AAMFT Consumer Update
Suicide in the Elderly

Older adults make up 12% of the US population, but account for 18% of all suicide deaths. This is an alarming statistic, as the elderly are the fastest growing segment of the population, making the issue of later-life suicide a major public health priority.

In 2002, the annual suicide rate for persons over the age of 65 was over 15 per 100,000 individuals; this number increases for those aged 75 to 84, with over 17 suicide deaths per every 100,000. The number rises even higher for those over age 85. Further, elder suicide may be under-reported by 40% or more. Not counted are "silent suicides," like deaths from overdoses, self-starvation or dehydration, and "accidents." The elderly have a high rate of completing suicide because they use firearms, hanging, and drowning. Double suicides involving spouses or partners occur most frequently among the aged.

An obstacle faced by mental health professionals and other caregivers in reaching this group is that older adults do not usually seek treatment for mental health problems. As such, family and friends can play an important role in prevention.

What are the Warning Signs?

. Loss of interest in things or activities that are usually found enjoyable
. Cutting back social interaction, self-care, and grooming

. Breaking medical regimens (such as going off diets, prescriptions)

. Experiencing or expecting a significant personal loss (spouse or other)

. Feeling hopeless and/or worthless

. Putting affairs in order, giving things away, or making changes in wills

. Stock-piling medication or obtaining other lethal means

Other clues are a preoccupation with death or a lack of concern about personal safety. Remarks such as "This is the last time that you'll see me" or "I won't be needing anymore appointments" should raise concern. The most significant indicator is an expression of suicidal intent.

Characteristics of high risk are increasing age, being a white male, and being divorced. The strongest risk factor appears to be a major psychiatric disorder at the time of death, as major depression is very often associated with suicide in later life. Most elder suicide victims either live with relatives or are in regular contact with family or friends, and this implies that depression is more a factor than social isolation. Misuse of alcohol in combination with a psychiatric illness also signifies a risk. All of these factors can be further intensified by medical illness, family discord, financial trouble, physical disability, unrelieved pain, loss and grief.

Despite the availability of safe and effective treatments, late-life mood disorders remain a large problem. One reason for this may be that the public sees depression and suicide as normal aspects of aging. A sizeable portion of the population views youth suicide as a greater tragedy than late-life suicide. This way of thinking works against effective outreach to the elderly and efforts to understand and treat their conditions. The health care system is not meeting the needs of many elderly, and discriminatory coverage and reimbursement policies for mental health care are significant barriers to treatment.

Why Isn't More Help Available?

Community agencies basically serve elderly women who have a suicide rate well under the national average for all ages. Community agencies may not be concerned because elder suicide is uncommon in their caseloads.

Most service agencies aim for self-sufficiency in terms of individual capability and safety. This commitment to independence may cause community agencies to let the client or patient control information, such as alerting relatives or involving other available services. In this way, the elder with thoughts of suicide can filter and control the flow of information about his or her condition.

What Community Agencies Can Do to Help

Taking action to help can include getting the word out (that someone is in danger of committing suicide) into the stream of communication, letting others know about it, breaking what could be called a fatal secret, talking to the person, talking to others, offering help, getting loved ones interested and responsive, creating action around the person, showing response, indicating interest, and, if possible, showing deep concern.

Options for prevention can contain various strategies, including limiting access to firearms and reducing the inappropriate use of sedative medications. Most importantly, educational programs for primary health care providers on the identification and treatment of late-life depression can be a vital component of lowering suicide rates. Evidence shows that most elderly suicide victims visit their physician shortly before dying. In fact, over 70% of older patients who die by suicide visit their primary care physician within a month of their death. Most of these clients are not diagnosed with a psychiatric disorder and do not seek mental health services. 

A Mental Health Therapist Can Help

Problems with public notions of what is, and is not, acceptable with regard to suicide, and the belief that old age equals depression, contribute to the lack of appropriate treatment of suicidal behavior and disorders among the elderly. The family can contribute to the risk--or to the reduction--and treatment of suicidal older adults.

A trained mental health practitioner, such as a family therapist, who is experienced with handling issues of the elderly, including depression and high risk for suicide, can offer services to help the suffering older adult, as well as assist the family as they cope with various issues surrounding the problem.

Studies show that brief therapy can be very beneficial, and even more so when combined with medication for depressive disorders. Over 80% of geriatric patients in one study recovered from depression when treated with this approach.   

Elder suicide will continue to be a major public health problem as the baby boomer generation enters retirement. More efforts surrounding community-based care, mental health, funding and legislative initiatives must be focused on this age group to reduce this preventable tragedy at the end of life.

Resources

The National Institute of Mental Health provides fact sheets online about depression and suicide, including "Older Adults: Depression and Suicide Facts," www.nimh.nih.gov/publicat/elderlydepsuicide.cfm

Information about older adults and depression can also be found at www.nimh.nih.gov/HealthInformation/depoldermenu.cfm; and warning signs concerning men and depression, symptoms, and aspects of treatment can be found at http://menanddepression.nimh.nih.gov/.

Suicide and Aging: International Perspectives. Jane L. Pearson and Yeates Conwell (Eds.) (1996). New York: Springer Publishing Company. This edited book examines the prevalence of suicide in late life from an international framework, comparing rates from multiple countries. Cultural and sociological aspects of suicidal behavior are also discussed. This book is an excellent resource for general information regarding suicidal behavior among older people.

Courtesy of the National Institute of Mental Health.

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