Exploring the concept of a “friendly relationship to death” in geriatric patients

TL;DR

This study explores how many older patients have a positive attitude toward death and finds it is common and not linked to mental illness.

Contribution

The study introduces and validates the concept of a 'friendly relationship to death' in geriatric patients.

Findings

70% of geriatric patients reported having a friendly relationship to death.

A friendly relationship to death was linked to greater acceptance of death and spirituality but not to depression or loneliness.

The concept of a friendly relationship to death is distinct from suicidality and disease burden.

Abstract

Positive attitudes toward death are common among geriatric patients, yet their distinction from mental illness and suicidality remains insufficiently understood. This study sought to characterize the concept of a “friendly relationship to death” (FRD), including its frequency in a geriatric sample and identifying variables from the geriatric assessment associated with a FRD.

A cross-sectional study was conducted in a geriatric unit, surveying N = 99 patients aged 65 years and older. Attitudes toward death were assessed using The Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F), supplemented by one question addressing a FRD (“I have a friendly relationship to death.”), as well as eight additional questions on attitudes toward death, dying and religiosity/spirituality. Furthermore, depression, suicidality, disease burden, frailty, and loneliness were evaluated using validated questionnaires.

A total of 70% of patients endorsed a FRD. A FRD was associated with greater acceptance of one’s own dying and death, lower fear and rejection of death, greater religiosity/spirituality, and a stronger sense of “satisfied hunger for life.” A FRD was not associated with depression, suicidality, overall disease burden, frailty or loneliness.

Among geriatric patients, a FRD appears to prevail, extending beyond a neutral acceptance of death’s inevitability and existing independently of suicidality, depression, frailty, or disease burden. Understanding a FRD may help contextualize older individuals’ acceptance of aging and could impact geriatric treatment outcomes.

The online version contains supplementary material available at 10.1186/s12877-025-06670-6.