title: Death with dignity from the perspective of the surviving family: a survey study among family caregivers of deceased older adults.
abstract: BACKGROUND
  Death with dignity has been identified as important both to patients and their surviving family. While research results have been published on what patients themselves believe may affect the dignity of their deaths, little is known about what family caregivers consider to be a dignified death.
  
  
  OBJECTIVE
  (1) To assess the prevalence of death with dignity in older adults from the perspective of family caregivers, (2) to determine factors that diminish dignity during the dying phase according to family caregivers, and (3) to identify physical, psychosocial, and care factors associated with death with dignity.
  
  
  METHODS
  A survey study with a self-administered questionnaire.
  
  
  METHODS
  Family caregivers of 163 deceased older (>55 years of age) adults ("patients") who had participated in the Longitudinal Aging Study Amsterdam.
  
  
  RESULTS
  Of the family caregivers, 69% reported that their relative had died with dignity. Factors associated with a dignified death in a multivariate regression model were patients feeling peaceful and ready to die, absence of anxiety and depressive mood, presence of fatigue, and a clear explanation by the physician of treatment options during the final months of life.
  
  
  CONCLUSIONS
  The physical and psychosocial condition of the patient in combination with care factors contributed to death with dignity from the perspective of the family caregiver. The patient's state of mind during the last phase of life and clear communication on the part of the physician both seem to be of particular importance.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands. i.vangennip@vumc.nl
authors.forename: Isis E
authors.initials: IE
authors.lastname: van Gennip
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Pam J
authors.initials: PJ
authors.lastname: Kaspers
authors.forename: Mariska G
authors.initials: MG
authors.lastname: Oosterveld-Vlug
authors.forename: Dick L
authors.initials: DL
authors.lastname: Willems
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003863:Depression; D005221:Fatigue; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010817:Physician-Patient Relations; D012297:Right to Die; D013727:Terminal Care / Q000523:psychology*
keywords: Death with dignity; end-of-life care; family caregivers; older adults