What are doctors tired of hearing

This is how general practitioners recognize suicidal patients

Getting old can be tough. Physical and mental illnesses increasingly impair quality of life, partners and friends die, independence is lost, but there is no hope of recovery.

Many old people give up and think more and more about "breaking up". The risk of suicide is significantly increased in old age.

In the brochure "When getting old becomes a burden", published by the "Working Group on Old People" in the National Suicide Prevention Program for Germany, numbers are given that are alarming.

Of the more than 9,000 people who commit suicide each year in Germany, over 40 percent are 60 years or older.

In contrast, the proportion of people over 60 in the total population is only 25 percent. Almost every two hours in Germany someone over 60 dies by their own hands.

Visiting a doctor before attempting suicide

Studies have shown that a high percentage of these people went to their family doctor in the week before the suicide, says Professor Martin Teising, President of the International Psychoanalytic University in Berlin and member of the "Old People Working Group", in an interview with the "Ärzte Zeitung" .

The old people, tired of life, often do not address their suicidal thoughts directly. So family doctors need to know what to look out for and how to recognize suicidality in old people in order to be able to provide help.

According to Teising, there are clear indications when old patients are no longer interested in what was previously important to them, when they are emotionally constrained and can no longer be happy or angry.

Even if old people suddenly start tidying up their things and papers, it can indicate suicidal ideation.

General practitioners should pay attention to feelings of despair, feelings of loss, for example after the death of the partner, constant brooding and, above all, serious emotional injuries and grievances.

But that, according to Teising, is very different from one individual to the next. "For some, these can be physical disabilities, for example when they can no longer read because their eyes are getting worse, for others, the children can cause offense because they do not behave as the old people imagine. It is always about what is particularly important for the self-esteem of the respective elderly person. "

Deceptive calm before the storm

The "calm before the storm" can also be a warning sign. Because if a person who has previously expressed suicidal thoughts or intentions suddenly seems relaxed and no longer speaks of suicide, this can mean that he has already made up his mind.

If there is reason to suspect that an old person is tired of life and desperate, feels helpless and subjectively lonely, then the next important step is to address this as well.

"There is a widespread fear that you will drive people to suicide even more and that if you ask them about it, they will lead to silly thoughts. But that is absolutely wrong," emphasizes the psychiatrist and psychoanalyst. "Nobody has ever committed suicide because someone asked if they were thinking about it."

On the contrary: if you meet the subjectively lonely old person and give him the opportunity to express his despair, then he no longer feels so lonely.

Life sustaining relationship

"It is crucial that the family doctor builds a relationship in which the emotional distress can be discussed." The next crucial step is to schedule another appointment, if that's just by phone. Because, according to Teising: "It is important to maintain the relationship. Relationship keeps you alive!"

It is important to help the patient regain meaning in life. Meaning in life arises in every phase of life, even in old age. Above all, it is important to maintain communication and social participation.

There are also many regional offers especially for old people who feel lonely. General practitioners should therefore be familiar with these offers and inform their elderly patients about them. In addition, information sheets from cities and municipalities should be in the waiting rooms.

If the suicidality is an acute crisis, it can make sense to consult a psychotherapist or psychiatrist. Often, however, it is sufficient if the family doctor initiates drug treatment for the depression.

Accompanying suicidal old people is a very difficult task, emphasizes Teising. Of course, even as a doctor, one can often understand the suicidal thoughts of old patients. "The big question for the doctor is: can he endure this helplessness, this desperation himself?"

Dealing with one's own helplessness is one of the doctor's tasks. Because empathizing and supporting is very difficult and a great challenge.

Guide to the prevention interview

Talking about suicide prevention with seniors General practitioners serve some basic rules for the doctor-patient relationship:

›Non judgmental conversational behavior in which openness and trust prevail and the suicidal old person feels accepted in emotional distress.

›Openly address death wishes, suicidal thoughts and intentions

›Take suicidality seriously, don't trivialize it, but don't dramatize it either

›Discuss the reasons, accompanying circumstances and acute triggers

›Understand and include life-historical contexts

›Explore possibilities of support in the social environment (e.g. caregivers, social services)

›Offer to continue the conversation (address fears, point out further advice and help options). (ug)