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Introduction: A passive death wish (PDW) increases risk for completed suicide. Depression in the presence of co-morbid physical illness is classically difficult to diagnose given overlapping somatic symptoms. Clinicians may benefit from knowledge of a simple screening question to assist targeting of further inquiry, investigation and treatment in older adults at high risk of both depression and physical frailty. We thus sought to investigate a potential relationship between the frailty phenotype and the report of a passive death wish in older adults.

Methods: Cross-sectional analysis of data from The Irish Longitudinal Study on Ageing (TILDA), from participants aged 60 and over, who completed a comprehensive health assessment (n = 2,440). Frailty was defined using the Fried Frailty criteria whereby participants are classified as robust, pre-frail or frail. PDW was assessed via a single question whereby respondents were asked by a trained interviewer if they had had thoughts that they would rather be dead in the last month.

Results: A PDW was reported by 2.4% of the population over 60 years. Of those who attended the health assessment 2.3% were classified as frail. 17.9% of those classified as frail reported a PDW. Regression analysis found that a PDW was significantly and independently associated with being categorised as frail (RR 2.4; p = 0.005) along with increasing age, higher levels of depressive symptoms, smoking and polypharmacy.

Conclusions: In those over 60 years the report of a PDW is associated with increasing risk of classification as frail, independent of depressive symptomatology. This underlines the importance of screening for depression and suicide risk in older patients with frailty.

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