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Terminal cancer and suicide in older people; clinical characteristics and motives

(2016) Douwes, G. (Gwendolyn)

Background: Terminally ill people represent a unique group where suicide may be considered as a rational and ethical act. Given their limited life expectancy and wish to reduce suffering, terminally ill people may exert their self-determination and autonomy by ending their life. Objectives: The aims of this study are to [i.] compare the socio-demographic and clinical variables of two groups of older people who completed suicide: those with advanced cancer and those without; and [ii] examine qualitatively whether the advanced cancer cases could be defined as rational suicide.
Methods: The New Zealand Coronial Services provided records of all suicide cases aged 65 years and over (n=225) between July 2007 and December 2012. We were able to determine whether there was an advanced cancer in 214 cases.
Findings: 23 (10.7%) older people who completed suicide were diagnosed with an advanced cancer. Bivariate analysis found that they were more likely to be male (91.3% versus 72.3%, p=0.048), married or in a defacto relationship (78.3% versus 46.1%, p=0.014); but less likely to have a diagnosis of depression (8.7% versus 46.6%, p=0.001), previous contact with psychiatric services (4.5% versus 35.0%, p=0.004) and past suicide attempt (9.1% versus 28.8%, p=0.048). Next to that the circumstances of 82.6 % of the advanced cancer patients who died by suicide were conceived as ‘understandable for uninvolved observers’.
Conclusions: With a growing elderly population and higher rates of suicide within the elderly, late-life suicide is becoming more prevalent. The diagnosis of terminal illness is higher amongst elderly. Further research is needed to delineate motives and suicide risks for terminally ill patients. More knowledge and understanding can offer the patient more targeted care and an earlier/better relieve of their mental and physical suffering.





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