After what seems like a lifetime, we are finally beginning to emerge from the pandemic and its lockdowns, restricted contact with loved ones, and wearing masks, all activities that were aimed at keeping our most vulnerable population safe - our elderly. But in hindsight, this population may be dealing with long-term mental health issues because of these "safety factors". And in particular, an increase in the rising suicidality rate that was already present in older adults and seniors before the coronavirus.
As we move through 2022, there are forty-six million Americans aged 64 years and older that lived through the pandemic. Unfortunately, all the fearmongering on social media and misinformation spread by all sides of the debate has exacerbated pre-existing mental health issues in this group that manifested in increased episodes of depression and suicide. According to the World Health Organization (WHO), before the pandemic, about 20% of those fifty-five and older were experiencing psychological and drug addiction issues and that number has undoubtedly risen.
"Adults seventy-five and older have some of the highest rates of suicide of all groups. Although they only comprise 12% of the population, they represent 18% of all suicide completions."
When it comes to senior suicides, there are disturbing numbers we do know -- adults seventy-five and older have some of the highest rates of suicide of all groups. Although they only comprise 12% of the population, they represent 18% of all suicide completions. One in four seniors who attempt to kill themselves will die, compared to 1 in 200 younger people. Information from the CDC reports that as our society ages and even if the rates of suicide remain stagnant among this demographic, more than 11,000 seniors aged sixty-five and above will kill themselves – a startling number, and this is before COVID is in the mix.
The Lethality of Method
Why are these numbers so high? It's because they often have access to some of the most lethal means: firearms and medication. According to the CDC, 51% of all completed suicides are with a firearm, and with older adults, that number rises to about 70%.
What’s even more concerning is the fact that the true numbers of suicide in the elderly may never be known. Mental health professionals, in reviewing some of the “suspicious deaths” of seniors, feel the numbers may be underreported by some forty percent. They cite deaths by “silent suicide” – those that occur from overdoses, self-starvation, dehydration, and other so-called “accidents”.
Adam is a 78-year-old widower, and a resident of southeastern Massachusetts, who shares with us his story of depression, suicide, and the pandemic.
We were told it was a virus of the aged. To be safe, we needed to remain home. We heard stories of those in assisted living programs being held hostage in their rooms, or those in nursing homes being unable to have visitors, dying alone with no one to care. But I lived at home in Southeastern Massachusetts, by myself. My wife died over ten years ago, and during this time, I was told I was lucky, I had the freedom of the home. But was I really?
I listened to TV and was told it was not safe to go out, so I didn't. Rhode Island had a lockdown, Massachusetts did not. It was confusing. I would joke with friends on the phone that the virus must be smart because it knew where the borders were and where to stop. Before the pandemic, I belonged to the YMCA in Fall River, I had friends there and by going daily I felt younger and connected. Now I had nothing but a big, empty home to roam around in.
The Y was forced to close. I would wonder to myself why the gyms were closed but liquor stores and convenience stores that allowed for gambling stayed open. Another illogical move during the pandemic that never had any reasonable answer. But I needed the gym, I needed to be with others. We lived in fear -- and alone.
One of the fallacies of the medical community was the assumption that COVID was the only threat to the health and well-being of seniors. As each day went by, I could see that this was a false assumption, so why couldn't the medical community see that? I would have much rather gotten COVID than feel the way I felt -- lonely and isolated. Then came the demon I feared - depression.
Depression ran in my family. My father had it and he would talk to me about it when I got older, and he felt he could confide in me. In those days, no one talked about mental illness, the state hospitals and the abuse that occurred within them provided plenty of stories for the newspapers. To have a mental illness in those days was scary. But I often wondered to myself just why couldn't he just be happy? Just have positive thoughts. It seemed simple when I was a kid.
When my wife died in 2013, that's when I got hit with my first real bout of major depression. Add to this, I was diagnosed with Type 2 diabetes and neuropathy, so my activities were limited. My doctor put me on medication, and that's when I joined the Y, this gave me a reason to go out and stay active. When COVID arrived and they started closing everything, my life took a dive like never before.
Last year, sitting alone in the house, unable to go out or if I did, feeling like I would get sick and be a burden on others, I began to think about killing myself. When I told a nurse friend of mine, she reacted at first with alarm, and then gave me a look of disgust. Her answer was, "Don't feel bad, we all do." That's when I decided that talking about it made me feel even more inferior. I was becoming a burden to even the most casual of my contacts.
In the spring of 2021, I began actively planning my suicide. I decided to take an overdose of a medication I had for my neuropathy. It didn't work. I got extremely ill, had a splitting headache, and was hospitalized for about a week. I overheard my doctor talking on the phone to my son, who lived in Texas. I heard him say "it was a cry for help". That made me so angry that I refused to talk to anyone about what I did or what I was feeling, even my kid. Why? Because I remember how I felt when my dad hung this on me, why would I hang this on him?
