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Walder F, Kobleder A. [Voluntary abstinence from food and fluid. The relatives' perspective: An integrative review]. Pflege 2023. [PMID: 38130160 DOI: 10.1024/1012-5302/a000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Voluntary abstinence from food and fluid. The relatives' perspective: An integrative review Abstract. Background: Unbearable states of suffering can cause a premature wish to die. Voluntary stopping of eating and drinking (VSED) offers a way to autonomously realize this wish. Relatives play a significant role in the process of realizing VESD. So far, it is unclear how relatives experience the supporting process. Aim: This review intends to systematically record experiences of accompanying relatives. Method: Within the framework of an integrative review, we conducted research in MEDLINE®, CINAHL® and PsychINFO®, as well as supplementary research. The selection was based on defined inclusion and exclusion criteria. For the synthesis, we used a thematic model. Results: From the four included studies, it emerged that the accompanying relatives accepted the family members' wish to die. They defended the realization of this wish with responsibility and advocacy until the death of the person wishing to die. As a result of their caring commitment, they neglected their own needs. Most relatives assessed the accompaniment as peaceful and dignified. Conclusion: Accompanying the VSED process represents an emotional tightrope walk with unfamiliar challenges for relatives. The results can contribute to a deeper understanding of relatives' needs. In this way, the findings can stimulate the derivation of suitable support offers.
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Affiliation(s)
- Fabienne Walder
- Institut für Angewandte Pflegewissenschaft, OST St. Gallen, Schweiz
| | - Andrea Kobleder
- Institut für Angewandte Pflegewissenschaft, OST St. Gallen, Schweiz
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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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Stängle S, Fringer A. "Discussion or silent accompaniment: a grounded theory study about voluntary stopping of eating and drinking in Switzerland". Palliat Care 2022; 21:85. [PMID: 35610598 PMCID: PMC9128132 DOI: 10.1186/s12904-022-00941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Voluntary stopping of eating and drinking as an option to end life prematurely is gaining international attention, and health care professionals are increasingly confronted with the wish to die through voluntary stopping of eating and drinking by individuals. While to date, there are no guidelines in Switzerland to orient professional support, it is of interest how professionals and other people involved react to the situation. The aim of this qualitative study was to explore how health care professionals in Switzerland accompany individuals during voluntary stopping of eating and drinking and to analyze this decision-making process. Methods Charmaz's grounded theory constructivist methodology uses guidelines for systematic, theory-driven data analysis underpinned by a pragmatic philosophical perspective. Data were collected in autumn 2016 as part of a regional palliative care conference on voluntary stopping of eating and drinking. All participants of the expert meeting (N = 50, including nurses, counsellors, ethicists, medical doctors, politicians, volunteers, and relatives) were invited to the focus group interviews, of which N = 47 participated. We conducted five focus group interviews, each lasting one hour. Results The results showed that the accompaniment of those willing to die during voluntary stopping of eating and drinking was either discussed and cleared with one another or was unspoken and silently accompanied. Conclusions The demands of participants for more knowledge must be heeded, and there is also a need for systematic instructions on how to proceed in the case of voluntary stopping of eating and drinking support and what needs to be considered.
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Affiliation(s)
- Sabrina Stängle
- Institute of Nursing, ZHAW School of Health Professions, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. .,Department of Nursing Science, Witten/Herdecke University Faculty of Health, Stockumer Strasse 12, 58453, Witten, Germany.
| | - André Fringer
- Institute of Nursing, ZHAW School of Health Professions, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.,Department of Nursing Science, Witten/Herdecke University Faculty of Health, Stockumer Strasse 12, 58453, Witten, Germany
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Hedna K, Fastbom J, Jonson M, Wilhelmson K, Waern M. Psychoactive medication use and risk of suicide in long-term care facility residents. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5684. [PMID: 35142388 PMCID: PMC9306521 DOI: 10.1002/gps.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. METHODS A Swedish national register-based cohort study of LTFC residents aged ≥75 years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N = 288,305). Fine and Gray regression models were used to analyse associations with suicide. RESULTS The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42-0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46-3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01-24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. CONCLUSIONS A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Statistikkonsulterna ABGothenburgSweden
| | - Johan Fastbom
- Aging Research CenterKarolinska Institute and Stockholm UniversityStockholmSweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and NeurochemistrySahlgrenska Academy, University of GothenburgGothenburgSweden,Affective ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Department of Health and RehabilitationInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden,Department of Acute Medicine and GeriatricsRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Psychosis ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
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Eppel‐Meichlinger J, Stängle S, Mayer H, Fringer A. Family caregivers' advocacy in voluntary stopping of eating and drinking: A holistic multiple case study. Nurs Open 2022; 9:624-636. [PMID: 34751005 PMCID: PMC8685828 DOI: 10.1002/nop2.1109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/26/2021] [Accepted: 10/14/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To gain insight into the experiences of family caregivers who accompanied a loved one during voluntary stopping of eating and drinking and to identify similarities and differences between cases of voluntary stopping of eating and drinking to develop a conceptual model. DESIGN A qualitative holistic multiple case study. METHODS We conducted narrative interviews with family caregivers (N = 17). We first analysed them inductively within the cases, followed by a cross-case analysis to merge the experiences into a conceptual model. RESULTS Family caregivers who could accept their loved one's wish to die stood up for the last will, especially when the cognitive abilities declined. They had to take on the role of an advocate to protect their self-determination from others who tried to interrupt the process. In their advocacy, they found themselves constantly in moral discrepancies. Usually without support, they provided nursing care until death. The subsequent processing phase was characterized by evaluating the dying situation and placing voluntary stopping of eating and drinking in their value scheme.
