Suicide and Older Adults - What We Need to Know
by Don Drake, Connelly Law Offices, Ltd.
September is Suicide Prevention Awareness Month and a time to openly discuss the topic of suicide, which is taboo for many due to the stigma attached to it. Although suicide occurs in all age groups, none is more affected than the senior demographic.
"When it comes to senior suicides, the numbers are frightening. Older adults make up 12 percent of our population but account for 18 percent of all suicides," said certified elder law Attorney RJ Connelly III. "One organization that works with seniors [ American Association for Marriage and Family Therapy] says that elderly suicide may be underreported by some 40 percent due to "silent suicides", defined by them as overdoses, self-starvation, self-dehydration, and accidents, a choice many seniors make for a variety of reasons."
“The numbers, as they stand today, are problematic," says Attorney Connelly, “but given the aging baby boomers and the growth of the senior population, these numbers could increase significantly unless we begin to take this problem seriously.”
Experts agree with Attorney Connelly’s observations. The Centers for Disease Control (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. "This is a problem that we must confront now, especially coming out of the pandemic where seniors have been isolated and the continued push for seniors to age in place," said Attorney Connelly.
Ruth entered counseling to address a drinking problem that arose after the death of her father. She spoke fondly of her dad, Jimmy, recalling looking at his hands for the final time, calloused, cracked, but always gentle. She remembered those hands struggling to button her shirts for school or trying to thread a needle to sew up a pair of pants torn on a school fence. She also remembered holding those hands when crossing the street on the way to school and how they made her feel safe. "I really did not want to leave him alone at the funeral home," she said. "He was always there, and now, he's not."
Jimmy took his own life with a handgun at the age of seventy-two after doctors told him that he had Alzheimer's Disease. "Up to that point, I can't ever remember my dad not smiling or making a joke, but after he got that news, he just got lost in himself," Ruth said sadly. "We tried to get him some help, he was a Vietnam Veteran, so we had the VA to help, they set him up with a counselor, but I don't believe he was ever honest with her about his feelings. He was just too damn proud. But one morning in May, he was especially happy and seemed like the weight of the world had been lifted off him, I remember calling my brother and telling him that dad was making progress, that night, he was dead."
While going through her father's room, Ruth came across letters he had written shortly before his death. In those writings, he shared what he was feeling, including the fact that he didn't want to be a burden to the family. "Why didn't he share this with us? Allow us to tell him how we felt. He never gave us that chance," said Ruth. "And now I ask myself every day, what more could I have done, what should I have looked for, what words could I have said to make things better?"
"And now I ask myself every day, what more could I have done, what should I have looked for, what words could I have said to make things better?" --- Ruth
"Dad's suicide changed so much in our family and not a day goes by that I don't miss him or am reminded of him. I know loss is difficult to overcome, but when it occurs because of suicide, so many thoughts and feelings roll through my head," Ruth shared. "I have had to come to a realization that my peace lies in the unknown. Unknowns like what was he thinking before he pulled that trigger, what could I have done to prevent this? Was it just Alzheimer's diagnosis or did the years at war play into it? I'll never, ever know how much pain he was in, that's why I started drinking, to stop trying to imagine his pain. I know I need help; dad wouldn't want to see me doing this, but it's just so hard to stop thinking about his final moments."
"The death of a parent is always a challenge for children, but even more so when it is the result of suicide," states Attorney Connelly. "Feeling of rejection, abandonment, and indescribable loss can have a particularly damaging effect on their well-being and, in some cases, future relationships."
Common Among Seniors
In his practice, Attorney Connelly is remarkably 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 Alzheimer's disease, cancer, Parkinson’s, diabetes, or other dementias can trigger depression and set the stage for thoughts of suicide. It is more common than many realize," says Attorney Connelly.
Dr. Alexandre Dombrovski, a psychiatrist at the University of Pittsburgh, says 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.
Researchers found that rates of suicide rise sharply in the months after such news is delivered.
The Veterans Administration Study
A study of 148,000 older United States Veterans, with the majority being men, focused on those diagnosed with some type of mild cognitive impairment (MCI), which is often a precursor to the development of dementia. The study found that the risk of suicide was 73% higher in those recently diagnosed with MCI and 44% higher in those diagnosed with dementia.
Jami Halpern, a neuropsychologist at Northwell Health's Institute for Neurology and Neurosurgery in Great Neck, New York, stated, "Following a [MCI] diagnosis, patients, their loved ones and providers should be conscious of an increase in symptoms of depression, for example, increased social withdrawal, apathy, increased feelings of sadness, increased tearfulness and suicidal thoughts, to name a few."