"Dammit, I thought. This wasn't a cry for help. I wanted to die, and still do, but my ignorance about how much medication I needed to accomplish this kept me alive...And make no mistake about it, there will be a next time." --- Adam
Dammit, I thought. This wasn't a cry for help. I wanted to die, I really did, and I still do, but my ignorance about how much medication I needed to take to accomplish this kept me alive. Now I was even more embarrassed by what I did and more determined to be successful the next time, and even more determined to keep my mouth shut. And make no mistake about it, there will be a next time. One thing I learned about depression is that we are all just one trauma away from getting sick again. Next time, I may keep this to myself.
Since Adam shared this story, his attitude has shown a marked change for the positive. He is receiving counseling, in the process of selling his home and moving into an assisted living residence. He is heading up a support group for men who have suicidal thoughts. This has given him a reason to be, and even more importantly, his experiences offer hope to others who struggle with the same demons.
Who is Really at Risk? Characteristics of considerable risk for seniors are being a white male and being divorced. The strongest risk factor, according to professionals, is having a serious psychiatric disorder such as major depression, which is very often associated with suicide.
In his legal practice, certified elder law Attorney RJ Connelly III is familiar with how depression affects seniors and their families, many times encountering them following a medical emergency. “An older person who is diagnosed with a complex illness such as cancer, Parkinson’s, diabetes, dementia, etc. can trigger depression and set the stage for suicidal thinking, attempts, and even completions. It is more common than many realize, and the numbers will increase as our nation ages," he says.
Dr. Alexandre Dombrovski, a psychiatrist at the University of Pittsburgh, states that depression itself is not the sole factor in senior suicide. Misuse of alcohol or prescription drugs is also a major risk factor as well as a recent medical diagnosis, family discord, financial problems, physical disability, chronic pain, and grief. “It is the combination of one or several of these problems with depression that leads the person to feel trapped, making suicide appear like the best solution,” Dombrovski said.
As a retired licensed clinician in the Commonwealth of Massachusetts, I certainly concur with Dr. Dombrovski's findings. Even before the pandemic, our society fostered certain beliefs and attitudes that became significant factors in suicidal behaviors. For seniors, losing autonomy, the perceived lack of dignity, and loss of a family role can lead to depression and a lack of self-worth. Add to this alcohol and drug abuse and the risk of suicide increases exponentially.
The higher rate for men is also the result of real or perceived societal expectations that have been in place since an early age. Even in the age of "political correctness" and "wokeism", men are still conditioned to withhold their feelings. Aging pushes these feelings down even more as we begin to lose the 'roles' we held in the family structure as our physical and mental abilities decline.
All of us know that death is inevitable, but for men, discussing our fears about the end of life can be terrifying. For some, suicide is about taking control of the situation rather than waiting for death to come. For others, the pain of multiple losses and the inability to express these feelings appropriately can also result in suicide. As a society, we need to do better at recognizing and treating this.
Financial Fraud Factors in Elderly Suicide
But there are also other reasons for adults to see suicide as an option. Becoming a victim of a financial swindle has become another factor that only reinforces for some seniors that they are no longer able to care for themselves. And for some, these types of events could be the last straw.
“Sadly, there are scammers lurking everywhere on the internet and in the community just waiting to separate a senior from their life savings. As a firm, we help seniors and their families on a regular basis address financial abuse perpetrated by these online charlatans”, said Attorney Connelly. “Unfortunately, many are too embarrassed when they are victimized and make the decision not to share this crime with others, leading to mental health issues or even worse outcomes”.
And it appears that the “even worse” that Attorney Connelly is alluding to is happening on a regular basis around the country as victimized seniors are taking their lives after falling for fraud. Here are a few examples:
A Texas woman says her 82-year-old grandmother, who lost all of her money to a con artist, was so devastated by the scam, she committed suicide. The woman said her grandmother fell prey to a sweepstakes scam. She was told she won money but needed to pay fees and taxes. She ultimately sent all of her money to scammers and later had to borrow money from family members, took out all of her life insurance and then tragically committed suicide. She died with $69 in her bank account.
A 77-year-old man took his own life after falling victim to what the FBI calls, 'the grandparent scam' earlier this year. According to Margie Limmer, the daughter of victim Ed Faust, her father received a call from the Dominican Republic. The scammers said they were the authorities and had Faust's grandson in custody. The scammers said if he didn't wire them money, his grandson would go to jail. "Daddy goes, 'I've just been scammed, I've been made a fool of,' and my nephew said that he was very upset and after that, he went in the backyard and killed himself," Limmer said.
Albert Poland, Jr, 81, took his own life after years of receiving daily calls from Jamaica asking him for money. The Harriman, Tennessee, resident was repeatedly promised a lottery jackpot of up to $3 million. Poland, who was married with two grown children and two granddaughters, suffered from Alzheimer's and dementia.
