Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on health, especially (...) among older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. “The proposal” section presents and defends the proposal. The “Replies to objections” section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The “Conclusion” section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly. (shrink)

In this paper, I offer a solution to the Capacity/Equality Puzzle. The puzzle holds that an account of the franchise may adequately capture at most two of the following: (1) a political equality-based account of the franchise, (2) a capacity-based account of disenfranchising children, and (3) universal adult enfranchisement. To resolve the puzzle, I provide a complex liberal egalitarian justification of a moral requirement to disenfranchise children. I show that disenfranchising children is permitted by both the proper political liberal and (...) the proper political egalitarian understandings of the relationship between cognitive capacity and the franchise. Further, I argue, disenfranchising children is required by a minimalistic, procedural principle of collective competence in political decision-making. At the same time, I show that political equality requires the enfranchisement of all adults, regardless of cognitive capacities, and that the collective competence principle does not ground adult disenfranchisement. This justifies the progressive legal trend that holds the capacity-based disenfranchisement of adults to be incompatible with liberal democratic principles. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the (...) ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)

This paper explores the debate between perfectionists and anti-perfectionists in the context of children. It suggests that the most influential and compelling arguments in favour of anti-perfectionism are adult-centric. It does this by considering four leading reasons given in favour of anti-perfectionism and shows that none apply in the case of children. In so doing, the paper defends a perfectionist account of upbringing from the attacks made against perfectionism more generally. Furthermore, because the refutation of the various anti-perfectionist arguments are (...) made exclusively dealing with children, the paper suggests that the perfectionist view of upbringing is compatible with anti-perfectionist restrictions on dealing with adults. This dual view combining perfectionism for children and anti-perfectionism for adults is referred to as restricted perfectionism. (shrink)

This paper explores the debate between perfectionists and anti-perfectionists in the context of children. It suggests that the most influential and compelling arguments in favour of anti-perfectionism are adult-centric. It does this by considering four leading reasons given in favour of anti-perfectionism and shows that none apply in the case of children. In so doing, the paper defends a perfectionist account of upbringing from the attacks made against perfectionism more generally. Furthermore, because the refutation of the various anti-perfectionist arguments are (...) made exclusively dealing with children, the paper suggests that the perfectionist view of upbringing is compatible with anti-perfectionist restrictions on dealing with adults. This dual view combining perfectionism for children and anti-perfectionism for adults is referred to as restricted perfectionism. (shrink)

Previous research reported that college students' symbolic addition and subtraction fluency improved after training with non-symbolic, approximate addition and subtraction. These findings were widely interpreted as strong support for the hypothesis that the Approximate Number System (ANS) plays a causal role in symbolic mathematics, and that this relation holds into adulthood. Here we report four experiments that fail to find evidence for this causal relation. Experiment 1 examined whether the approximate arithmetic training effect exists within a shorter training period than (...) originally reported (2 vs 6 days of training). Experiment 2 attempted to replicate and compare the approximate arithmetic training effect to a control training condition matched in working memory load. Experiments 3 and 4 replicated the original approximate arithmetic training experiments with a larger sample size. Across all four experiments (N = 318) approximate arithmetic training was no more effective at improving the arithmetic fluency of adults than training with control tasks. Results call into question any causal relationship between approximate, non-symbolic arithmetic and precise symbolic arithmetic. (shrink)

In a digital era that neglects handwriting, the current study is significant because it examines the mechanisms underlying this process. We recruited 9- to 10-year-old Chinese children, who were at an important period of handwriting development, and adult college students, for both behavioral and electroencephalogram experiments. We designed four learning conditions: handwriting Chinese, viewing Chinese, drawing shapes followed by Chinese recognition, and drawing shapes followed by English recognition. Both behavioral and EEG results showed that HC facilitated visual word recognition compared (...) to VC, and behavioral results showed that HC facilitated visual word recognition compared to drawing shapes. HC and VC resulted in a lateralization of the N170 in adults, but not in children. Taken together, the results of the study suggest benefits of handwriting on the neural processing and behavioral performance in response to Chinese characters. The study results argue for maintaining handwriting practices to promote the perception of visual word forms in the digital age. (shrink)

