What's the problem?

Someone age 65 or over completes suicide every 90 minutes -- 16 deaths a day. Elders account for one-fifth of all suicides, but only 12% of the population. White males over age 85 complete suicide at almost six times the national average. Elder suicide may be under-reported 40% or more. Omitted are "silent suicides", i.e., deaths from medical noncompliance and overdoses, self-starvation or dehydration, and "accidents." The elderly have a high suicide "success rate" because they use firearms, hanging, and drowning . "Double suicides" involving spouses or partners occur most frequently among the aged.

What are the causes?

Elder suicide is associated with depression and factors causing depression, e.g., chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Depression is tied to low serotonin levels. Serotonin, which decreases with aging, is a neurotransmitter which limits self-destructive behavior.

What are the warning signs?

The following may indicate serious risk:

~ Loss of interest in things or activities that are usually found enjoyable ~ Cutting back social interaction, self-care, and grooming. ~ Breaking medical regimens (e.g., going off diets, prescriptions) ~ Experiencing or expecting a significant personal loss (e.g., spouse) ~ Feeling hopeless and/or worthless ("Who needs me?"). ~ Putting affairs in order, giving things away, or making changes in wills. ~ Stock-piling medication or obtaining other lethal means. ~ Most elder suicide victims saw a doctor within a month of their deaths. Nearly 40% did so within a week. Physicians may not recognize such patients as depressed.

Other clues are a preoccupation with death or a lack of concern about personal safety. "Good-byes" 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.

Why aren't community agencies or providers doing more?

Service involvement with older men:

Community agencies basically serve elderly women who have a suicide rate well under the national mean for all ages. Community agencies may be little concerned because elder suicide is uncommon in their caseloads.

Agency philosophy:

The prevailing value in most services for the aged is to optimize self-sufficiency in terms of individual capability and safety. A commitment to autonomy may cause community agencies to let the client or patient control decisions on referrals to other resources, alerting relatives, or involving available services.

Agency Misconceptions:

Community agencies and providers may accept some of the myths about suicide such as:

~ If someone's determined to kill themselves, no one can stop them. ~ Those who complete suicide do not seek help before their attempt. ~ Those who kill themselves must be crazy. ~ Asking someone about suicide can lead to suicide. ~ Pain goes along with aging so nothing can be done. ~ It makes sense for an old person to want to end their suffering. ~ Old people are used to death and loss and don't feel them like younger folks. ~ Those who talk about suicide rarely actually do it.

How many health or human service professionals, other staff, and volunteers believe these statements to be true?

Lack of risk assessment:

~ A lack of attention to elder suicide and a concentration on client or patient self-determination and self-sufficiency may limit community agencies' response. ~ Most community agencies do not recognize the problem and consequently do little or no screening for it among their clientele. ~ Most elder suicide victims either live with relatives or are in regular contact with family or friends. This implies that depression is more a factor than social isolation.

What can community agencies do?

Prevention must focus on what drives suicide. Shneidman (1995) notes:

...it is best to look upon any suicidal act as an effort by an individual to stop unbearable anguish...by "doing something." ...The way to save a person's life is also to "do something." Those "somethings" include putting that information (that the person is in trouble with himself) 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, proffering help, getting loved ones interested and responsive, creating action around the person, showing response, indicating interest, and, if possible, showing deep concern.

The issues raised here are more fully developed in Salvatore, T., "Elder Suicide: A Gatekeeper Strategy for Home Care" Home Heathcare Nurse 18(3), March 2000, pp.180-186. Hard copies are available on request.

"Doing something" comes down to caring.

© Tony Salvatore, 1999-2001

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