"I live my own life": relationship between will to live and wish to die in nursing home residents and their opinions about actions to promote their will to live.

Background: The will to live (WTL) is a crucial marker of nursing home residents' subjective psychological state. Previous studies have indicated that nursing home residents express a relatively strong WTL, and the link with their wish to die (WTD) is ambiguous. There is a lack of literature exploring nursing home residents' experiences of the co-existence of WTL and WTD and whether and how residents want their WTL to be enhanced. This study aimed to explore (i) the link between WTL and WTD in nursing home residents, (ii) their opinions about support to improve their WTL, and (iii) their suggestions for interventions to achieve this goal.

Method: Participants were nursing home residents aged 70 + living in a nursing home for ≥ 1 month, who maintained decision making capacity. Intensity of WTL and WTD was measured with a single-item numerical rating scale (0 to 10). Semi-structured interviews were conducted to explore residents' opinions about WTL interventions.

Results: One hundred and nineteen residents participated in the study. Results showed a significant negative association between WTL and WTD (r=-.58, p=.001), and insights into this relationship are provided through the analysis of qualitative data. 49% expressed that they did not want interventions to support their WTL; 39% were favorable to interventions, and 9% had reservations about accepting such interventions. Regardless of their desire for intervention, most participants provided suggestions regarding the mechanisms through which such interventions could increase WTL: (i) increasing quality human contact, (ii) reducing pain and disability, (iii) facilitating personalized activities, (iv) promoting adaptive institutions with caring and trained staff, (v) promoting opportunities to contribute to others and society and (vi) strengthening their own attitude and levers.

Conclusion: Overall, this study provides a better understanding of the relationship between WTL and WTD, their coexistence, and of the subjective needs and concerns in older nursing home residents, thus providing insights into ways to improve their care and, where desired, their WTL.