Sullivan M, Ormel J, Kempen G I, Tymstra T
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA.
J Am Geriatr Soc. 1998 Oct;46(10):1251-7. doi: 10.1111/j.1532-5415.1998.tb04541.x.
Population surveys have documented increasing public support for euthanasia and assisted suicide but have not focused on the population of chronically ill older persons, obtained detailed sociocultural or health status information, or performed repeat assessments. This study seeks to describe the views of functionally-impaired Dutch elders on death, dying, and hastened death and to relate these to sociocultural and health status.
One-year prospective epidemiologic survey.
Community-dwelling participants in the longitudinal component of the Groningen Longitudinal Aging Study were assessed at home by interview and questionnaire in 1994 (n = 632) and again in 1995 (n = 575).
Independent variables were sociocultural characteristics (eg, age, sex, income, education, religious affiliation, strength of religious belief), physical health status (number of chronic medical conditions, functional impairments), and mental health status (life satisfaction, self-efficacy, anxiety, depression, and neuroticism). Dependent variables were preoccupation with and fear of death, fears of the dying process, and attitudes toward hastened death.
Low and stable rates of preoccupation with death and fear of death were found. Occasional but not persistent fears about the dying process were common. Fears of death and dying were most closely related to health status, especially mental health status. Views concerning hastening death were most strongly related to sociocultural variables, especially religious belief and affiliation. There was little change over the 1-year follow-up, with a trend toward less fears of death and dying and less support for hastened death. Significant changes in fears of death and dying and attitudes toward hastened death were not seen even in the 25% of subjects with the greatest deterioration in activities of daily living or greatest increase in anxiety and depression during the 1-year follow-up.
Beliefs about death, dying, and hastened death are stable over 1-year follow-up. Fears of death and dying are most strongly related to mental health in this community sample. Attitudes about hastening death are primarily related to religious belief and secondarily to mental health. Mental health factors may determine the distress associated with the prospect of death and dying, whereas religion may dictate the actions considered proper when dying.
人口调查记录了公众对安乐死和协助自杀的支持度不断上升，但这些调查未聚焦于慢性病老年人群体，未获取详细的社会文化或健康状况信息，也未进行重复评估。本研究旨在描述功能受损的荷兰老年人对死亡、临终及加速死亡的看法，并将这些看法与社会文化和健康状况联系起来。
为期一年的前瞻性流行病学调查。
参与格罗宁根纵向衰老研究纵向部分的社区居住参与者于1994年（n = 632）和1995年（n = 575）在家中接受访谈和问卷调查评估。
自变量为社会文化特征（如年龄、性别、收入、教育程度、宗教信仰、宗教信仰强度）、身体健康状况（慢性疾病数量、功能障碍）和心理健康状况（生活满意度、自我效能感、焦虑、抑郁和神经质）。因变量为对死亡的关注和恐惧、对临终过程的恐惧以及对加速死亡的态度。
发现对死亡的关注和恐惧发生率较低且稳定。偶尔而非持续地对临终过程感到恐惧很常见。对死亡和临终的恐惧与健康状况，尤其是心理健康状况关系最为密切。关于加速死亡的观点与社会文化变量，尤其是宗教信仰和归属关系最为紧密。在为期一年的随访中变化不大，有对死亡和临终的恐惧减少以及对加速死亡的支持减少的趋势。即使在为期一年的随访中日常生活活动能力恶化最严重或焦虑和抑郁增加最多的25%的受试者中，对死亡和临终的恐惧以及对加速死亡的态度也未出现显著变化。
在为期一年的随访中，关于死亡、临终和加速死亡的信念是稳定的。在这个社区样本中，对死亡和临终的恐惧与心理健康关系最为密切。关于加速死亡的态度主要与宗教信仰有关，其次与心理健康有关。心理健康因素可能决定与死亡和临终前景相关的痛苦，而宗教可能决定临终时被认为恰当的行为。
