Suicide Prevention & Intervention in Older Adults
The unexpected deaths of Kate Spade and Anthony Bourdain are tragic. I can’t think of a better word to describe their passing since every sentiment feels like an understatement. Suicide is powerful: it reverberates through cities like a seismic wave, belying prediction and perception.
Like other forms of mental illness, depression doesn’t discriminate. It permeates the lives of many people regardless of socioeconomic status, age, race, gender and sexual orientation. In 2016, an estimated 16.2 million Americans experienced at least one major depressive episode, and depression remains the leading cause of disability for people worldwide.
Older adults have higher suicide rates
Older adults are the most rapidly growing segment of the population worldwide and maintain higher suicide rates than any other segment of the population. By virtue of the size of this age group and the fact that Baby Boomers tend to have higher suicide rates than earlier or later birth cohorts, we will most likely continue seeing more suicides. Notably, 74% of suicides among adults age 70 and older involve firearms, a statistic which indicates our cultural relationship with guns.
Ubiquitous among various age groups is that it’s difficult to prevent suicide once a person initiates suicidal behavior. The implication is that we must be aggressive when faced with these attitudes and responses. As Dr. Yeates Conwell, psychiatrist with the University of Rochester, says:
“The challenge with older people is that [clinical depression] goes undetected, and when it is, it’s inadequately treated. Primary care is the major setting for this because older people don’t go to mental health providers. Suicide prevention in later life is about mental health partnering with primary care to optimize detection and treatment of depressive disorders and other conditions.”
In fact, only 3 percent of all Medicare reimbursement is for psychiatric treatment, a statistic grossly incongruent with the reality that 20% of people over 55 suffer from a mental disorder.
The Four D’s of Suicide Risk in Older Adults
On a more positive note, we can alter the trajectory towards suicide and save lives when we recognize certain traits and actions. Psychiatrist Dr. Yeates Conwell identifies “The Four D’s” of suicide risk in older adults, a framework which helps us identify worrisome behaviors that demand our attention.
#1 — Depression
An older adult with clinical depression will typically be sad and lose interest in things that they previously enjoyed. They might also be anxious, have trouble sleeping, or experience a loss of appetite. Somatic symptoms may appear such as pain, stomach upset and fatigue.
Should you recognize any of these symptoms in a loved one, contact his or her primary care doctor to share your observations and concern.
Geriatric physicians and many primary care physicians are trained to detect and screen for depression with standardized questionnaires such as the PHQ9 and GDS, Geriatric Detection Scale. Since older people do not generally visit mental health professionals, primary care is the major setting for depression treatment. Additionally, while there is concern around the safety of medication for depression, antidepressants are safe and effective for reducing suicidality in older adults.
#2 — Debility
Approximately 80% of older adults have at least one chronic disease such as heart disease, cancer, stroke, or diabetes, and 77% have at least two. As these illnesses become additive, they can affect a person’s ability to function and maintain independence, such as a person’s ability to enjoy activities that they used to find meaningful, like exercise, driving and reading.
Despite limited mobility, it is still possible to remain active and engaged in different ways. For seniors with visual impairments, audiobooks and ebooks represent a great way to connect with favorite authors and news outlets. It may be worth exploring exercises like chair yoga, water aerobics and light weights. Also, activities like painting, coloring and sculpture require less movement and have been proven to improve medical outcomes.
#3 — Disconnectedness
It is extremely important for older people to maintain social connection with others. If an older person withdraws from social interactions due to physical illness and functional impairments, they’re at an additional risk. Even speaking on the phone has been shown to decrease suicidality as proven by a study in which elderly people received twice-weekly support calls.
The Institute on Aging supports seniors by providing a 24-hour toll-free Friendship Line, a nationwide program that reaches out to lonely, depressed, isolated, frail and/or suicidal older adults. Trained volunteers listen kindly to depressed older adults and offer their support.
#4 — Deadly Means
Over 70% of older people who take their own lives do so with a firearm. An older adult who keeps a firearm in the home and exhibits signs of the three other D’s is at an increased risk of death by suicide.
If you are concerned about a loved one’s ability to exercise safe control over a firearm, alert his or her primary care doctor who can evaluate the stage of dementia (if applicable) and ability to complete complex tasks, including firearm handling. You might also consider a family firearm agreement in which the family member commits to surrendering control of all firearms when he or she can no longer make the best safety choices.
Depression is never a part of aging
Dr. Jo Anne Sirey, professor at the Weill Cornell Medical College, Department of Psychiatry, says:
“One of the primary issues is that depression is often not well detected. It’s mistaken as a natural part of aging, and depression is never a natural part of aging. We really need to work together — mental health and the aging service providers.”
It’s not normal to feel as if life has no meaning in old age. If someone expresses this attitude, it should symbolize a red flag and prompt additional evaluation because these illnesses can be changed. If you are concerned about the health of someone you love, please reach out to his or her primary care doctor so they can be properly evaluated.
Resources
- Suicide Prevention Resource Center: (800) 273-TALK
- Institute on Aging — Friendship Line: (800) 971–0016
- American Foundation for Suicide Prevention
For more information on aging and eldercare, visit our website and sign up for our weekly newsletter. This post originally appeared on the Ayuda Care Blog.
