Trinity research reveals ‘wish to die’ linked to loneliness and depression in older adults

New Trinity study outlines greater need for mental health support to tackle ‘wish to die’.

Scientists at The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin have released fresh research findings outlining the frequency in which older people in Ireland express a ‘wish to die’, including thoughts of one’s own death, that one would be better off dead, or wishing for one’s death. The findings are published in the journal Age and Ageing today (Thursday, 18th February 2021).

The research, involving a large population of over 8,000 community-dwelling older people, examines the prevalence of those who wish to die, how closely it is linked with depression and loneliness and the likelihood that the wish to die persists over time.

Researchers found that almost 4% of people surveyed, who were over the age of 50, expressed a wish to die, however research shows that these feelings were transient for most, and did not persist in over 70% of participants surveyed two years later.

Researchers propose that an enhanced focus on improving access to mental health care is needed, in addition to addressing social isolation in older people should therefore be a public health priority. This is particularly pertinent in the current contest of the COVID-19 pandemic.

Assisted dying and wish to die

Assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life. Currently, in Ireland, it is illegal to provide such assistance to those who express a wish to die or suicidal thoughts. However, a new bill to legalise assisted dying for those with terminal illnesses, the Dying with Dignity Bill 2020, is due to be considered in the coming months. These findings are particularly pertinent in Ireland where lawmakers are considering the provision of assistance to die for those living with terminal illness.

What are the key findings of the study?

  • One out of 29 community-dwelling older people reported that during the preceding month they had felt that they would rather be dead.
  • 60% of those who reported a wish to die had co-existing depressive symptoms.
  • Over half of those with a wish to die and depressive symptoms had been diagnosed with depression, indicating a high burden of undetected mental health problems in this group.
  • Almost three quarters of those with a wish to die were also lonely.
  • Seventy-two per cent of these participants no longer reported a wish to die when reassessed 2 years later, indicating that in many cases the wish to die did not persist.
  • In cases where wish to die did not persist, loneliness and depressive symptoms also improved significantly, suggesting an important link.
  • These finding are particularly relevant given the current debate around proposed legislation for assisted dying and the Dying with Dignity Bill 2020.

Dr Robert Briggs, Medical Gerontology, Trinity College and Consultant Geriatrician, St James’s Hospital, Dublin and first author of the study said:

‘These findings demonstrate the close association between depression and the wish to die in later life. Most older people with both a wish to die and co-existing depression had not been formally diagnosed with depression, nor received appropriate mental health treatment. Less than one tenth had received psychological counselling. 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.’

Professor Rose Anne Kenny, Head of Medical Gerontology, Trinity College and Consultant Geriatrician, St James’s Hospital, Dublin, and senior author of the study said:

‘The timing of these findings greatly increases their importance and they should inform the decision of legislators and practitioners as they consider the complex issue of assisted dying in the Dying with Dignity Bill 2020. Almost two-thirds of participants expressing a wish to die in this study have at least one chronic illness; meeting the criteria for a ‘terminal illness’ as proposed in the bill.

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.’

To view the study ‘The ‘Wish to Die’ in later life: prevalence, longitudinal course and mortality. Data from TILDA’, as published in Age and Ageing, visit: https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afab010/6133225

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