Suicide Does Not Discriminate
We mentioned earlier that suicide affects older, white, divorced males more than any other group, but the truth is, suicide does not discriminate. People of all genders, ages, and ethnicities are at risk.
The CDC reports that Native Americans and Alaskan Natives (it's also important to note that these two groups also have extremely high rates of alcohol use disorder) have the highest rates of suicide followed by non-Hispanic whites. African Americans tend to have the lowest rates of suicide while Hispanics tend to have the second-lowest rate. The bottom line is this – any threat of suicide, from any individual no matter what age, race, gender, ethnicity, or religion needs to be taken seriously. So, what do we need to be aware of? Let's review some risk factors.
Risk Factors for Suicide
Depression, or other mental illnesses.
Alcohol or drug abuse or addiction.
A history of suicidal thoughts or attempts.
A family history of mental illness or substance abuse.
Family violence, including physical or sexual abuse.
Having guns or other firearms in the home.
Recently released from prison.
Being exposed to the suicidal behaviors of others – such as family members, peers, or celebrities.
Signs of Depression in Seniors
Fatigue or apathy (that cannot be linked to a medication or health condition).
A change in eating habits or sleeping habits.
Crying for no apparent reason.
Inability to express joy or have fun.
Changes in personality – “They’re just not themselves.”
Withdrawal from family and friends.
Loss of interest in hobbies.
Personal appearance and hygiene deteriorate.
A Suicidal Individual May Also:
Talk about or be preoccupied with death.
Begin giving away prized possessions.
Take unnecessary risks.
Increase the use of drugs, alcohol, or other medications.
Fail to take prescribed medicines or follow required diets.
Skip medical appointments.
Acquire a weapon.
Precipitating Factors for a Suicide Attempt:
The recent death of a loved one or close friend.
A prolonged physical illness.
Fear that a chronic illness will damage the family emotionally and financially.
Social isolation and loneliness.
Major changes in social roles like retirement.
Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.
I also want to mention something that a mentor of mine, the late Dr. Paul Gerson would often discuss when it came to working with suicidal individuals. He would point out that many believed that suicide would occur when the depressed individual is at the height of the depressive episode, or "rock bottom", as some would call it. This was not true.
Dr. Gerson would point out that suicide required thought and action. Someone who is at the peak of a depressive episode doesn't have the energy to put such a thought into action. He would say that the most dangerous time is either on the way to the peak (the person with depression knows their level of energy is waning so if they are going to do it, it must be done now...) or on the way out of the episode (when newfound energy gives them the ability to plan and carry out the action).
Although he would add the caveat that it was impossible to quantify when rock bottom occurs, he cautioned to be aware of tell-tale warning signs such as a resignation to die or even an upbeat attitude that is out of the norm for the person who has been living with depression. That "upbeat attitude" could be an inner peace that has developed because the person has finally made a choice. The lesson here is don't be lulled into a false sense that all is well.
How to Help
Here is a list of some Dos and Don’ts should you see some of these warning signs and suspect that a senior may be depressed or be at risk of suicide.
DO learn what the signs of depression and the behaviors of a suicidal person are.
DO ask directly if a person is thinking about suicide. DO NOT BE AFRAID TO ASK. The question will not “make” someone commit suicide and, in most cases, the suicidal person is relieved to be able to talk about their pain with another.
DO NOT act shocked if you receive an honest answer. This may make the suicidal person shut down and stay quiet.
DO NOT attempt to shame the person about their feelings or say something like “it will get better”. Instead, tell them you understand and offer them hope by saying that help is available for their feelings and offer them support.
DO NOT taunt them or dare them “to do it”. This approach has had fatal consequences.
DO NOT be judgmental. This is not the time to debate the morality of suicide. Don’t give them a lecture on the value of life.
DO NOT allow them to swear you to secrecy. Seek support and help. There are agencies that specialize in crisis intervention and suicide prevention. Also seek the help of family, friends, medical personnel, or clergy.
DO offer hope that alternatives are available but do not offer glib reassurance. It may make the person feel as if you don't understand.
DO take action. Remove easy methods that they may use to carry out the act such as firearms, rope, excess medications, etc.
DO NOT leave an actively suicidal person alone unless you need to run for help. If a person is in the process of suicide, do not talk – ACT. Call 911.
Connelly Law Offices offers training on preventing senior suicides. This training is based on the QPR – Question, Persuade and Refer – method and is a non-clinical presentation for the layperson. This training is available free of charge and is appropriate for senior centers, nursing homes, churches, or any organization that works with seniors and their families. To schedule a presentation, call Connelly Law Offices at 401-724-9400 and ask for Don Drake or email him at firstname.lastname@example.org.