Background: The wish to die has mainly been studied in terminally-
ill young adults. In elderly persons, factors associated with the
wish to die are likely to differ from those observed in younger people.
Since the most frequently used scale -"The Schedule ofAttitudes Toward
Hastened Death" (SAHD, Rosenfeld et al., 2000)- was previously
used in terminally ill cancer or AIDS patients, its use in elderly
people suffering from multiple comorbidities is problematic. The objectives
of this study were 1) to adapt the SAHD for use in elderly
people, 2) to develop a new instrument to assess patients' attitudes towards
death 3) to test the relevance/acceptability of these instruments.
Methods:An adapted version of the SAHD to the elderly population
(SAHD-OLD) was obtained by analyzing all items of the instrument
instrument
in an interdisciplinary group of experts in geriatric care.
Items were modified according to their relevance in elderly population.
An instrument to assess patients' attitudes towards death was
built on previous qualitative work performed by Schroepfer. These 2
instruments were subjected to cognitive testing in a convenience sample
of 11 community-dwelling people (median age = 82 years; range
76-91).
Results: The SAHD-OLD was obtained by modifying those
items addressing palliative care issues (eg. irreversible consequences
of stopping treatment) and systematically replacing "illness/disease"
by "health problems". We expressed in statements the 6 categories
identified by Schroepfer, and created instructions asking respondents
to describe their current attitude towards death (Adapted
Schroepfer). During cognitive testing, our sample assessed the
SAHD-OLD and the Adapted Schroepfer as relevant for elderly
people. Respondents judged these 2 instruments acceptable and appreciated
the direct manner in which they addressed end of life issues.
The opportunity to speak openly on this topic was welcomed.
Conclusions: The SAHD-OLD and the Adapted Schroepfer
seem promising instruments to assess the wish to die in elderly people
suffering from multiple comorbidities. Preliminary results show good
comprehension, high relevance and acceptability. Psychometric properties
of the SAHD-OLD are currently being tested in a large sample
of patients.