# 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.

## Key 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.