What Matters at the End of Life: A Qualitative Study of Older Peoples Perspectives in Southern Denmark

Abstract

What matters at the end of life (EOL) among the older population in Denmark is poorly investigated. We used focus groups and in-depth interviews, to identify perspectives within the EOL, along with what influences resuscitation, decision making, and other treatment preferences. We included eligible participants aged ≥65 years in the Region of Southern Denmark. Five focus groups and nine in-depth interviews were conducted, in total 31 participants. We found a general willingness to discuss EOL, and experiences of the process of dying were present among all participants. Three themes emerged during the analysis: (a) Being independent is crucial for the future, (b) Handling and talking about the EOL, and (c) Conditions in Everyday Life are Significant. Life experiences seemed to affect the degree of reflection of EOL and the decision-making process. Knowing your population of interest is crucial, when developing an approach or using an advance care plan from another setting.

What Matters Most in Life? A German Cohort Study on the Sources of Meaning and Their Neurobiological Foundations in Four Age Groups

“…This was an interesting finding since our quantitative analyses of the same database showed that the correlation between health and life satisfaction was weaker among older than younger individuals, 1 . Other authors have controversially discussed the relationship between health and subjective well-being (e.g., Okun et al, 1984 ; Berg et al, 2006 ; Gana et al, 2013 ; Steptoe et al, 2015 ), with several studies pointing toward a “health paradox.” Although the importance of health for meaning and well-being tends to increase with increasing age, only a few illnesses are statistically associated with lower levels of subjective well-being ( Berg et al, 2009 , 2011 ; Hanson et al, 2019 ; Näsman et al, 2020 ). According to the neurobiological model, physical health is especially important to experience happiness driven by the Wanting System (Type A Motivation), which is typically seen during adolescence and young adulthood.…”

Perspective of geriatric patients on advance care planning in Denmark: a qualitative study

“…Previous studies27–29 show a similar desire among patients that the doctor should take the initiative to talk about resuscitation, which may be a subtopic of ACP. However, the approach from a health professional concerning resuscitation should be cautious 25…”

“…24 Some of our participants found it depressing to talk about the EOL and wanted to postpone such discussions until later. Similarly, Hanson et al 25 reported that some participants found that an EOL conversation could give rise to anxiety and depressive thoughts.…”

“…However, the approach from a health professional concerning resuscitation should be cautious. 25 The timing of an ACP conversation was difficult for the participants to define. However, the participants pointed out that they need to feel a readiness to talk about EOL.…”

“…This view also appeared in a study by Pleschberger,37 in which the participants mentioned inadequate care in nursing homes, a desire to be active to the last and a desire to 'be allowed to die'. A recent study 25 mentions the same fear of lack of autonomy and dignity in nursing homes, and it is further pointed out that moving to a nursing home is associated with fear: 'if you are not already crazy, then you will be'.…”