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Monday, August 6, 2018

Suicide Is Rising for Older Adults

Suicide Is Rising for Older Adults

Within America’s suicide epidemic, the rate among older adults is outpacing other age groups and the outlook is bleak.

The recent deaths of celebrities Kate Spade and Anthony Bourdain were shocking to many. How could two adults who had achieved fame and financial success possibly want to take their own life? But delve into the numbers and you’ll find that depression, from which both suffered, is an equal opportunity problem, and suicide among seniors is more common than most people think.

Older Adults Have High Suicide Rate

Seniors commit suicide at an alarming rate. According to the Centers for Disease Control and Prevention (CDC), the suicide rate among Americans 65 and over is 15 out of 100,000, while that number drops to 12 out of 100,000 for all ages combined. Those age 85 and older have the highest suicide rate among adults.

“Although this may seem like a small number statistically,” says Certified Elder Law Attorney R.J. Connelly III, “given the aging baby boomers and the growth of the senior population, these numbers could increase significantly unless we begin to take this problem seriously.”

Adding to the problem, many suicides may never get reported. Mental health professionals are suspicious that up to 40 percent of suspect deaths among seniors may fit into the category of “silent suicide,” those that happen due to overdose, self-starvation, dehydration and other “accidents.”

Why Is This Happening?

Today’s older adults grew up in an era when mental health services were associated with weakness. Asylums were standard places to send people with mental illness, and lobotomies were a legitimate treatment. Not only do seniors want to avoid being judged by their own community, but they may also be hard on themselves and fail to seek treatment for depression. Stigmatization around mental health services can also lead to poor adherence to medication and treatment, even after help is sought.

“Depression is often not well detected in older adults,” says Dr. Jo Anne Sirey, a specialist in aging and mental health care. “It’s mistaken as a natural part of aging. Depression is not a natural part of aging.”

The numbers help tell the story. Up to a quarter of older adults need some form of mental health care, but Medicare reimbursement for psychiatric treatment is only given to 3 percent of this population. The services are simply not meeting the need.

Researchers point to the need for better palliative care for older adults suffering from chronic pain. Longer life expectancies have not been accompanied by more pain-free years. Instead, debilitating and painful health conditions go hand-in-hand with old age more often than we would wish.

Causes of Depression in Older Adults

Some people struggle with depression throughout their lives, but it can become worse as they age. Physical illness exacerbates depression, as does the fear of becoming a burden, social disconnection and an inability to function in daily life.

Suicide notes among adults age 65 and over most commonly mention the unbearable pain of cancer, arthritis or other conditions, according to an analysis of 10 years of data by Dr. Diana M. DiNitto and Dr. Namkee G. Choi. The pair also found references to cognitive and/or functional decline, loss of independence and fear of or refusal to enter a nursing home influenced the decision. Nearly a quarter of these seniors had told someone about their intent, most often a family member.

“It is the combination of one or several of these problems with depression that leads the person to feel trapped, making suicide appear like the best solution,” says Dr. Alexandre Dombrovski, a psychiatrist at the University of Pittsburgh. He notes that alcohol or prescription drug abuse, family discord, financial problems, grief or a recent medical diagnosis can all factor in to an older adult’s decision.

A recent study found that older adults in general, and men in particular, regard suicide as an acceptable solution to physical illness. Men over 65 commit suicide more often than their female counterparts.

“Even in the age of political correctness, men are still conditioned to withhold their feelings,” says retired licensed clinician and community educator Don Drake. “Aging pushes these feelings down even more as we begin to lose the roles we held in the family structure as our physical and mental abilities decline. Death is inevitable, but for men, discussing our fears about the end of life can be terrifying. For some men, suicide is about taking control of the situation rather than waiting for death to come. For others, the pain of multiple losses and the inability to express these feelings appropriately can also result in suicide. As a society, we need to do better.”

Becoming the victim of a financial scam can also cause someone to commit suicide. The shame and embarrassment can be too much to handle. The stories are variations on a theme: the 82-year-old grandmother who was told she’d won a sweepstakes, the 77-year-old who became convinced his grandson had been kidnapped, the 81-year-old man who was promised a $3 million lottery jackpot. All of them got strung along, wound up feeling “like a fool” and chose to die.

Preventing Suicide in Seniors

Seniors from all walks of life and racial groups commit suicide. Native Americans and Alaskan Natives run the highest risk, followed by Caucasians, Hispanics and African Americans. Recent events tell us that having plenty of money offers no guarantee. So what can we do?

