Table 1

Table of studies

AuthorStudy aimsSampleSettingMethodRelevant findings
Arber et al19To examine gender differences in attitudes towards the use of life-prolonging medical technologies among older people69 participants; age range 65–93; 52% womenGeneral practices in southeast EnglandQualitative interviewsOlder women twice as likely as men to oppose the use of medical technologies to prolong life
Women more likely to voice ‘other oriented’ reasons for their opposition, primarily the wish to avoid burdening others
Men more likely to express ‘self-oriented’ views
Catt et al15To determine relationship between age and attitudes to death and preparation for death, and knowledge about and attitudes to cancer and palliative care256 participants; 129 participants aged 55–74 years, 127 aged 75+; 55% women; 81% whiteGeneral practices in LondonStructured interviewsOlder age group:
• more concerned about dying alone
• preference for death in hospital compared with hospice
Younger age group:
• more open to discussion about death and dying
• more supportive of euthanasia/PAS
Charlton7To survey views of GP attenders about death and dying4117 respondents; mean age 36.4 years; 70% women9 general practices in southwest Scotland and 1 semirural/urban practice in EnglandSurvey63% expressed a preference to die at home
When asked what they feared about dying:
• 44% stated leaving their families
• 24% stated fear of the unknown
• 16% stated fear of pain
• 3% stated fear of going into hospital
• 54% supported PAS and 34% were opposed to it
Charlton et al8To explore attitudes to death and dying in the UK, New Zealand and Japan981 from all countries; 223 from the UK, 81 of whom were members of the general publicUK, New Zealand and JapanQuestionnaire surveyHigh levels of support expressed for openness and honesty relating to death and dying
A majority of the UK general pubic respondents indicated support for euthanasia and a preference for death at home
Worries about death included pain, leaving family and the unknown
Clarke et al16To explore older peoples' concerns about end-of-life care74 participants; age range 60–88; 67% womenCommunity groups in North England, South England, Scotland and WalesFocus groupsConcerns raised included that:
• ageism was responsible for poor end of life care
• doctors, nurses and other care staff lack motivation and or skills to care for older dying people
Many participants were anxious about the process of dying, place of care and who would look after them
People perceived that they had little control over these issues
Clery et al22To report public views about assisted dying1700 respondentsUK wideBritish Social Attitudes Survey, 2005People make clear distinctions between the acceptability of assisted dying in different circumstances
Certain groups are particularly opposed to euthanasia—especially those with religious beliefs
Attitudes to euthanasia have remained remarkably stable over time, given the public debates that have taken place over the last decade
Daveson et al20To identify English and German understandings of end-of-life care30 respondents; 15 from the UK; 15 from Germany; age range 17–81; 60% womenUK and GermanyInterviewsCommon themes between UK and Germany included the importance of social and relational dimensions, dynamic decision making comprising uncertainty, a valuing of life's quality and quantity, and expectations for holistic care involving autonomy, choice, and timely information from trusted professionals
Donnison and Bryson23To explore public attitudes to euthanasia984 respondentsUK wideBritish Social Attitudes Survey, 1994Over 80% support PAS for a person with a painful, incurable and terminal illness
Less support for non-physician assisted death or when assisted death is requested by someone with a non-terminal illness
Field10To examine commentaries provided by older people who responded to the 1994 Mass Observation Survey directive54 accounts; age range 65–80; 48% written by womenUKSecondary qualitative data analysis of written accountsEvidence of extensive experience of death in childhood and in World War II
Respondents more concerned about the manner of their dying than of death itself—alongside continuing desire to live as long as possible in spite of advancing age
*Gott et al14To explore the attitudes of older people towards home as a place of care when dying32 participants took part in eight focus groups; 45 participants were interviewed; age range <55 to >85; 68% women; 95% white, 4% blackCommunity groups in Sheffield, UKFocus groups and interviewsParticipants identified that home was more than a physical location, representing familiarity, comfort and the presence of loved ones
Participants anticipated that home would be their ideal place of care during dying
However various concerns regarding care at home were expressed, such as:
• the necessity of having an informal carer
• the worry of becoming a ‘burden’
• the prospect of family members witnessing distressing suffering
• receiving intimate care from their children
• inadequate pain and symptom relief
Howarth9To explore perspectives of older people about maintenance of autonomy and independence72 participants; age range >75Two contrasting districts of a north London boroughQualitative interviewsNo direct questions about death, dying and bereavement. 58% of interviewees raised these issues spontaneously
People's thoughts about their own death were categorised into four themes: `good' and `bad' death; the extent of control which they might be able to exert over this final status passage; the way in which death could be legitimated or made meaningful; and the question of funeral rituals and the desire to be remembered
Lloyd-Williams et al18To explore how older people living in the community perceive issues around death, dying and the end of life40 participants; age range 80–89; 60% women; 100% whiteThe Wirral, Merseyside, UKQualitative interviewsIssues associated with end of life included fear of how they would die, fear of becoming a burden to others, wanting to prepare for and have a choice with regard to where and when they die and issues relating to assisted dying
O'Neill et al24To establish and critically examine societal attitudes to PAS and FASNot providedUK wideSecondary analysis of data from the: 1983, 1984, 1989 and 1994 British Social Attitudes SurveysFindings demonstrate a slight increase in support for PAS from around 75% to around 84% over the 11-year period in the UK
