It is little known, perhaps, how much at risk the elderly are to commit suicide. Perhaps society thinks of the elderly as too wise, mature, and happy, basking in their golden years, to be at risk for such a heinous act. Yet the reality is that, in the United States and in other countries, the elderly commit suicide at alarming rates.
South Korea has seen a rise, recently, in incidences of suicide in the elderly. This rate rose more than five times between 1990 and 2011. The suicide rate remains higher for elderly people than for young people by a wide margin. An article from the New York Times traces this phenomenon back to a social movement away from Confucian notions of filial piety (the obligation to take care of one's parents) which leaves many seniors without money or a social safety net. Feelings of depression, loneliness, or burdensomeness overwhelm seniors in South Korea, and the problem has yet to be solved.
Regardless of the overall population rate, which has fluctuated wildly in the past few decades and especially so since the Great Depression, suicide rates in the elderly American population are much higher than any other age group. Often given less-than-peak physical conditions, sometimes underreported due to the ease with which an overdose or physical injury may be perceived as accidental by coroners or loved ones, suicide completion rates in the elderly are higher than in youth, whose bodies bounce back from suicide attempts more frequently.
So what are the numbers? What are the possible causes? What can we do, as caregivers, family members, and loved ones, to lower these rates to as close to zero as possible?
It should be noted that this is a delicate and sensitive topic. We are focusing here on the realities, the causes, and the ways in which we can change those realities, but some may find this discussion upsetting. If you are worried about yourself or a loved one or feel that someone you know may be contemplating suicide, reach out to a mental health professional immediately.
The realities of suicide completions in the elderly are staggering. The American Foundation for Suicide Prevention notes figures from the Centers for Disease Control and Prevention (CDC)'s 2014 Data and Statistics Fatal Injury Report. These figures show that there are 14.9 suicides out of every 100,000 people over 65 in the United States. This is compared to a number close to 12 out of 100,000 for all people in the U.S., according to that same data from the CDC. This may seem like a small amount of difference, but with the number of seniors in the United States growing as a result of aging baby boomers, this rate is significant. According to the U.S. Census Bureau, there are 75.4 million baby boomers. If elderly suicide rates remain the same, that means that more than 11,000 lives will be lost to suicide annually as baby boomers reach 65 and older.
This number has changed in recent years, and varies depending on the country where seniors live, but it is clear that those numbers are far too high. Neglecting the problem will not solve it, but identifying and eradicating the causes just might.
The Possible Causes
Depression is the number one reason for suicidal ideation and completion. This means that untreated depression (or related mental illnesses, such as anxiety, bipolar disorder, or obsessive compulsive disorder, which can all be related to depression) is the biggest cause of suicide in the elderly. Without treatment, depression can get worse over time and end tragically, so early detection and continuous treatment once diagnosed is vital.
Depression is often not alone in causing suicide. University of Pittsburgh psychiatrist Alexandre Dombrovski told the Washington Post that depression rarely is solely responsible for suicide. It is usually paired with alcohol or drug abuse. Substance abuse raises suicide rates. According to a white paper from the Substance Abuse and Mental Health Services Administration (SAMHSA), abuse of alcohol or drugs is one of the biggest risk factors for suicide. That same white paper notes that the only larger risk factor for suicide is depression or other mood disorders, which means that seniors who abuse drugs or alcohol are taking big risks.
Dombrovski elaborated on his comments to Washington Post in an interview with SeniorsMatter.com. He reiterated that depression is "the most significant factor" putting seniors at risk for depression, but that "suicide is a very complex behavior... Other important factors are addiction, particularly drinking." Many people perceive older adults to be immune to these kinds of things, but they are not, he says. Baby boomers are just as vulnerable as they age, so alcohol intake and drug use should be noted even in those over 65.
Identifying and addressing substance abuse is almost as difficult as treating it, since many seniors grew up in a time when people did not always address such issues, especially if the user is nonviolent. But these behaviors alter the chemicals in the brain, and, coupled with other imbalances, may be the tipping point.
Seniors, especially those that have lost a spouse or close friends, are more likely to be socially isolated. (Additionally, seniors living in very remote places are less likely to see people or have access to communal social experiences). Without access to others and without the support of their peers, elderly people often experience loneliness, which can cause them to consider suicide a viable solution to their emotional struggles.
Dombrovski also notes that seniors whose personalities affect their relationships are at risk for suicide. "Personality and the ability to have functional and fulfilling relationships," affect a senior's risk for suicide. "People whose relationships are chronically unfulfilling are often at risk," he says, and should meet with a professional regularly to evaluate their mental state.
Elderly white men are the most at risk for death by suicide. In the same study quoted by the New York Times, the Centers for Disease Control and Prevention noted that roughly 51 of 100,000 white males 65 or older commit suicide. Why men? There is no one, cut- and-dried answer, but it is true that gender roles were more rigid and enforced when today's seniors grew up. Believing that they cannot show emotion, equating emotion with weakness, or needing to "be strong" for others may stop older men from seeking help or voicing their feelings of loneliness and depression. Gender roles that see men as "breadwinners" and providers may also contribute to feelings of a loss of control or depression in elderly men. Many elderly people unfortunately face financial difficulties, such as eviction or high medical bills, and since they may not be able to work due to physical disability, these men feel that they have failed in some way. Being unable to provide for a spouse, family member, or even themselves forces a feeling of loss, which may lead to impulsivity--a common factor in suicide attempts, and one that can affect the elderly, whose cognitive functions can decline in such a way as to present suicide as the only escape.