  • Ask someone you suspect is depressed if she’s having suicidal thoughts. This helps the person talk about their pain and bring it out in the open.
  • Avoid looking shocked if someone tells you he feels suicidal. A stunned reaction may cause him to shut down.
  • Don’t offer platitudes or say “It will get better.” Listen, tell her you understand and offer concrete hope about help that’s available.
  • Leave the morality lesson behind. Ditto regarding the value of life.
  • Gently refuse a request to be sworn to secrecy. Seek support and help from agencies that specialize in crisis prevention. Seek support from loving family members, friends, health care personnel or clergy.
  • Offer hope that alternatives are available without minimizing the problem or the person’s feelings.
  • Take action. Remove firearms, excess medication and anything that you think may help them carry out the act.
  • Never leave an actively suicidal person alone, unless you have to run to get help. When in doubt, call 911.

The National Suicide Prevention Lifeline is 1-800-273-8255; it’s available 24/7.

Death by Firearm

You’ve considered all the angles around when to take away the car keys. But have you considered where the line might be for taking away the guns?

A retired police officer had a lifetime habit of sleeping with his .38 service revolver next to his bed. But as his cognition receded in his late 70s, he would awaken and think his wife was a stranger. One night, he woke up and pointed the loaded weapon at her.

His doctor learned what had happened and knew he had to act fast. He put in a call to the man’s former police partner, someone the man knew and trusted, to convince him it was time to give up the gun. Fortunately, the story ended well.

The connection to guns can be quite strong for older adults. Even after dementia develops, giving up their weapons can feel “almost like an amputation,” says, Dr. Michael Victoroff, a family medicine specialist at the University of Colorado School of Medicine and certified firearms instructor.

Suicide plays a big role in the gun debate with older adults. Older Americans are more likely to die by their own hand than any other age group, and the majority of these suicides involve a gun.

Guns Create Grim Statistics

Older people make fewer suicide attempts than their younger counterparts, but they die more often. The reason: 4 out of 5 attempts carried out with a firearm result in death.

Seniors use guns in 32 percent of attempts to take their life, and they account for 70 percent of fatalities. Looking at all age groups together, firearms are used in only 6 percent of all suicide attempts, but result in 54 percent of total fatalities.

A drug overdose is only lethal 12 percent of the time, but attempt suicide with a firearm, and that “success” number jumps to 82.5 percent.

Risk Factors Accumulate

“Older people who die by suicide aren’t just more likely to die because they’re frail and less resilient to an injury than younger people,” says Dr. Yeates Conwell, director of the Geriatric Psychiatry Program at the University of Rochester, “but also because they use more lethal methods, and they do so with more thoughtful planning.”

Conwell’s research shows that depression, psychiatric disease and physical illness are the most common risk factors for late-life suicide attempts. Chronic and severe pain, especially when it prevents someone from living an independent life, can also lead to thoughts of self-harm.

Other indicators are the loss of a spouse, anxiety, living alone and social isolation. Often, it’s a combination of these factors that leads to committing an act. “Imagine these to be Venn diagrams,” Conwell says. “Their interaction, rather than any one of them, helps us understand why a person might take their life.”

Dementia Increases Risk

Nearly a third of Americans above the age of 65 own a gun, and another 12 percent live with somebody who does, according to the Pew Research Center.

At the same time, more and more Americans are joining the “over 65” club. While the dementia rate is declining, sheer numbers of older adults mean more people will develop cognition problems.

“Suicide risk is elevated in people with dementia, but it’s more of a factor early in the illness,” says Conwell. Later on, “people are less able to organize a suicide attempt and more apt to be under supervision.”

White Males Most Likely to Shoot

Older white men account for 88 percent of suicides by gun among seniors. Females over 65 account for 8 percent of suicides by firearm, and that number falls to only 2 percent among older black men.

Why? One reason is that the typical gun owner in the U.S. is overwhelmingly white, male and above 50 years old.

Saving Lives by Prevention

One study showed that handgun access was a much greater predictor of attempted suicide than having a long gun, such as a rifle.  

Of course, barriers to access can save lives. Dr. Liza Gold, a clinical professor of psychiatry at the Georgetown University School of Medicine, studies suicide among seniors. Her research shows that suicide rates are reduced by 10 percent if the gun in the house isn’t loaded, another 10 percent if it’s also locked, and an additional 10 percent when the ammunition is locked up away from the firearm.

After decades of clinical practice, Gold knows what to ask if a client is worried their loved one might be suicidal. “If a patient comes in and says he’s worried about his elderly father,” Gold said, “the most important thing to ask is, ‘Does your father have a firearm?’”



Blog posting provided by Society of Certified Senior Advisors