To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period.

Population-based study using data from the National Self-Harm Registry Ireland.

National hospital EDs.

Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019.

ED self-harm presentations.

Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60–69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007–2012), self-harm presentations were 7% higher compared to 2013–2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02–1.13, p = 0.01).

Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007–2012) had significantly higher rates of self-harm compared to subsequent years.

Vascular dementia (VD) is one of the more common types of dementia. Much is known about VD in older adults in terms of survival and associated risk factors, but comparatively less is known about VD in a younger population. This study aimed to investigate survival in people with young-onset VD (YO-VD) compared to those with late-onset VD (LO-VD) and to investigate predictors of mortality.

Retrospective file review from 1992 to 2014.

The inpatient unit of a tertiary neuropsychiatry service in Victoria, Australia.

Inpatients with a diagnosis of VD.

Mortality information was obtained from the Australian Institute of Health and Welfare. Clinical variables included age of onset, sex, vascular risk factors, structural neuroimaging, and Hachinksi scores. Statistical analyses used were Kaplan–Meier curves for median survival and Cox regression for predictors of mortality.

Eighty-four participants were included with few clinical differences between the LO-VD and YO-VD groups. Sixty-eight (81%) had died. Median survival was 9.9 years (95% confidence interval 7.9, 11.7), with those with LO-VD having significantly shorter survival compared to those with YO-VD (6.1 years and 12.8 years, respectively) and proportionally more with LO-VD had died (94.6%) compared to those with YO-VD (67.5%), χ2(1) = 9.16, p = 0.002. The only significant predictor of mortality was increasing age (p = 0.001).

While there were few clinical differences, and older age was the only factor associated with survival, further research into the effects of managing cardiovascular risk factors and their impact on survival are recommended.

To analyze how people cope with suicide loss and the implications for primary health care.

Previous studies have shown that primary health care will often be an initial source of support for those bereaved by suicide.

We included adult persons who were ready to talk about a suicide completed by a person they knew well (family member or close friend). Participants were recruited via mixed media (television, radio, print, social media, etc.). Altogether, we conducted 37 individual interviews, which were recorded using a dictaphone and lasted from 46 to 158 min. The interviews were transcribed verbatim and analyzed using a content analysis method. The interviewees were mostly women (n = 27) and family members (n = 28) of a person who had died by suicide during the years 2012–2018.

We identified two main themes in the data: supporters and barriers in support. Coping with suicide takes time, and support was mostly found among friends and family. Support from GPs was mentioned in the context of diagnosing medical problems and prescribing medicines. Respondents indicated that feeling ashamed and a lack of trust impeded their willingness to seek help from their GP. Unmet needs among the bereaved may increase their risk of diminished mental health outcomes. Thus, primary health care practitioners may have a substantial opportunity to support those who are bereaved by suicide.

Primary care providers have an opportunity to provide bereavement support among their patients. Continuing medical education regarding the needs of the bereaved and a coordinated approach among primary care practitioners may be useful to proactively identifying and supporting those in need.

Rates of suicide in older adults may be higher than reported due to poor understandings of presentation of suicide ideation in this group. The objectives of this paper were to (i) review current measurement tools designed for older adults to detect suicide ideation and (ii) assess their psychometric properties.

We used a systematic review approach to identify measurement tools developed specifically for older adults without cognitive decline or impairment.

Ten articles that reported on a total of seven different measurement tools were identified. These included tools that focused on resiliency to suicide and those that measured risk of suicide behavior. There was wide variation across the articles: some were adaptations of existing scales to suit older populations, others were developed by authors; they varied in length from four to 69 items; a range of settings was used, and there was a mix of self-report and clinician-administered measures. Most displayed good psychometric properties, with both approaches showing similar quality. Limitations in terms of samples, settings, and measurement design are discussed.

The case for specific measures for older adults is clear from this review. There appear to be unique factors that should be considered in understanding suicide ideation and behavior among older adults that may not be directly assessed in non-specific measurements. However, there is a need to expand the diversity of individuals included in measurement development to ensure they are appropriate across gender, culture and minority status, and for the views of professionals to be considered.

