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Summary
Suicide is a critical public health problem that affects individuals of all ages, sexes, races, and statuses. According to official sources, suicide is the 11th leading cause of death in the United States (Barlow et al., 2018). Older adults (65 years and older) account for 12% of the population of the United States but approximately one-fifth of deaths that resulted from suicide were in this age group. These disturbing trends call for increased attention to the identification of underlying causes, recognition of warning signs, and prevention of suicide among the elderly.
Indicators of Suicidal Behavior
Ideation
Suicide ideation is the serious consideration of possibly ending ones own life. Fassberg et al. found that social isolation is strongly associated with non-fatal suicidal behavior (as cited in Conejero et al., 2018). 12% of the participants (older than 64) of a study by Sias et al. had a desire to die, with the loss of a spouse being a significant factor (as cited in Heuser & Howe, 2019).
Plan
A suicide plan is contemplating a detailed method of killing oneself. Those with access to lethal means, i.e., fire weapons and medication, are more at risk of dying from suicide (Conejero et al., 2018). The likelihood of a suicide attempt is two to three times higher for those aged 75 years or older (Heuser & Howe, 2019).
Attempt
A Suicide attempt is inflicting potentially lethal injuries on oneself on purpose. Despite suicide attempts being more prevalent among adolescents and young adults, older people exhibit the highest suicide rate worldwide. In general, socio-economic (bereavement, retirement, and social isolation) and clinical (dementia, physical illness, and disability) factors were strongly associated with suicide attempts in the elderly population (Conejero et al., 2018).
Suicide and Co-existing Disorders
Suicide is strongly associated with substance abuse and mental health disorders. Particularly, more than 80% of people who take their own lives suffer from a psychological disorder, substance use, or impulse control disorder (Barlow et al., 2018). Conditions that affect serotonin balance, such as depression and bipolar disorder, can cause instability and impulsivity, which can contribute to ones decision of killing oneself (Barlow et al., 2018). Executive dysfunction in depressed patients may predispose them to suicidal ideations and/or behaviors, especially if it is exacerbated by a loss of a loved one or a physical illness (Conejero et al., 2018). Overall, mental health disorders, such as depression and substance use, contribute to suicidal thoughts and behaviors among the elderly.
Depression and other mental health disorders contribute to suicidal thoughts and behaviors among older individuals.
Risk Factors
There are factors that put the elderly population at risk of suicide, straining their mental health and enabling suicidal ideation.
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Loss of social support, resulting depression, isolation, and hopelessness (Barlow et al., 2018);
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Economic uncertainty (homelessness or poverty, job loss, reduced income or retirement savings;
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Feeling a burden to others and/or loss of independence;
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Recent severe emotional distress (e.g. loss of a loved one);
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Declining health, lack of mobility, and disability;
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Chronic illness and pain (Suicide Prevention Resource Center, 2020).
Warning Signs
It might be challenging to clearly identify warning signs early enough because such behaviors can stem from lifestyle adaptations or physical health issues.
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Isolating from people and previously enjoyed activities;
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Changes in diet and sleep patterns;
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Substance abuse (excessive smoking, drinking, or taking medication);
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Excessive worrying and inexplicable guilt;
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Feeling hopeless or helpless;
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Getting ones affairs in order, e.g. adjusting will or giving things away (Suicide Prevention Resource Center, 2020).
Prevention Strategies
Early interventions are associated with the most favorable outcomes. Timely identification of unsuccessful coping mechanisms (warning signs) is important to further address the issue of suicide among the elderly population. Those considering the so-called rational suicide, in which individually control the circumstances of their own death, would also benefit from the following strategies.
Physicians
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Addressing cognitive decline. Recognizing cognitive decline in the early stages may help individuals develop better coping mechanisms to address potential stressors, such as feeling a burden or lack of social support (Van Orden & Deming, 2018).
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Addressing firearm access. Firearm access is strongly associated with an increased risk of suicide among all age groups. Assessing firearm access and offering safety counseling could contribute to lower suicide rates among older adults (Van Orden & Deming, 2018).
Family members, peers, and professionals are essential in helping identify warning signs and preventing suicide among the elderly.
Family members
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Addressing loneliness. Becoming a widower/widow and being socially isolated are risk factors associated with suicidal behavior (Conejero et al., 2018). Family members could address this issue by maintaining regular contact and sharing personal stories/experiences that might deepen personal relationships (Suicide Prevention Resource Center, 2020).
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Addressing warning signs. Family members can recognize early warning signs of suicidal behavior, and encourage and assist the individual in finding professional help if needed (Suicide Prevention Resource Center, 2020). Acknowledging an individuals feelings and guiding them in the right direction increases the likelihood of them getting help (Suicide Prevention Resource Center, 2020).
Loneliness, social isolation, and solitude are among the leading causes of suicide among the elderly.
National Suicide Prevention Lifeline
This lifeline provides emotional support for people in emotional crisis. It can be accessed either online or by phone at 1-800-273-TALK (8255).
Crisis Text Line
The Crisis Text Line provides 24/7 free crisis counseling and emotional support with a crisis counselor. It can be accessed by texting HOME to 741741.
Increased Access to Mental Health Care for Older Adults: Getting Support during COVID-19
This resource provides general information on mental health care for older adults and tools for finding an appropriate mental health provider during COVID-19.
Substance Abuse and Mental Health Services Administration National Helpline
SAMHSAs helpline is a free resource for finding information on treatment referrals for those struggling with mental disorders and/or substance use. It can be accessed by phone at 1-800-662-HELP (4357).
References
Barlow D. H., Durand V. M., & Hofmann, S.G. (2018). Abnormal psychology: An integrative approach (8th ed.). Cengage Learning.
Conejero, I., Olié, E., Courtet, P., & Calati, R. (2018). Suicide in older adults: Current perspectives. Clinical Interventions in Aging, 13(1), pp. 691699. Web.
Heuser, C. & Howe, J. (2019). The relation between social isolation and increasing suicide rates in the elderly. Quality in Ageing and Older Adults, 20(1), pp. 2-9.
Suicide Prevention Resource Center. (2020). Promoting psychological health and suicide prevention among older adults during COVID-19. Web.
Van Orden, K. & Deming, C. (2017). Late-life suicide prevention strategies: Current status and future directions. Current Opinion in Psychology, 22(8), 79-83. Web.
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