[NYAPRS Enews] Friedman: Elder Suicide, Public Health Challenge of the Elder Boom

Wed Jan 4 07:41:14 EST 2012

Elder Suicide: A Public Health Challenge of the Elder Boom

By Michael Friedman  Adjunct Associate Professor, Columbia University
Schools of Social Work and Public Health  

Huffington Post  January 3, 2012

By the age of 88, Mr. W.* had lost most of his closest friends to death
or dementia. His children had moved to other parts of the country. He
saw them and his grandchildren rarely. He had retired from his long
career as a teacher without finding new interests. But he and his wife
were happy. They both read a great deal, and every day they took a walk
together, talked about books and the state of the world, stopped for
happy hour at a local restaurant where "everyone knew their name." When
his wife developed lung cancer, he took her for treatment and nursed her
at home. But her cancer was more virulent than most. She died quickly.
The children came for the funeral and stayed a couple of weeks, but then
they went back to their homes. He was alone, and he felt lost. He began
to have bouts of dizziness and severe heart burn. He went to the doctor,
who prescribed medications that helped a bit. One day after a doctor's
visit he went home and took his own life. (1)

Nearly 15 older adults take their own lives every day in the U.S. --
about 5400 per year. (2) The frequency of suicide among older adults is
not well-known, probably because older adults die from many other
causes. Suicide is among the top three causes of death for teenagers and
young adults; it is not among the top 20 causes of death for women over
65 and is only the 17th leading cause of death for older men. But the
fact of the matter is that older adults complete suicide at a rate
nearly 50 percent greater than people 15-24 years old. Older white men
are particularly vulnerable, completing suicide at a rate three times
that of the general population. White men over 85 are the population at
highest risk; they take their own lives at about four times the rate of
the general population. (3)

There are a number of striking facts about suicide among older adults.

*	Older men are far more likely to take their own lives than older
women, despite the fact that women are far more likely to have a major
depressive disorder. (4)
*	Most older adults who complete suicide have seen their primary
care physician within 30 days of taking their own lives but have not
been identified as a suicide risk. (5)
*	Older adults may not attempt suicide more frequently than
younger people, but their attempts are generally more lethal. (6)
*	Men usually use guns to take their lives. Women usually take
pills. (7)

Reducing suicide among older adults is an important public health
imperative that will become even more important over the next two
decades as the population of older adults booms (8). But it will not be
easy to achieve.

Frequently the onus is placed on primary care physicians because a
majority of older adults who take their own lives have made a doctor's
visit shortly before they choose to end their lives. And it is likely
that if doctors screened for depression as a matter of course, asked
more questions and explored what was going on in their patients' lives,
they would identify more of their patients who are depressed and might
be able to provide treatment that would avert suicide. (9)

But suicide risk is not easy to identify. Most people who are depressed
are not going to kill themselves, some people who kill themselves are
not depressed, and a great many people who do kill themselves hide their
intention very effectively. Let me rush to say that some do not hide
their intentions, and people who say they are considering suicide must
be taken seriously.

If you are worried about yourself or someone you know, CALL THE NATIONAL
SUICIDE PREVENTION LIFELINE -- 1-800-273-TALK -- or visit
http://www.suicidepreventionlifeline.org/

There are other warning signs of suicide in addition to talking about
suicide, including depression, substance abuse, history of suicide
attempts, and more. For older adults, recent loss, severe physical
illness, social disconnection or increased dependency and loss of
dignity sometimes contribute to the decision to attempt suicide. For
more warning signs visit NSPL
athttp://www.suicidepreventionlifeline.org/GetHelp/SuicideWarningSigns.a
spx.

But most people who exhibit warning signs do not attempt suicide, and
people like Mr. W., who are stoic by nature, keep their feelings to
themselves and who have guns at home are very hard to identify as
suicide risks.

Yeates Conwell <http://www.urmc.rochester.edu/people/?u=20410452> ,
perhaps the nation's leading expert on suicide among older adults, uses
the interpersonal theory of suicide (10) to explain the complex factors
that contribute to older adults' decisions to take their own lives.
According to this theory the decision arises in large part from a mix of
"thwarted belongingness" and "perceived burdensomeness."

The implication of this theory is that prevention of suicide cannot be
accomplished solely through improved identification of risk, timely
intervention and access to help. These are important; but, in addition,
older people need a place of belonging and a sense that becoming
dependent does not mean becoming an intolerable burden.

That will be a tremendous challenge in our ageist society, which tends
disparage age. Even in families who choose to be caregivers, older
adults with disabilities are often not treated with enough dignity and
respect.

In other contexts, the kind of societal change that is needed has been
called building "age-friendly communities" (11) (12). It may well be
that in the long run the public health challenge of elder suicide is
more about building such communities than about traditional preventive
interventions.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide
Prevention Lifeline <http://www.suicidepreventionlifeline.org/> .

References:

1.	*Mr. W. is a composite of characteristics of men over 85 who
take their own lives.
2.	According to data at the Centers for Disease Control, 27,000
people 65 or older took their own lives in the five year period from
2004-2008, the most recent years for which data are
available.http://www.cdc.gov/injury/wisqars/index.html
3.	All data in this paragraph are from "Injury Prevention and
Control: Data and Statistics (WISQARS)" on the website of the Centers
for Disease Control.http://www.cdc.gov/injury/wisqars/index.html
4.	National Institute of Mental Health. Suicide in the
U.S.:Statistics and Prevention.
2011.http://www.nimh.nih.gov/health/publications/suicide-in-the-us-stati
stics-and-prevention/index.shtml
5.	Louoma, J. et al. "Contact With Mental Health and Primary Care
Providers Before Suicide: A Review of the Literature" in American
Journal of Psychiatry, June
2002.http://ajp.psychiatryonline.org/article.aspx?Volume=159&page=909&jo
urnalID=13
6.	Centers for Disease Control. Suicide Facts At A Glance.
2009.http://www.cdc.gov/ViolencePrevention/pdf/Suicide-DataSheet-a.pdf
7.	Centers for Disease Control. "Injury Prevention and Control:
Data and Statistics (WISQARS)" on the website of the Centers for Disease
Control.http://www.cdc.gov/injury/wisqars/index.html
8.	U.S. Census Bureau. "U.S. Population Projections."
2008.http://www.census.gov/population/www/projections/2008projections.ht
ml
9.	Friedman, M., Sederer, L. et al. "Treating The
Individual--Advice for Physicians Treating Older Adults" in Aging Well,
Fall 2011.http://www.agingwellmag.com/archive/fall2011_p18.shtml
10.	Joiner T. et al. Interpersonal Theory of Suicide : Guidance for
Working With Suicidal Clients. American Psychiatric Association, 2009.
http://www.apa.org/pubs/books/4317175.aspx
11.	World Health Organization. Global Age Friendly Cities: A Guide.
2007http://whqlibdoc.who.int/publications/2007/9789241547307_eng.pdf
12.	Williams, K and Friedman, M. Addressing The Mental Health Needs
of Older Adults in Age Friendly Communities,
2010.http://www.michaelbfriedman.com/mbf/images/stories/geriatric_MH_pol
icy/Age-Friendly_Communities/Age-Friendly_Communities--Guide_for_Planner
s.pdf
<http://www.michaelbfriedman.com/mbf/images/stories/geriatric_MH_policy/
Age-Friendly_Communities/Age-Friendly_Communities--Guide_for_Planners.pd
f%3C/li%3E%3C/ol%3E> 

http://www.huffingtonpost.com/michael-friedman-lmsw/suicide-risk_b_11605
54.html

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