To conceptualize a “good end of life” for people with dementia from the perspectives of bereaved family caregivers in Japan.

A qualitative study using in-depth, semi-structured interviews focused on the family caregivers’ perceptions of their loved one’s experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted.

From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a “Peaceful Death” while “Maintaining Personhood” at a “Preferred Place” allowing for feelings of “Life Satisfaction.” A “Preferred Place” emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, “Maintaining Personhood.” However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a “Preferred Place.”

Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort.

Ethics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2)

The Ars moriendi was a book written in the early 15th century with the goal of assisting friars in their work of helping the dying. The aim of our study was to review the current literature on the Ars Moriendi concerning the field of medicine, to analyze the psychological mechanisms for coping with death anxiety within Ars Moriendi, and to explore parallels between the strategies used in the medieval book and in contemporary literature about death and dying.

A review of literature using Pubmed, EMBASE, JSTOR, Project MUSE, and the New York Public Library was undertaken first. The primary source was then interpreted from a medical/psychological point of view.

Seven articles were selected by literature review. These works comment on the importance of the Ars Moriendi in its historical context and explore the possibility of retrieving the principles of the text in contemporary society. The original text of Ars Moriendi, the primary source, presents death as a relief from the sufferings of earthly life and a gateway to eternal glory. According to the author, a good death implied the triumph over five demonic temptations in agonizing people: a lack of faith, despair, impatience, pride and greed.

Analyzed from a modern psychiatric perspective, the Ars Moriendi offers descriptions of behavioral manifestations compatible with delirium, mood and anxiety disorders that characterize people with terminal illnesses. Moreover, we also explored parallels between the strategies used to cope with death anxiety in the Late Middle Ages and in contemporary society.

Physical health has been demonstrated to mediate the mental health and mortality risk association. The current study examines an alternative hypothesis that mental health mediates the effect of physical health on mortality risk.

Participants (N = 14,019; women = 91%), including eventual decedents (n = 3,752), were aged 70 years and older, and drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Participants were observed on two to four occasions, over a 10-year period. Mediation analysis compared the converse mediation of physical and mental health on mortality risk.

For men, neither physical nor mental health was associated with mortality risk. For women, poor mental health reported only a small effect on mortality risk (Hazard Risk (HR) = 1.01; p < 0.001); more substantive was the risk of low physical health (HR = 1.04; p < 0.001). No mediation effects were observed.

Mental health effects on mortality were fully attenuated by physical health in men, and partially so in women. Neither mental nor physical health mediated the effect of each other on mortality risk for either gender. We conclude that physical health is a stronger predictor of mortality risk than mental health.

This study investigates the views on death among cancer patients in Japan and examines how these views are related to age, sex, and physical condition. We also investigate how these views are related to where patients would like to spend their final days and whether or not they would like to be told how long they have left to live.

We targeted 450 cancer patients receiving outpatient treatment in the radiology department at the University of Tokyo Hospital. We used the Death Attitudes Inventory (DAI) developed by Hirai to measure attitudes about death.

Of the 450 patients approached, we received responses from 310 (69% collection rate). The results of the t test and one-way ANOVA showed that, in terms of “death anxiety/fear,” the under-65 group (17.73 ± 6.69) scored significantly higher than the 65-and-over group (15.43 ± 7.69, t = 2.685, df = 280, p < 0.01); the group with KPS scores 70 or above (16.88 ± 7.21) scored higher than the group with KPS scores below 70 (12.73 ± 7.09, t = 2.168, df = 280, p = 0.03); and no significant difference was found for sex, metastasis, or treatment stage.

Our results demonstrate that, although views on death among cancer patients may differ according to sex, age, and physical condition, taking these factors into account when understanding such views can be useful in predicting where patients may wish to spend their final days.

Death wishes are not uncommon in older persons, and to date, several risk factors have been identified. The presence of these risk factors is insufficient to fully understand why some older people, who are exposed to them, develop a wish to die and why others do not. The purpose of the study was to explore whether Purpose in Life as well as other life attitudes are associated with a death wish in older males and females.

