“I’m tired of living.”
“I can’t handle this anymore—I just want to die.”
“I miss my spouse so much. I’m ready to go and be with them again.”
Family caregivers hear these kind of statements from their care recipients all too often. What many haven’t figured out, though, is how you are supposed to react and respond to such shocking comments. Furthermore, how do you personally cope with the implication that the care you’re providing doesn’t seem to be enough?
Reasons for an Elderly Person “Giving Up on Life”
Each person’s life is unique, so there are countless factors that may cause a senior to want to hasten their death. One study found that recurring themes among elders who expressed a death wish include “being widowed, feeling lonely, being a victim, being dependent, and wanting to be useful.” These participants found themselves in self-described intolerable situations with no ability to make improvements and began to see death as the only viable option for regaining control over their circumstances.
Another study delved deeper into this phenomenon and found that elderly participants felt a profound disconnectedness to life and other people as they also faced becoming more vulnerable and dependent. Additionally, losing the ability to participate in projects and activities that generated a sense of purpose and reflected one’s personality causes some older adults to feel as if they have lost their identity and place in the world.
Even those who do not have a life-threatening disease or psychiatric condition face age-related changes and life losses. Expressing the desire to join a lost loved one may indicate that a senior feels their life is complete. Whether saying they are “ready to die” is an indication of pain and suffering, or they just want to talk about the physical and emotional toll of aging, it’s important to take this cue as an opportunity to encourage discussions about quality of life and worries about the future.
How to Respond to a Patient Who Wants to Die
Meg Sherlock, RN, MA, PMHCNS-BC, an advanced practice psychiatric nurse, has years of academic and first-hand experience in depression screening, suicide prevention, home health care and behavioral health care services for older adults. She offers the following advice for caregivers who are dealing with this difficult situation.
Help them cope with their emotions.Sherlock says that the painful emotions surrounding the topic of death can sometimes make caregivers “allergic” to having honest, open dialogues with their care recipients. If your loved one keeps expressing that their life is no longer worth living or that they would be better off dead, Sherlock suggests asking questions to get them thinking about ways they might be able to better cope with the aging process. Queries like, “Why do you feel that way?” and “What would you like to be different?” can help a senior focus on the facts of a situation instead of getting caught up in their feelings of pain and powerlessness.
If your loved one is living with Alzheimer’s disease or another form of dementia, they may not fully understand these questions or be able to respond to them. To make matters worse, when a dementia patient wants to die, their memory loss may cause them to repeatedly verbalize this wish. In this case, a caregiver should address the issue through validation and redirection. Acknowledge your loved one’s thoughts and feelings to ensure they feel heard, but then attempt to distract them by changing the subject to something more pleasant or beginning an activity together. Ruminating on thoughts of death and dying isn’t healthy for dementia patients or dementia caregivers, so it’s important to find a solution that helps both of you remain focused on other more positive aspects of life.
Set limits.While it’s healthy to talk to your loved one about their feelings, Sherlock emphasizes that it’s also vital to know when to stop talking about them. Dementia patients can’t help repeating themselves, but if a senior has their faculties and still will not stop bringing up wanting to die, then their caregiver should set some boundaries.
Sherlock recommends designating some time to discuss the tough stuff. This will help prevent difficult dialogues from popping up out of the blue, which can be emotionally draining—especially for family caregivers who are already spread so thin. If your loved one broaches the topic when you are emotionally unavailable, gently remind them that you both agreed to set aside time later on to talk about that issue.
Allow them to “prepare.”In some cases, these seemingly morbid statements don’t actually stem from feelings of loneliness or depression. For the elderly, talking about death may truly be part of preparing themselves for the end of life. Whether your loved one has been diagnosed with a terminal illness or is grappling with advancing age and some chronic health conditions, they are likely facing many uncomfortable thoughts and difficult care decisions.
An elder’s announcement that they are ready to die may be part of their process for accepting that death is near. Hesitating to acknowledge this reality is normal, but engaging in matter-of-fact conversations is likely to provide relief from psychological distress for both of you. End-of-life discussions give seniors the opportunity to process their feelings, share their preferences for end-of-life care and funeral arrangements, and articulate instructions for their estate. Addressing some of these logistical aspects of the end of life will help seniors and caregivers feel confident that they are on the same page and better prepared in the face of such uncertainty. Encourage your loved one to make all their plans and preferences official if they have not already done so. This may include advance care directives, a DNR or POLST form, a preplanned and/or prepaid funeral, a will, a trust, or other legal, financial and medical tools and documents. If a senior has already finalized their end-of-life plan, then confirm that it still reflects their current wishes, financial situation, etc.
Look for signs of depression.As always, it’s important for family caregivers to be vigilant about monitoring for symptoms of depression. Regular comments about wanting to die could be a sign that your loved one is suffering from this mental health disorder. According to Sherlock, common symptoms of depression in seniors can include constant feelings of sadness and anxiety, loss of interest in activities they used to enjoy, sleeping too much or too little, loss of energy, irritability, and loss of appetite.
Address physical symptoms.The end of life is an emotionally challenging time, but physical symptoms wear an elder down, too. Age-related changes, such as vision and hearing loss, decreased energy, poor sleep and joint pain, combined with symptoms of other health issues and medication side effects can have a significant impact on a loved one’s functional abilities and quality of life.
If an elder is expressing the desire to die, ask about their physical complaints and health care goals. These goals tend to change over the years, especially later in life. The focus often shifts from quantity to quality. Work with your loved one’s doctor to see if changes can be made to their care plan to better reflect their goals and address their needs. Palliative care is an excellent option for many seniors because it employs an interdisciplinary approach to managing the physical and mental symptoms of a serious illness. A patient can receive palliative care in conjunction with curative treatments.
Depending on a loved one’s health status, hospice may be appropriate. Hospice care is a type of palliative care for individuals who have an estimated life expectancy of six months or less. The goal of hospice care is to provide a dignified death and physical, emotional and spiritual support throughout the dying process. However, note that a patient must forgo curative treatment to qualify for this type of care. It can be difficult to know when to call hospice, but it’s always best to inquire sooner rather than later. Many families wait too long and aren’t able to fully benefit from all the services a hospice provider has to offer.
Lastly, Sherlock stresses the importance of taking time for yourself, particularly when you’re dealing with a loved one who keeps saying they want to die. A family caregiver can become so overwhelmed by their care recipient’s constant negativity that they may end up becoming depressed themselves. These conversations can be mentally exhausting, but they are often necessary. Seek relief by recruiting other family members or a respite care provider so you can take a break from your caregiving duties and recharge. Without regular respite, caregivers run the risk of developing compassion fatigue.