The Differing Challenges of Averting Suicide Among the Elderly

Suicide rates are among the highest for the elderly, and prevention measures need to be aimed at increasing social connectedness and addressing emotional and mental conditions that predispose individuals to contemplate taking their lives. 

For some seniors, the so-called “golden years” are not so golden. As physical abilities deteriorate and mental abilities slow, older people may also experience added stress as sources of emotional support disappear. Pain may be a constant companion. It may be hard for some seniors to find continuing purpose or experience satisfaction under such circumstances. Underlying mental illnesses, diagnosed or not, may affect their ability to cope with these challenges. 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, 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 Veteran 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. 

Women have higher rates of disclosed suicide ideation and attempted suicides than men, but women, at all ages, have lower rates of completed suicides. Another reason might be greater familiarity or access to lethal means of death. Research has shown that a significant factor of the disparity between suicide rates for men and women at all ages is that men are more likely to use more lethal means, such as firearms, to take their lives. Greater social connectedness may be a protective factor for women and that 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. 

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.   

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.”  

Researcher Yeates Conwell, the primary author of several studies contrasting the behaviors of seniors vs younger people who have completed suicide, has found that that those who attempt suicide at an older age devote greater attention to planning and are less likely to reveal their suicidal thoughts or plans than younger people. This means immediate interventions and response to identifiable risk signals are less effective than prevention strategies aimed at addressing chronic mental health problems such as depression. “Efforts designed to treat conditions that predispose to development of the suicidal state promise to be more effective strategies over the long term in preventing suicide among elderly persons,” Conwell wrote in a 1997 article, Age Differences in Behaviors Leading to Completed Suicides. 

“Training of primary care providers to recognize and effectively treat affective illness, the use of “gatekeepers” to increase recognition of vulnerable elders, and development of outreach programs to decrease isolation among older people are alternatives worth further study,” Conwell wrote.

On a practical basis, this could mean steps such as 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 can help seniors to enjoy their golden years. 

For more information about available resources, visit www.zerosuicidesnh.org.