The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the SCID-II. Logistic regression analyses estimated the unique contribution of (the interaction between) life attitudes and gender to the wish to die, controlling for sociodemographic variables, depressive disorder, and somatic symptoms.

We observed a statistically significant relationship between life attitudes and the wish to die. Purpose in Life and the Purpose in Life*Gender interaction explained significant additional variance in the prediction of the wish to die. Purposelessness in life might therefore be an important correlate of a wish to die, especially in older men, independently from sociodemographic and clinical features.

In assessing a wish to die in older adults, life attitudes need to be taken into account, besides the presence of a depressive disorder and/or somatic health. More specifically, finding or maintaining a purpose in later life might be an important feature in the prevention of the wish to die, especially in male persons.

With spirituality being one of the most important components of end-of-life (EOL) care, this study explored the oral responses of 44 dying persons who expressed spirituality.

Four identified spiritual themes: religious systems of beliefs and values, life meaning, purpose and connections with others, nonreligious systems of beliefs and values, and metaphysical or transcendental phenomena served as a framework for a content analysis of 91 spiritual references.

From the content analysis, eight interrelated and separate themes emerged. Although the highest number of responses centered on religious beliefs and values, nonreligious beliefs and values that included reason, dignity, mental discipline, and communion were expressed. The themes of life meaning, purpose, and connections with others also surfaced as important aspects of EOL spirituality.

The findings support the need for hospice/palliative care professionals to approach spirituality from other than a Judeo-Christian viewpoint, help dying persons create meaning and purpose within the context of their lives, and assist them in their desire for connectedness to faith communities and other significant individuals in their lives.

End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Despite this, there is little DNR utilization data to guide the design of communication-training programs. The objective of this study was to determine DNR utilization patterns and whether their use is increasing.

A retrospective database analysis (2000–2005) of DNR data for 206,437 patients, the entire patient population at Memorial Sloan-Kettering Cancer Center (MSKCC), was performed.

The hospital recorded, on average, 4,167 deaths/year. In 2005, 86% of inpatient deaths had a DNR, a 3% increase since 2000 (p < .01). For patients who died outside the institution (e.g., hospice), 52% had a DNR, a 24% increase over 6 years (p < .00001). Adult inpatients signed 53% of DNRs but 34% were signed by surrogates. The median time between signing and death was 0 days, that is, the day of death. Only 5.5% of inpatient deaths had previously signed an outpatient DNR. Here, the median time between signing and death was 30 days.

Although DNR directives are commonly utilized and their use has increased significantly over the past 6 years, most cancer patients/surrogates sign the directives on the day of death. The proximity between signing and death may be a marker of delayed end-of-life palliative care and suboptimal doctor–patient communication. These data underscore the importance of communication-training research tailored to improve end-of-life decision making.

This qualitative research study listens to the narratives of people experiencing the dying process who attended the Otago Community Hospice, Dunedin, New Zealand.

Ten people, aged between 51 and 65, were approached; two declined and one died sooner than expected. All were women (although this was not part of the original design) and all had carcinoma. Data for the study was sought through qualitative research interviews, considering the development of each participant's illness in relation to her perception of her embodiment in the palliative care setting, and concluding with questions about what she wants the people who care for and about her to learn from her experience. Consistent with this phenomenological approach, the method of analysis was thematic and interpretive.

The main theme was the uncertainty that all participants felt throughout the diagnostic process and during treatment. Uncertainty, too, was a factor in how they managed their day, whether they would be able to sustain an outing or an activity or not and whether they would be pain free. None were afraid of dying but hoped that when they did die, they would do so comfortably. The relationship with their general practitioners varied. Where fatigue or the effects of medication were not an issue, they could think clearly, but their bodies were experienced as letting them down and limiting their activities. The ideal of “living until you die” was not able to be fulfilled. The increasing approach of social death as they withdrew from their employment and social responsibilities affected them.

Whether one has a “good death” or not is determined not only by the progression and management of the disease process by health professionals, but also by the way in which one is perceived, by self and others. There are no guidelines for the dying role; everybody dies differently and individually.