Older Americans disproportionately are likely to die by suicide. Although they comprise only 12 percent of the United States population, people 65 and older accounted for 16 percent of the suicide deaths in 2004. In general, suicide attempts are much more likely to result in death in the elderly population. One out of four older adults who attempt suicide dies compared to 1 in 200 young adults who attempt suicide.
There are several reasons why older adults are more likely to die after a suicide attempt:
- Older adults are more likely to plan carefully and use more deadly methods.
- Older adults are less likely to be discovered and rescued.
- Many older adults are physically frail, and are less likely to recover from a suicide attempt.
Depression is one of the conditions most commonly associated with suicide in older adults. Studies have shown that of the older adults, 75 percent had visited a primary care physician within several months of their death. Why is depression common in the elderly population? Sometimes it is situational. For example, depression may occur in people who felt fine but are now dealing with a death in the family or a serious illness. People with a diagnosis of a serious illness such as cancer, diabetes, heart disease, stroke, Parkinson's or Alzheimer's disease can be at an increased risk of depression and suicidal ideation. Up to 40 percent of people with Alzheimer's disease suffer from significant depression. Another cause for depression is genetics. Many studies have shown that depression may run in families. In addition, depression tends to be a disorder that occurs more than once; if someone has past episodes of depression, they are at higher risk of becoming depressed in the future.
In many nursing homes, rates of a correct diagnosis by nursing home staff are low in newly admitted residents. The risk of depression increases with other illnesses and when the ability to function becomes limited. Untreated depression can delay recovery or worsen the outcome of these other illnesses. However, depression is not a normal part of aging. Health-care providers mistakenly may think that persistent depression is an acceptable response to other serious illnesses and the social and financial hardships of aging. Depression in older adults is often manifested physically in "not feeling well" and unexplained physical pains.
Don't be afraid to get help. Often short-term psychotherapy is needed and covered by Medicare. Some treatment providers may be able to offer services on your ability to pay. It is important to talk to your doctor about your depression. Not all doctors are comfortable addressing depression. If this is the case, it is important to talk to someone who is. Often psychotherapists (social workers, therapists, counselors, psychologists or psychiatrists) are a good professional resource to use when talking about depression. It is important to remember that it takes time to get better from depression and to give yourself time to heal, just like a physical illness. Following your health-care professional's or counselor's advice and treatment plan is an important part of getting well. It also is important to discuss your treatment with them in a trusted partnership working towards good health. Your family and friends can play a vital role in getting better after depression also. Remember, feeling better takes time, but it can happen.
Risk factors for suicide are personal characteristics, life circumstances and situations that lead to, or are associated with suicide. Risk factors in the elderly population include:
- Mental illness.
- Major depression
- Other mood disorders
- Psychotic disorders
- Substance misuse and abuse.
- Alcohol (this is less of a risk factor in the elderly population)
- Prescription and over the counter medication
- Physical illness, disability and pain.
- Poor physical health
- Functional impairments
- Side effects of some medications
- Personal and family history of suicide.
- Previous suicide attempt
- A family member who has died by suicide
- Current life circumstances.
- Social isolation
- Major life transitions, such as moving to a new setting
- Family conflict and loss
- Financial problems
- Lack of a sense of safety
- Losing autonomy, respect, supportive relationships, and participation in civic and social life
- Other people having lower expectations for them
- Personal characteristics.
- Inability to adjust to change
- Low rating of their own health
- Low self-esteem
- Impulsive or aggressive behavior
- Cultural or religious beliefs favorable to suicide, especially among older people
- Access to means.
- Stockpiling medications
- Older adults can also stop eating, drinking or taking medication, which can be considered risk factors
Warning signs in the elderly population include:
- Nervous or feeling "empty."
- Feelings of guilt or worthlessness.
- Feeling very tired.
- No longer enjoying things that used to bring you enjoyment.
- Feeling restless and irritable.
- Feeling like a burden.
- Feeling like no one loves you.
- Feeling like life is not worth living.
- Sleeping more or less than usual.
- Eating more or less than usual.
- Having unexplained headaches, stomach aches or chronic pain.
For good mental health:
- Use your mind, stay mentally active.
- Set goals for yourself and take steps to move towards them.
- Be physically active every day.
- Get proper nutrition at each meal, including beverages.
- Get adequate sleep.
- Develop and maintain good relationships.
- Learn to recognize the signs and symptoms of depression in yourself and others around you.
- Get regular checkups from your health-care provider.
For family and friends:
If your loved one refuses to get treatment for depression, it can be very beneficial to discuss how he or she will feel better after the depression is under control. For those still unwilling to go, it may be possible for a health-care professional to call the loved one and initiate the conversation. The phone call doesn't take the place of an office visit, but may be enough to get the person with depression to visit them in person. Try to be patient and understanding with the course of depression. Ask questions. It may be necessary for you to accompany loved ones to their health-care provider, especially when discussing medications or treatment plans.
Information adapted from Substance Abuse and Mental Health Services Administration, National Institute of Mental Health and the National Institute on Aging.