Chinese mind-body exercises are positively associated with executive function, but their effects on EF, from synthesized evidence using systematic and meta-analytic reviews, have not been conducted. Therefore, the present systematic review with meta-analysis attempted to determine whether CMBEs affect EF and its sub-domains, as well as how exercise, sample, and study characteristics moderate the causal relationship between CMBEs and EF in middle-aged and older adults. Seven electronic databases were searched for relevant studies published from the inception of each database (...) through June 2020. Randomized controlled trials with at least one outcome measure of CMBEs on EF in adults of mean age ≥ 50 years with intact cognition or mild cognitive impairment and with or without chronic diseases were included. A total of 29 studies ultimately were included in this study. The results indicated that CMBEs improved overall EF, as well as its sub-domains of working memory and shifting. The beneficial effects of CMBEs on EF occurred regardless of type, frequency of group classes, session time, total training time, and length of the CMBEs, in addition to that more frequent participation in both group classes and home practice sessions resulted in more beneficial effects. The positive effects of CMBEs on EF were also demonstrated, regardless of participants mean age, sex, and cognitive statuses, health status, as well as training mode and study language. This review thus suggests that CMBEs can be used as an effective method with small to moderate and positive effects in enhancing EF, and that more frequent group classes and home practice sessions may increase these effects. However, certain limitations, including strictly design studies, limited ES samples for specific variables, and possible biased publications, required paying particular attention to, for further exploring the effects of CMBEs on EF. (shrink)

Instagram serves as a powerful instrument for youth socialization, self-expression, and self-performance in visual online spaces. Using social semiotics and multimodal discourse analysis, this study examines the potential ideological meanings and implications of selfie-shooting and sharing on Instagram on young adults’ self-concept. A corpus of 110 questionnaires, including almost 85 captioned selfies, was surveyed as multimodal utterances. In doing so, this study argues that selfies can create young adults’ split-selves while constructing their multiple personas in visual online spaces. (...) This marks the significance of viewing selfie-creators not only as authors of their selfies, but rather as viewers of a three-fold self: an ideal-self, a projected-self, and an internal-self, to negotiate social and power relationships, while (re)positioning observer-observed roles. This study claims originality in unraveling how young adults use visual and textual mediated communication to represent and perform their split-selves. It suggests that selfie-shooting-sharing has become a key self-performance tactic and behavior in online cultures. Therefore, young adults deploy selfies and captions to posit a redefinition of certain social values, such as aesthetics and freedom, while deploying their selfies and captions. Challenging certain orthodox social allegiances, they conceive wildness, messiness, and exuberance as emerging neo-aesthetics components of appeal. This study contributes to the literature on personal visual communication with insights on how Egyptian young adults perform their self-concept via the semiotic practice of selfie-shooting-sharing. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision‐making (...) and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix as a ‘whole person in context’ 2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’,4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’.2 We agree with these authors that identity development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression, D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender and gender diverse individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (shrink)

BackgroundSleep, physical activity, and diet have been associated with mental health and well-being individually in young adults. However, which of these “big three” health behaviors most strongly predicts mental health and well-being, and their higher-order relationships in predictive models, is less known. This study investigated the differential and higher-order associations between sleep, physical activity, and dietary factors as predictors of mental health and well-being in young adults.MethodIn a cross-sectional survey design, 1,111 young adults ages 18–25 from New (...) Zealand and the United States answered an online survey measuring typical sleep quantity and quality; physical activity; and consumption of raw and processed fruit and vegetables, fast food, sweets, and soda, along with extensive covariates and the outcome measures of depressive symptoms [measured by the Center for Epidemiological Depression Scale ] and well-being.ResultsControlling for covariates, sleep quality was the strongest predictor of depressive symptoms and well-being, followed by sleep quantity and physical activity. Only one dietary factor—raw fruit and vegetable consumption—predicted greater well-being but not depressive symptoms when controlling for covariates. There were some higher-order interactions among health behaviors in predicting the outcomes, but these did not survive cross-validation.ConclusionSleep quality is an important predictor of mental health and well-being in young adults, whereas physical activity and diet are secondary but still significant factors. Although strictly correlational, these patterns suggest that future interventions could prioritize sleep quality to maximize mental health and well-being in young adults. (shrink)

