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Influence of Age of Patients Who Wish to Die on Treatment Decisions by Physicians and Nurses

Received September 26, 2002; revised January 9, March 24, 2003; accepted March 4, 2003. From the Department of Psychiatry, Ernst Moritz Arndt University of Greifswald (SB,M.Lucht,HJF) and the Research Group, Psychosomatic Rehabilitation at the Free University of Berlin and the Department of Behavioral Medicine, Rehabilitation Centre, Seehof, Teltow/Berlin, Germany (M.Linden). Send correspondence to Sven Barnow, PhD., Department of Psychiatry and Psychotherapy, Ernst Moritz Arndt University of Greifswald, Ellernholzstr. 1-2, 17487 Greifswald, GERMANY. e-mail: barnow{at}uni-greifswald.de
© 2004 American Association for Geriatric Psychiatry

Objective: There is an ongoing debate on whether the wish to die in old age is a normal phenomenon and should be accepted as opposed to similar wishes in younger ages. The authors asked to what extent the age of a patient influences treatment decisions of physicians and nurses. Methods: Real-life case vignettes of three persons ages 70 and over, with subthreshold depression and a wish to die, were presented to 19 physicians and 83 nurses, with the question of whether they would initiate psychopharmacological treatment or psychotherapy. For half of the participants, the real age of these persons was reduced by 20 years. Neither the participants nor the facilitators were aware of the focus of the study. Results: The patient's age had a major influence on treatment decisions by physicians and nurses. The question of whether patients who expressed the wish to die should receive treatment, be it psychotherapy or intensive care, was answered with "yes" by both physicians and nurses significantly less frequently when the real age of the patient was known, whereas when a lower patient age (–20 years) was given, they more often saw the need for psychotherapy or other medical interventions. Conclusions: Age stereotypes have an influence on medical decision-making. Physicians and nurses must be trained in this respect in order to avoid maltreatment of elderly patients.

Key Words: Suicidality • Age Stereotypes • Depression • Caregivers • Primary Care

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