[Tiredness of life in older adults]

Tiredness of life in older adults can lead to a request for the wish to die. This article provides a practical approach for physicians of this problem on the basis of a flow chart. The main causes of tiredness of life should be identified and evaluated for their reversibility and treatment options. The first group are the physical factors which, besides organ pathology, should also take frailty into account as a possible cause. A second important group are the psychological risk factors such as psychiatric disorders, loneliness, dignity, subjective well-being, coping and spiritual power. These factors also determine the complaint and needs of the patient. Here is a multidisciplinary assessment and approach desirable. This multidisciplinary approach also applies to the socioeconomic risk factors. In addition, the caregiver should examine if the weariness of life indeed gives rise to the suffering of the older person and to what extent this is hopeless and unbearable suffering. Hopelessness is a professional judgment about the remaining treatment and care perspective and is often objectified; unbearable is a matter of the patient and therefore always subjective and personal. The current legislation on euthanasia, the reversibility of the underlying causes and the unbearable suffering will determine whether the request of the patient with tiredness of life can be considered. Some questions will not fit within the proposed framework. For those a multidisciplinary advice of an ethics committee may be desirable.