The present study analyzes metaphors of life, self, emotional states, and relationships in forty life stories that differ in their communicative situations and narrative goals. Twenty interviews were conducted with people who were seeking psychological help. Another twenty interviews were conducted with Russian celebrities for publication in popular psychology magazines. Metaphors in happy stories were more numerous and diverse than in unhappy stories. Some conceptual metaphors (e.g., “LIFE IS A CONTAINER,” “LIFE IS A JOURNEY,” and “EMOTION IS A PHYSICAL IMPACT”) (...) were found in both happy and unhappy narratives. More specific metaphors demonstrated significant differences between the two types of narratives. The metaphors of life as a “purposeful journey,” self as “alive and flexible object,” and emotional states as “internal and controlled forces” were used more often in happy narratives. This may reflect higher levels of activity, responsibility, and awareness of the authors of happy narratives. Specific for unhappy stories were metaphors “LIFE IS DEATH” and “SELF IS A DEAD OBJECT,” which may indicate a low level of personal well-being and serve as specific markers of personal unhappiness. The results of our study suggest that metaphors may help to construct the subjective reality of happy and unhappy life. By telling their life stories people are able to redefine their past experiences and future perspectives. Specific metaphors play an important part in defining subjective happiness or unhappiness. (shrink)

ABSTRACTFacial stimuli are widely used in behavioural and brain science research to investigate emotional facial processing. However, some studies have demonstrated that dynamic expressions elicit stronger emotional responses compared to static images. To address the need for more ecologically valid and powerful facial emotional stimuli, we created Dynamic FACES, a database of morphed videos from younger, middle-aged, and older adults displaying naturalistic emotional facial expressions. To assess adult age differences in emotion identification of dynamic stimuli and to provide normative (...) ratings for this modified set of stimuli, healthy adults categorised for each video the emotional expression displayed, rated the expression distinctiveness, estimated the age of the face model, and rated the naturalness of the expression. We found few age differences in emotion identification when using dynamic stimuli. On... (shrink)

Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial RegistrationISRCTN89993391. (shrink)

Call generalism about children’s and adults’ wellbeing the thesis that the same theory of wellbeing applies to both children and adults. Our goal is to examine whether generalism is true. While this question has not received much attention in the past, it has recently been suggested that generalism is likely to be false and that we need to elaborate different theories of children’s and adults’ wellbeing. In this paper, we defend generalism against the main objections it faces (...) and make a positive case for it. (shrink)

Determining whether and/or how to enable older persons with disabilities to engage in sex raises several ethical considerations. With the goal of enabling the sexual functioning of older adults with disabilities, Jecker argues that sex robots could be used as a helpful tool. In her article, ‘Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities’, Jecker acknowledges the importance of sexual functioning and the fact that ageist assumptions incorrectly classify older persons as asexual. Additionally, older (...) adults may experience disabilities that negatively influence their sexual functioning, which is problematic since sex may be linked to the following capabilities: developing a meaningful life narrative; being healthy; experiencing bodily integrity; feeling and communicating emotions; affiliating with others and reflecting on and choosing a life plan.1 In accordance with Nussbaum’s capabilities approach,2 Jecker says that society has a duty to support these capabilities at a minimal threshold. And insofar as sexual functioning may be relevant to the capabilities for older adults with disabilities, then we need to respond accordingly. One way of achieving this aim is by providing access to sex robots. I agree that sex robots ought to be made available for older adults with disabilities. Nevertheless, the article inspires several areas for further exploration. As Jecker rightfully mentions, older adults are often incorrectly labelled as non-sexual. For instance, in their analysis of older individuals’ views on sex and quality of life, Gott …. (shrink)