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Affiliation(s)
- Jasmin Eppel‐Meichlinger
- Institute for Applied Nursing SciencesEastern Switzerland University of Applied SciencesSt. GallenSwitzerland
- Department of Nursing ScienceUniversity of ViennaViennaAustria
| | - Sabrina Stängle
- Institute of Nursing, School of Health ProfessionsZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Hanna Mayer
- Department of Nursing ScienceUniversity of ViennaViennaAustria
| | - André Fringer
- Institute of Nursing, School of Health ProfessionsZHAW Zurich University of Applied SciencesWinterthurSwitzerland
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Stängle S, Schnepp W, Büche D, Fringer A. Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care. GEROPSYCH 2021. [DOI: 10.1024/1662-9647/a000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Besides physician-assisted suicide, there is another end-of-life practice under discussion: voluntary stopping of eating and drinking (VSED). In this study, we assess the occurrence of VSED in outpatient care and evaluate nurses’ attitudes about it. We recruited 395 nurses (24% response rate) in our online survey. The occurrence of VSED in Switzerland lies at 0.5%. Most nurses (84.6%) were aware of VSED, and 39.5% had experienced it with patients. VSED was mostly (70.3%) regarded as a natural death, and nearly all (95.1%) were willing to care for these patients; however, about one-quarter (26.5%) expressed moral concerns. Our results show that VSED occurs in rare cases, and that nurses are willing to accompany patients during this VSED, but express moral concerns.
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Affiliation(s)
- Sabrina Stängle
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Institute of Nursing, ZHAW School of Health Professions, Winterthur, Switzerland
| | - Wilfried Schnepp
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Büche
- Palliative Centre St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - André Fringer
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Institute of Nursing, ZHAW School of Health Professions, Winterthur, Switzerland
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Stängle S, Schnepp W, Büche D, Häuptle C, Fringer A. Family physicians' perspective on voluntary stopping of eating and drinking: a cross-sectional study. J Int Med Res 2020; 48:300060520936069. [PMID: 32787706 PMCID: PMC7427036 DOI: 10.1177/0300060520936069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/26/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to determine how often patients who choose voluntary stopping of eating and drinking (VSED) are accompanied by Swiss family physicians, how physicians classify this process, and physicians' attitudes and professional stance toward VSED. METHODS We conducted a cross-sectional study between August 2017 and July 2018 among 751 practicing family physicians in Switzerland (response rate 74%; 70.7% men; average age 58 (±9) years). We used a standardized evidence-based questionnaire for the survey. RESULTS VSED is well-known among family physicians (81.9%), and more than one-third (42.8%) had accompanied at least one patient during VSED. In 2017, 1.1% of all deaths that occurred in Swiss nursing homes or in a private home were owing to VSED. This phenomenon was classified as a natural dying process (59.3%), passive euthanasia (32.0%), or suicide (5.3%). CONCLUSIONS Although about one in three Swiss family physicians have accompanied a person during VSED, family physicians lack sufficient in-depth knowledge to address patients and their relatives in an appropriate manner during the process. Further training and development of practice recommendations are needed to achieve more standardized accompaniment of VSED.International Registered Report Identifier: DERR1-10.2196/10358.
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Affiliation(s)
- Sabrina Stängle
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Wilfried Schnepp
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Daniel Büche
- Cantonal Hospital St. Gallen, Palliative Centre St. Gallen, St. Gallen, Switzerland
| | - Christian Häuptle
- Cantonal Hospital St. Gallen, Centre for General Practitioner Medicine, St. Gallen, Switzerland
| | - André Fringer
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
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Lowers J, Hughes S, Preston N. Experience of Caregivers Supporting a Patient through Voluntarily Stopping Eating and Drinking. J Palliat Med 2020; 24:376-381. [PMID: 32644873 DOI: 10.1089/jpm.2020.0223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Voluntarily stopping eating and drinking (VSED) is an ongoing voluntary choice to forego food and hydration in an effort to hasten death. Ongoing caregiving is necessary as patients become weak and lose focus as a result of dehydration, but little is known about the process of supporting a patient through VSED. Objective: To explore the experiences of caregivers who supported a patient through VSED. Methods: Qualitative study with thematic analysis of transcripts of semistructured interviews with 24 U.S. caregivers for 20 individuals who had attempted VSED. Results: Analysis produced four themes: (1) Caregivers believe that VSED is the best death available to the patient. (2) Caregivers act as advocates and worry that the patient's goals will be challenged by health care professionals, the community, or legal authorities; obtaining support from a hospice is an important way to legitimize VSED. (3) Through the VSED process itself, caregivers carry the responsibility for the patient's success as the patient becomes weaker and loses focus. (4) Because there is no social script to guide the VSED process, caregivers choose what roles to play during VSED, such as focusing on physical care or being emotionally present as the patient's spouse or child. Conclusions: Caregivers face unique challenges in helping patients undertake VSED. Many are uncertain about whether they will receive support from clinicians or the community. Support from health professionals may improve caregiver confidence and reduce worry.
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Affiliation(s)
- Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Sean Hughes
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
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