fair manner” and that in cases of terminal illness, “patients deserve to have their choice respected”.

However, palliative care consultants have described the bill as “deeply flawed” and say it lacks the adequate safeguards to ensure society’s most vulnerable are not pressurised into seeking assisted suicide. The group also warned that the Bill’s definition of what constitutes a terminal illness was too broad.

Doctors in favour of the legislation say the Bill’s criteria for qualifying for assisted dying is appropriately “conservative and restrictive” and that the safeguards proposed are “conservative, balanced and fair”.

To read the full report visit here.