But when looking at the numbers, why would the suicide risk be so high in those with a diagnosis of MCI and almost cut in half with a more serious diagnosis of dementia? The answer is in the early diagnosis. Those in the very early stage of cognitive decline are still able to understand what dementia entails. As with our story of Jimmy, they can anticipate what cognitive and functional decline looks like and don't want to be a burden on others. They are also better able to plan out a suicide attempt and complete the act.
"Those in the very early stage of cognitive decline are still able to understand what dementia entails...they can anticipate what cognitive and functional decline looks like and don't want to be a burden on others."
And there is a behavior to be aware of that can be quite surprising, as Ruth spoke about in Jimmy's case - a sudden improvement in mood. This tends to occur when the individual finally decides to take his or her life, a decision that had weighed upon them for some time. When this is combined with the giving away of personal items, it may be a strong indicator that a plan is now in place. In such cases, loved ones need to question their sudden mood change.
When it comes to suicide and depression, the times that are important are when the person is sinking into a depressive episode or emerging from one. This may appear to many to be perplexing, but the reason is that when the person is the most depressed, they do not have the strength to carry out the act of suicide and, there is no truth to the myth that asking a person if they are considering suicide will trigger that action to occur. In fact, asking that question often allows them to speak openly about what they are feeling and even ask for help.
Why More Men than Women
In looking at some recent data on suicide numbers, characteristics of elevated risk for seniors are being a white male and divorced. According to professionals, the strongest risk factor is having a major psychiatric disorder such as depression, which is very often associated with suicide.
Why men continue to take their lives at a higher rate than women can be attributed to multiple factors, but much of this can be linked to the method -- gun use by men is usually lethal while women tend to use less lethal methods like overdoses and suffocation allowing them to be found and saved by others. But some concerning research indicates that females in the 65-74 age are experiencing the highest increase in suicide attempts compared to other males and females across all age groups. Another startling statistic, in the 85+ age group, men kill themselves at a much higher rate than their female counterparts by a ratio of 14:1. And there are still societal expectations of men in this demographic.
“Our society has fostered certain beliefs and attitudes that become significant factors in suicidal behaviors. For seniors, losing autonomy, the perceived lack of dignity, and losing 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," said Attorney Connelly.
“Even in the age of political correctness, 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 due to our physical and mental abilities declining. Death is inevitable, but for men, discussing our fears about the end of life can be terrifying. For some men, 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."
"For some men, suicide is about taking control of the situation rather than waiting for death to come. As a society, we need to do better." -- Attorney RJ Connelly III
Dealing with Losses
As we mentioned earlier, seniors often struggle with multiple losses as they age. Mental health professionals cite the fact that losing status in the family and society can be the precursor to a depressive episode. Becoming a victim of financial fraud only reinforces for some seniors that they can no longer care for themselves. For some, these kinds of events could be the last straw.
“Sadly, scammers are 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 regularly address financial abuse perpetrated by these online charlatans”, said Attorney Connelly. “Unfortunately, some 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."
And it appears that the “even worse” that Attorney Connelly alluded to is happening regularly around the country as victimized seniors are taking their lives after falling for a swindle. Here are a few examples:
A Texas woman says her 82-year-old grandmother, who lost all her money to a con artist, was so devastated by the fraud, she committed suicide. The woman said her grandmother fell prey to a sweepstakes swindle. She was told she won money but needed to pay fees and taxes. She sent all her money to scammers and later had to borrow money from family members, took out all 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.
We also 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 can be at risk. The CDC reports that Native Americans and Alaskan Natives 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 race, gender, ethnicity, or religion needs to be taken seriously.
"The bottom line is this - any threat of suicide, from any individual no matter what race, gender, ethnicity, or religion needs to be taken seriously."
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 includes 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 a highly publicized suicide by a celebrity.
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 or 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 stress response. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should never be ignored.
What Should We Do
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. DO seek support and help. Some agencies 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 act immediately. 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 act, do not talk – TAKE ACTION. Call 911.
“What’s important here," says Attorney Connelly, “is that there are several actions that can be taken to prevent suicide attempts in the elderly. That includes reaching out to those who are isolated, in pain, have a mental illness, or experiencing a recent loss. If those of us who provide services to the elderly work together and show them the compassion, support, and care they deserve, we can identify the problem early and lives can be saved."