A much lower level of support (54%) was recorded in relation to FAS
Strength of religious affiliation found to be a significant determinant of opposition to legalisation of both PAS and FAS
Education, income, sex, marital status, longstanding illness and age not significant predictors of attitude
Phillips and Woodward26To explore how healthy older people feel about resuscitation and the decision not to resuscitate17 participants; one focus group held with people in their 50s the other with people in their 70sNo information givenFocus groupsYounger age, desire to live and good quality of life identified as factors for resuscitationYounger age group wished to be involved in any decision themselves; the older group said they would not wish to be consulted, citing fear and risk of distress
*Seymour et al21To examine older people's assessments of the risks and benefits of morphine and terminal sedation in end-of-life care32 participants; age range <60–87; 72% women; 81% white, 9% blackCommunity groups in Sheffield, UKFocus groupsFindings suggest that older peoples' evaluation of the risks and benefits of morphine administration and terminal sedation depend on moral concerns that are social, contextual and bound up in the desire to protect, care and represent the identity of dying family members
*Seymour12To examine older people's beliefs and risk perceptions regarding the use of innovative technologies in end-of-life care32 participants took part in eight focus groups; 45 participants were interviewed; age range <55 to >85; 68% women; 95% white, 4% blackCommunity groups in Sheffield, UKFocus groups and interviewsFindings highlight the variety of understandings that older people have about life-prolonging and basic care technologies and the need to deliver end-of-life care in ways which respect understandings about love, comfort, obligation and burden during dying
*Seymour et al13To explore older people's views about advance statements and the role these might play in end-of-life care decisions32 participants; age range <60 to 87; 72% women; 81% white, 9% blackCommunity groups in Sheffield, UKFocus groupsAdvance statements were understood primarily in terms of their potential to aid personal integrity and to help the families of older people by reducing the perceived ‘burden’ of their decision making
Concerns included the perceived link between advance care statements and euthanasia, their future applicability, and the possibility that preferences for care may change
Participants reported worries related to thinking about and discussing death and dying
*Seymour et al17To compare experiences and expectations of end-of-life care between white and Chinese older adults living in the UK169 participants; age range 50–85+; 70% women; 54% Chinese, 46% whiteCommunity groups and general practices in Sheffield and Manchester, UKQualitative focus groups and interviewsOnly one-quarter of Chinese respondents had heard of the term ‘hospice’. For these, hospices were regarded as repositories of ‘inauspicious’ care. They instead expressed preference for care in hospital
Among both groups preferences for institutional death seemed to be related to concerns about the demands on the family that may relate to having to manage pain, suffering and the dying body within the home
Vandrevala et al11To examine older people's perspectives on end-of-life decisions and advance care planning12 participants; age range 60–79; 50% womenCommunity groups in southeast EnglandQualitative interviewsOlder people indicated that they wished to talk with their doctors and family members about end-of-life issues
An emphasis on curative treatment and a desire to avoid causing distress to patients were perceived as reasons
Why doctors may not talk to patients about end-of-life issues
Fear of burdening family members was identified as a reason why older people may not talk to their families about end-of-life issues
Vandrevala et al27To examine the views of healthy older people about end-of-life care decision making, specifically the use of cardiopulmonary resuscitation48 participants; age range 65–80+; 58% women; 98% whiteCommunity groups in southeast EnglandFocus groupsQuality of life identified as the central value underlying the dilemma of whether or not to attempt resuscitation
Women more likely than men to take perception of burden into account when considering resuscitation
Williams6To complete an in-depth ethnographic and survey-based study of attitudes to death and illness within one community70 people interviewed; 619 people in survey; age range 60+Aberdeen, ScotlandMixed methods study involving a qualitative interview study and a complementary surveyRespondents indicated concepts of ‘good’ death drawn from a variety of cultural and historical influences deeply affected by biographical and experiential influences:
some respondents preferred ‘ritual dying’ in which achieving readiness for death was combined with an emphasis on the importance of the reunion of the dying with those close to them
Other respondents expressed a preference for ‘disregarded dying’ which combined the moral expectation of death in old age with the ideal of a quick, unaware death
Third group of respondents exhibited patterns of ‘transitional’ ideas about death, in which elements of ritual and disregarded dying were combined
A minority group expressed a preference for ‘controlled dying’ in which the ordering of one's own fate was paramount
Williams et al25To elicit the views of the general public on euthanasia and life-sustaining treatments in the face of dementia725 respondents; age range 14–90; 47% women; 69% white, 7% Asian, 6% blackStations, shopping centres and GP surgeries across London and southeast EnglandQuantitative surveyRespondents were more conservative in decisions about others than themselves
Majority supported PAS in severe dementia
Young favoured resuscitation post cardiac arrest more than older people
  • * Seymour et al13 ,21, Seymour12 and Gott et al14 report different aspects of the same study. The Seymour et al 2007 paper compares data from 32 focus group participants (Seymour et al13 ,21; Seymour12; Gott et al14) with a later study of Chinese older people living in England.

  • Statistically significant finding.

  • FAS, family-assisted suicide; GP, general practitioner; PAS, physician-assisted suicide.