Seiler Annina, Evstigneev Sophia Rose, Hepp Zehra, Hertler Caroline, Peng-Keller Simon, Blum David
Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich und Universität Zürich, Rämistrasse 100, 8091, Zürich, Schweiz.
Professur für Spiritual Care, Theologische und Religionswissenschaftliche Fakultät, Universität Zürich, Zürich, Schweiz.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2024 Oct;67(10):1144-1151. doi: 10.1007/s00103-024-03943-0. Epub 2024 Aug 23.
Advanced incurable diseases are often accompanied by numerous losses and burdens as the disease progresses, leading to a loss of autonomy, self-determination, and dignity for those affected, all of which can subsequently promote feelings of loneliness at the end of life. Declining health, increasing symptom burden, loss of social roles, and the fear of death and dying are among the key risk factors for loneliness towards the end of life. In this article, we provide an overview of the different dimensions of loneliness experienced at the end of life. We discuss existential loneliness alongside emotional and social loneliness, explore causes and health implications of loneliness at the end of life, suggest diagnostic tools for assessing loneliness, and finally provide recommendations for addressing emotional, social, and existential loneliness at the end of life. The loneliness of caregivers is also discussed. We suggest that addressing social and emotional loneliness early in the course of a terminal illness is crucial. Palliative, psychological, and spiritual support can strengthen interpersonal relationships, foster a sense of meaning and purpose, and alleviate the adverse effects of loneliness on mental and physical health as well as quality of life. In contrast, existential loneliness is considered an expression of profound emotional maturity and can offer opportunities for inner growth, contributing to a more refined sense of self while reinforcing identity, dignity, and transcendence at the end of life.
随着病情进展，晚期不治之症往往伴随着诸多损失和负担，导致患者失去自主性、自我决定权和尊严，所有这些都可能进而加剧临终时的孤独感。健康状况下降、症状负担加重、社会角色丧失以及对死亡的恐惧是导致临终时孤独的关键风险因素。在本文中，我们概述了临终时所经历的孤独的不同维度。我们讨论了存在孤独感以及情感和社交孤独感，探讨了临终时孤独的成因及其对健康的影响，提出了评估孤独感的诊断工具，最后针对解决临终时的情感、社交和存在孤独感提供了建议。我们还讨论了照顾者的孤独感。我们认为，在晚期疾病病程早期解决社交和情感孤独感至关重要。姑息治疗、心理和精神支持可以加强人际关系，培养意义感和目标感，并减轻孤独感对身心健康以及生活质量的不利影响。相比之下，存在孤独感被视为深刻情感成熟的一种表现，并且可以为内心成长提供机会，有助于在临终时形成更精致的自我意识，同时强化身份认同、尊严和超越感。