Double suicides, which take the life of a person and a spouse, are also more likely among the elderly, many for gender-related reasons; without a spouse to support/care for them, elderly women are more likely to see themselves as alone, weak, or isolated, and thus will complete the act along with their spouse.
Chronic pain is complex, since it often is the cause of many of the other experiences and risk factors listed here. Chronic pain often causes depression and can lead to feelings of hopelessness, a cognitive distortion that can end in suicide among the elderly. Fear of pain or disability can often lead to suicide as well, since many believe that with extreme age comes extreme physical discomfort and a reliance on others to care for them. This is not always true, but still causes enough fear to create that hopelessness that leads to a final decision on suicide.
Men are more at risk for developing suicidal thoughts as a reaction to pain or disability, Dombrovski says. He acknowledges that "it seems that men are particularly burdened by physical illness and it contributes more to their suicide risk compared to women." This could be for a host of reasons, which also relate to the pressure of gender role enforcement which can burden some men into feeling that an inability to perform physical tasks impacts their self-worth negatively.
Impoverished seniors are more likely to commit suicide, which is, like pain or fear of pain, a cause of many other risk factors. Impoverished seniors are less likely to get good medical attention when they need it, or be able to afford continuous treatment of a possibly long-term disorder like depression. They are more likely to abuse substances, experience pain or injury as a result of poor medical care or unsafe housing, be socially isolated, and financially unstable. All of this puts low-income seniors across the board at higher risk of suicidal ideation.
What You Can Do
Seniors who feel loved and social are less likely to be depressed, and therefore less likely to commit suicide. We cannot all live with our loved ones, but we can provide letters, phone calls, pictures of grandchildren or pets; we can arrange visits or outings to community events. Professional caregivers can help by making social time a priority, reading books together or cooking favorite meals side by side. These interactions are small but vital to preserving the happiness of seniors as they age.
Dombrovski notes that this is truly the first and best step for an at-risk senior. "There are multiple lines of defense," he says, but "the first line of defense is to detect depression and help people connect with treatment for it. At the population level, that is probably the best prevention strategy." Symptoms of depression may seem like normal aging to you, or may slip past a caregiver during the daily grind. Having a mental health professional evaluate your loved one regularly (once or twice a year, at least) can catch depression before it claims a life.
If you are worried that a senior in your life is depressed, voice this concern. Tell them that you want to help. Sometimes, all a depressed person needs to hear is that they are not the only one that can see changes, and it can inspire them to get medical attention. Keeping silent may seem kind or polite, but it is dangerous.
Whether you spend 24 hours a day caring for a senior or only manage a weekly phone call, seniors that are reminded of good times in their lives and good moments to come are more likely to continue being happy as they age. Small things may make all the difference--favorite meals, favorite movies, pets, walks in the park can all remind someone why life is worth continuing.
Seniors may not know this, but there are communities out there that want to help provide suicide-preventing activities and support. Some seniors will find comfort in faith-based or ethnicity-based organizations, which can provide a very specific kind of support and community. Others should seek out veterans organizations, facilities that offer more interaction with young people (perhaps a local YMCA, or similar location, where seniors can exercise and have social time), and/or activity-based groups like book clubs. These provide what a doctor or pill cannot: a sense of belonging, an end to loneliness, and a purpose to continue living.
This may prove a controversial statement in a country as comfortable with gun ownership as America, but Dombrovski says that firearms, in the case of at-risk seniors and especially those who have already voiced suicidal thoughts or attempted suicide, should be removed from the home. He says that, according to research, "80% of older men who kill themselves kill themselves with a firearm, and a somewhat smaller proportion of women." But won't those with suicidal thoughts find other ways to harm themselves, even without their firearms? Yes and no, he says. "There was research that there is unique risk that is explained by having access to a firearm. If people did not have it and they only had other means... they would be either deterred or do something that is not lethal," such as a drug overdose, which could be counteracted with medical treatment more effectively than an injury resulting from a firearm. If removing firearms is causing trouble, consider removing ammunition from the home. Without ammunition, a firearm is considerably less lethal and therefore poses less of a risk of aiding in the suicide of a senior.
There are many resources available for general suicide prevention, but one of the most valuable resources for seniors are hotlines tailored to their experience. All that is required is a phone line and your loved one can access the Veterans Crisis Hotline, the "friendship line" at the Center for Elderly Suicide Prevention, or set up an appointment with a mental health professional.
Resources may also be financial. The BBC reports that the United Kingdom found that suicide rates in the elderly declined precipitously when the elderly were part of a stable, growing economy, which provides them with financial stability and less emotional trauma. (Disclaimer: this is merely a correlation--the UK has not definitively identified a reason for this decline.) Providing financially for a senior, if you can, or finding programs that can help do so, may help him or her live longer.
As you can see, there is a wealth of actions to prevent suicide in the elderly. The focus should be on identifying and reaching out to at-risk seniors--those who are isolated, in pain, experiencing mental illness, etc. If we communally reach for them and show support and care, these rates can decrease, and lives can be saved
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American Foundation for Suicide Prevention (AFSP). Suicide Statistics. Available at http://afsp.org/about-suicide/suicide-statistics/. Retrieved February 17, 2016.
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