A growing volume of research from global data demonstrates that institutional care under conditions of deprivation is profoundly damaging to children, particularly during the critical early years of development. However, how these individuals develop over a life course remains unclear. This study uses data from a survey on the health and development of 420 children mostly under the age of three, placed in 12 infant care institutions between 1958 and 1961 in Zurich, Switzerland. The children exhibited significant delays in cognitive, (...) social, and motor development in the first years of life. Moreover, a follow-up of a subsample of 143 children about 10 years later revealed persistent difficulties, including depression, school related-problems, and stereotypies. Between 2019 and 2021, these formerly institutionalized study participants were located through the Swiss population registry and invited to participate once again in the research project. Now in their early sixties, they are studied for their health, further development, and life-course trajectories. A mixed-methods approach using questionnaires, neuropsychological assessments, and narrative biographical interviews was implemented by a multidisciplinary team. Combining prospective and retrospective data with standardized quantitative and biographical qualitative data allows a rich reconstruction of life histories. The availability of a community sample from the same geographic location, the 1954–1961 cohort of the Zurich Longitudinal Studies, described in detail in a paper in this issue, enables comparison with an unaffected cohort. This article describes the study design and study participants in detail and discusses the potential and limitations of a comparison with a community sample. It outlines a set of challenges and solutions encountered in the process of a lifespan longitudinal study from early childhood into the cusp of old age with a potentially vulnerable sample and summarizes the lessons learned along the way. (shrink)

In this study, Limburgian and Dutch 2,5- to 4-year-olds and adults took part in a word learning experiment. Following the procedure employed by Quam and Swingley (2010) and Singh et al. (2014), participants learned two novel word-object mappings. After training, word recognition was tested in correct pronunciation (CP) trials and mispronunciation (MP) trials featuring a pitch change. Since Limburgian is considered a restricted tone language, we expected that the pitch change would hinder word recognition in Limburgian, but not in (...) non-tonal Dutch listeners. Contrary to our expectations, both Limburgian and Dutch children appeared to be sensitive to pitch changes in newly learned words, indicated by a significant decrease in target fixation in MP trials compared to CP trials. Limburgian and Dutch adults showed very strong naming effects in both trial types. The results are discussed against the background of the influence of the native prosodic system. (shrink)

This paper argues that there is a need to critically assess bias in the representations of older adults in the field of Human–Robot Interaction. This need stems from the recognition that technology development is a socially constructed process that has the potential to reinforce problematic understandings of older adults. Based on a qualitative content analysis of 96 academic publications, this paper indicates that older adults are represented as; frail by default, independent by effort; silent and technologically illiterate; (...) burdensome; and problematic for society. Within these documents, few counternarratives are present that do not take such essentialist representations. In these texts, the goal of social robots in elder care is to “enable” older adults to “better” themselves. The older body is seen as “fixable” with social robots, reinforcing an ageist and neoliberal narrative: older adults are reduced to potential care receivers in ways that shift care responsibilities away from the welfare state onto the individual. (shrink)

Influential theories on moral judgments propose that they rely either on emotions or on innate moral principles. In contrast, the mental model theory postulates that moral judgments rely on reasoning, either intuition or deliberation. The theory allows for the possibility that intuitions lead to utilitarian judgments. This paper reports two experiments involving fifth-grade children, adolescents, and adults; the results revealed that children reason intuitively to resolve moral dilemmas in which action and inaction lead to different outcomes. In particular, the (...) results showed female children to be more utilitarian than female adults in resolving classical moral dilemmas: they preferred an action that achieved a good outcome for a greater number of people. Within the mental model theory’s framework there is no reason to expect that females and males differ in their ability to reason, but at the moment the results for females cannot be generalized to males who were not properly represented in the adults groups of the two experiments. The result revealing that (female) children are more utilitarian than (female) adults, which is hard to explain via many current theories, was predicted by the mental model theory. (shrink)

