Abstract
AIM: To examine the relationship between wish to die (WTD) and healthcare use in primary and secondary care among older adults living in Ireland. SUBJECT AND METHODS: Secondary analysis of a nationally representative sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA). Primary outcomes were self-reported general practitioner (GP) and emergency department (ED) visits in the last 12 months. Negative binomial regression was used to examine the associations between WTD and healthcare use. RESULTS: Out of 8174 individuals aged 50 and older, a total of 8149 provided information relating to WTD at wave 1. Of these, 279 (3.4%) individuals disclosed a WTD, while 7870 did not. The mean number of self-reported GP visits in the last 12 months was 4.81 (standard error [SE] = 0.29, 95% confidence interval [CI] 4.25-5.37) for those disclosing a WTD (n = 261), while it was 3.59 (SE = 0.04, 95% CI 3.51-3.67) for those without a WTD (n = 7791). WTD was associated with a higher number of GP visits (incidence rate ratio [IRR] = 1.03, p = 0.03, 95% CI 1.00-1.06). After adjusting for relevant covariates, associations between WTD and ED visits were not observed. Female gender, lower education levels, living alone, depressive and anxiety symptoms, chronic health conditions, severe chronic pain, problematic alcohol consumption, smoking, falls, disability, and regular medication use showed significant associations with WTD. Limitations of the study include the presentation of cross-sectional results; thus we do not make causal inferences or conclusions on the directionality/trajectory of WTD and healthcare use. CONCLUSION: Older adults reporting WTD presented to GPs approximately five times within the previous 12 months. While effect sizes were small, these findings may help inform health services. Future research can further examine potential longitudinal associations and whether GP and ED attendance patterns change over time.