Since the rapid spread of the Coronavirus Disease 2019 (COVID-19), older adults with and without preexisting medical conditions have been identified early as particularly vulnerable to the physiological effects of the virus. In Switzerland, public health policies for COVID-19 were especially targeting individuals aged 60 and over, as most of the COVID-19-related deaths occurred among this age group. The media also extensively covered the issue of COVID-19-related health and mortality risks, confronting everyone, directly or indirectly, with the topic of death and dying. The pandemic, thereby, also contributed to increasing public awareness about the use of invasive and intensive medical treatment such as medical ventilation or sedation, the complexity of medical decisions at the end of life (EOL), e.g., concerning withholding or withdrawing life-supporting treatments as well as possibilities to engage in advance care planning (ACP). In this context, older adults’ perceptions and experiences regarding EOL health issues, including ACP or advance directives (ADs), may have changed.
While editorials, commentaries, and viewpoints on the importance of promoting and implementing ACP & ADs during the COVID-19 pandemic have been booming in the scientific literature, only a limited number of studies have focused on the actual influence of the COVID-19 pandemic on EOL-related outcomes in the general population to date. To address this gap in the literature, we aim to provide an update on older adults’ EOL preferences, communication, health literacy, knowledge, and behaviors in the “new normal” since the start of the COVID-19 pandemic and their association with individuals’ socio-demographic, regional, cultural and health characteristics. To this end, we will analyze existing and new (to be collected) data related to EOL planning of the Survey of Health, Ageing and Retirement in Europe (SHARE), a nationally representative survey of adults aged 50 years and older living in Switzerland.
Specifically, we aim:
- To develop a questionnaire on EOL preferences, communication, health literacy, knowledge, and behaviors in response to the COVID-19 pandemic that also allows for assessments of potential changes in core outcomes based on longitudinal pre- and newly collected pandemic data;
- To explore the interplay between individuals’ attitudes towards EOL and EOL planning before the COVID-19 pandemic and wellbeing and mental health during the COVID-19 pandemic;
- To explore the change or stability of EOL preferences within domains that are central to individuals’ perceptions of “healthy aging at the EOL” and a “good death” before and during the COVID-19 pandemic;
- To explore changes in EOL communication with family members, close friends, and healthcare providers before and during the COVID-19 pandemic and to assess the acceptability of technology use for this purpose;
- To explore the longitudinal trend of health literacy, EOL knowledge and EOL health literacy before and during the COVID-19 pandemic and to assess the digital health literacy skills after the first waves of the COVID-19 pandemic;
- To estimate the prevalence of ACP, including ADs, and to compare the estimates before and after the first waves of the COVID-19 pandemic.
Building on the long-lasting expertise and previous work of our interdisciplinary team, the proposed project represents a unique opportunity to portray the role that COVID-19 played in reframing EOL planning in a population-based sample of older adults living in Switzerland. Besides its scientific impact, our research will also help to inform public health policies and intervention designs to improve EOL planning during these challenging times at both the individual and societal levels.
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