ABSTRACTEmotion understanding, which can broadly be defined as expertise in the meaning of emotion, is a core component of emotional intelligence and facilitates better intra- and interpersonal outcomes. However, to date only very few standard tests to measure emotion understanding in healthy adults exist. Here, we present two new performance-based tests that were developed and are scored based on componential emotion theory and large-scale cross-cultural empirical findings. These instruments intend to measure facets of emotion understanding that are not included (...) in existing tests. The first test measures the ability to understand and label emotional experiences of a target person from a description of emotion features covering five emotion components embedded in a written vignette. The second test measures semantic knowledge about which features from each component a... (shrink)

Social cognition, social skill, and social motivation have been extensively researched and characterized as atypical in autistic people, with the assumption that each mechanistically contributes to the broader social interaction difficulties that diagnostically define the condition. Despite this assumption, research has not directly assessed whether or how these three social domains contribute to actual real-world social interaction outcomes for autistic people. The current study administered standardized measures of social cognition, social skill, and social motivation to 67 autistic and 58 non-autistic (...) adults and assessed whether performance on these measures, both individually and relationally between dyadic partners, predicted outcomes for autistic and NA adults interacting with unfamiliar autistic and NA partners in a 5 minute unstructured “get to know you” conversation. Consistent with previous research, autistic adults scored lower than NA adults on the three social domains and were evaluated less favorably by their conversation partners. However, links between autistic adults' performance on the three social domains and their social interaction outcomes were minimal and, contrary to prediction, only the social abilities of NA adults predicted some interaction outcomes within mixed diagnostic dyads. Collectively, results suggest that reduced performance by autistic adults on standardized measures of social cognition, social skill, and social motivation do not correspond in clear and predictable ways with their real-world social interaction outcomes. They also highlight the need for the development and validation of more ecological assessments of autistic social abilities and the consideration of relational dynamics, not just individual characteristics, when assessing social disability in autism. (shrink)

ABSTRACTAdults use a variety of strategies to reason about fraction magnitudes, and this variability is adaptive. In two studies, we examined the relationships between mathematics anxiety, working memory, strategy variability and performance on two fraction tasks: fraction magnitude comparison and estimation. Adults with higher mathematics anxiety had lower accuracy on the comparison task and greater percentage absolute error on the estimation task. Unexpectedly, mathematics anxiety was not related to variable strategy use. However, variable strategy use was linked to more (...) accurate magnitude comparisons, especially among adults with lower working memory performance or those who use mathematics less frequently, as well as lower PAE on the estimation task. These findings shed light on the role of strategy variability in fraction problem solving and demonstrate a link between mathematics anxiety and fraction magnitude reasoning, a key predictor of general mathematics achievement. (shrink)

Recent work asked if visual cues facilitate word segmentation in adults and infants. While adults showed better word segmentation when presented with a regular visual cue, infants did not. This difference was attributed to infants' lack of understanding that objects have labels. Alternatively, infants’ performance could reflect their difficulty with tracking and integrating multiple multimodal cues. We contrasted these two accounts by looking at the effect of visual cues on word segmentation in adults and across childhood. We (...) found that older children benefitted from the regular visual cues, but younger children, who already knew that objects have labels, did not. Knowing that objects have labels was not enough to use visual cues as an aid for segmentation. These findings show that the ability to integrate multimodal cues develops during childhood, and it is not yet adult-like in children. (shrink)

ObjectiveTo examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.MethodsA cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.ResultsOne hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across (...) all five scenarios. Nearly half of the participants provided responses that were discordant in all scenarios. Only two participants provided concordant responses across all five scenarios.DiscussionParticipants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.ConclusionThis is the first study to examine health and social care professionals’ knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals’ understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required. (shrink)

BackgroundLiterature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions. Aim(1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to (...) die; (3) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems.MethodsData of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems.ResultsN = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear.ConclusionA small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die. (shrink)