Taking Suicide Off The Table: Signs To Watch For As We Help Our Aging Population Through End-of-Life Challenges
For some seniors, the so-called “golden years” are not so golden. As physical abilities deteriorate and mental abilities slow, the elderly population may also be experiencing stress as sources of emotional support disappear and their own abilities erode. Pain is a difficult barrier to overcome. It may be hard for some seniors to find continuing purpose or experience satisfaction. Loss of independence and mobility can trigger depression and impede seniors’ ability to access care to address medical or emotional needs.
Adults who are age 75 and older account for fewer than 10% of all suicides, but men aged 75 and older have the highest suicide rate (39.9 per 100,000) compared to other age groups. Non-Hispanic white men have the highest suicide rate among these older adults (46.7 suicides per 100,000).3
According to research studies, loneliness and depression, loss of independence and social isolation are a few challenges the elderly population face – challenges that make them a vulnerable population when it comes to suicide.
Thomas Joiner, in his 2005 book Why People Die by Suicide, puts forth the Interpersonal Theory of Suicide Joiner’s theory identifies two factors that combine to produce a strong desire for suicide: “thwarted belongingness” – in other words, marginalization and social isolation; and “perceived burdensomeness” – the feeling that one is a burden to others.
A third factor, according to Joiner, is the “acquired capability” to engage in a behavior that will result in death. Joiner’s research shows that people who have experienced trauma, are experiencing a chronic illness or pain, or have had a career as a Veterans or First Responder, are less fearful of death, and, according to his theory, are thus at a greater risk of considering suicide. Chronic pain, particularly in men, is a factor in suicide ideation, one study found.
Research is still ongoing -- but it may be that a higher tolerance for pain andgenerally higher rates of social connectedness are protective factors for women, and could explain the disparity between suicide rates for men and women at all ages. Another reason might be greater familiarity or access to lethal means of death. Isolation may not only contribute to suicide ideation, but also may decrease the chance that someone will be seen or stopped during a suicide attempt.
Older people who attempt suicide are often more isolated, more likely to have a plan, and are more determined than younger adults, according to one study. A startling statistic: among people who attempt suicide, one in four seniors will succeed, compared to 1 in 200 youths. Even if a senior fails a suicide attempt, they are less likely to recover from the effects. ( Conwell Y, Duberstein PR, Cox C, Herrmann J, Forbes N, Caine ED. Age differences in behaviors leading to completed suicide. Am J Geriatr Psychiatry. 1998;6(2):122–126.)
The elderly are also less likely than the younger population to choose or have access to mental health care even though they are at greater risk for depression and other mental health conditions. A 2018 survey of research on elderly suicide found that “prevalence of any psychiatric treatment and disorder also decreases with age,” while at the same time physical conditions and illnesses, which bring the prospect of increased pain and hopelessness, increase. The loss of a spouse was also a factor. (Conejero, Ismael et al. “Suicide in older adults: current perspectives.” Clinical interventions in aging vol. 13 691-699. 20 Apr. 2018, doi:10.2147/CIA.S130670.)
Another study of suicide among the elderly found that the association of painful conditions and thoughts of suicide was more prevalent in older men than among women late in life.
The National Council on Aging, in partnership with Mental Health America, offers a guide to identifying risk of suicide in older adults. The guide notes: “It is crucial that friends and family of older adults identify signs of suicidal thoughts and take appropriate follow-up actions to prevent them from acting on these thoughts. Suicidal thoughts are often a symptom of depression and should always be taken seriously”.
Passive suicidal thoughts include thoughts such as, “I would be better off dead.” They are not necessarily associated with increased risk for suicide, but are a sign of significant distress and should be addressed immediately.
However, in order to identify these signs, we need to remain connected to the older people in our lives. In addition to calling regularly, there are many resources for family members who do not live nearby, including adult daycare programs, paid companions who can also help with cooking, cleaning and errands and programs through churches and senior centers that center on a regular schedule for visiting “shut-ins.”
Another potential solution: training those who are interacting with the elderly on a regular basis, like Visiting Nurses and Meals on Wheels, to pick up on signs of depression and lack of a will to live by asking questions during their visit.
Finally, there are suicide screening tools used by providers that are designed specifically for the elderly – for example, the Geriatric Depression Scale (GDS). The GDS contains a series of “yes” and “no” questions that are relatively simple for seniors to answer. Examples of questions include, “Are you basically satisfied with your life?” “Do you feel that your situation is hopeless?” and “Do you often feel downhearted and blue?” There is also a 10-minute Targeted Geriatric Assessment tool (10-TaGA) that can be incorporated into a medical check-up.
If you or someone you know is experiencing passive or active suicidal thoughts, or has described a plan with intent to act, it is essential that you intervene and get help from a mental health professional immediately. A timely and appropriate intervention can prevent suicide, and addressing issues sooner rather than later often results in better treatment outcomes. For more information about available resources, visit www.zerosuicidesnh.org.