Suicide Risk Among Older Adults - The Increasing Numbers and Risk Factors
By Don Drake, Connelly Law Offices, Ltd.
"Suicide risk among older adults is a significant problem," said professional fiduciary and certified elder law Attorney RJ Connelly III. "Suicide rates are exceptionally high among older men, with men ages eighty-five and older having the highest rate in the country. Suicide attempts by older adults are much more likely to result in death than among younger persons. The reasons are that older adults plan more carefully and use more deadly methods, are less likely to be discovered and rescued, and are less likely to recover from an attempt because of their frailty."
"If we break down the numbers, they tell an important story," Attorney Connelly said. "Older adults account for 16 percent of suicides; however, they only comprise 13.3 percent of the population. And these numbers, say the experts, are vastly underreported."
"Some older adults purposely engage in indirect suicidal behaviors, which will eventually lead to their death. These include refusing medication, food, or liquid, ignoring medical advice, and living in unsafe/unsanitary conditions. In most cases, these deaths are not labeled as suicide, even though that was the intent."
A Story of Suicide
When Sasha turned sixty years old, her sister, Cecile, who was fifty-five, hung herself in the basement of her mother’s home. Her brother Paul had died ten years earlier in a car accident in New Jersey.
This story is not about a dysfunctional family but is far from it. The three children were raised in an upper-middle-class Long Island home, with their father a medical doctor and her mother a dentist. Sasha said that as children, they had everything they wanted. The children grew up, married, and raised families near their parents. But as adults, situations occurred that sent them down the path of severe mental health issues.
The first tragedy occurred when Paul, the youngest of the three, was driving back from New York after a business trip and was killed in an accident. Another driver, who was drunk, crossed over the median on the highway and struck him head-on. The drunk driver survived.
Several years later, a man appeared at Sasha’s home after her husband went to work, looking for odd jobs. When she stepped outside the door, she could smell alcohol on the man’s breath and knew he was drunk. At that point, he pushed Sasha aside and went into her house. As she followed, the man grabbed her and sexually assaulted her. This event set her on years of nightmares and flashbacks, which were treated with Valium -- ever-increasing amounts of Valium.
For thirty years, Sasha struggled with depression and suicidal thoughts, partly brought on by the increasing amounts of the medication she was taking. Whenever she had a suicidal idea or a passive attempt, she spent time in the hospital and came out with more drugs that continued to numb her.
After her last attempt, where she stood on a railroad crossing waiting for a train to pass and run her over, her husband took her to a different doctor who felt the medications played a considerable role in her suicidal thinking. After a long talk and discussing ways to wean her off the drug, the doctor sent her to a therapist who dealt with PTSD.
"After several months, I started to feel again," Sasha said. "I could feel the love of my mother and father, who were still alive on Long Island, and my husband's love." Unfortunately, Cecile was not doing well. She had become addicted to pain medications after a fall at her job, which fractured multiple vertebrae.
“We got together when I felt better and cried about what each of us was going through,” said Sasha. “We became extremely close.”
Sasha and Cecile were inseparable. Then, one October morning, the parents found Cecile hanging in the basement. “I am at a loss as to what happened,” Sasha said. “Just a few days before, we rode horseback and had an impromptu picnic. We discussed our lives and our future dreams and goals. She was so happy when we parted, and there is no explanation.”
Meanwhile, their elderly parents, who found Cecile, were traumatized and required medical care. After several months, Sasha returned to treatment, grieving the loss of her brother and sister and the loss of thirty years of her life.
“I stopped looking for answers and have focused on acceptance, but I do know that I have multiple supportive people around me who know what to look for if I begin sinking into depression again,” said Sasha. “I have my faith and love for others and wake up every day hoping I continue to have the strength to move forward.”
"The reason I wanted this story told was to remind everyone that suicide can happen to anyone and any family," stated Attorney Connelly. "And with the expected increase in our senior population, having knowledge about this subject is imperative."
An Increasing Risk
According to the Substance Abuse and Mental Health Administration, baby boomers born between 1946 and 1964 have had a higher suicide rate at any given age than earlier or subsequent birth cohorts. Demographers estimate that by 2030 over seventy-one million Americans will be sixty-five or older, or 20 percent of the U.S. population. Baby boomers are a group with historically high rates of suicide, and as they enter older adulthood, it is anticipated the rate of suicide in men and women will rise again. Some of the triggers for seniors considering suicide are:
Death of family and friends: Losing a partner or a close friend could trigger feelings of depression and grief. It may make a person wonder when their time will come. Losing long-term relationships can leave a vacancy in the person’s social circle and further isolate them from others.
Facing an illness: As we age, we develop certain conditions that can cause pain and discomfort. We may be diagnosed with a disease that affects our quality of life. These ailments can cause significant distress.
Financial insecurity: Seniors often rely on a fixed income for daily needs. As prices continue to rise, they may have less money to support themselves. Without family support, they may feel discouraged from the financial strain and consider suicide a way out.
Loss of mobility: Some older people discover they can no longer get around like they used to. They may be forced to use a wheelchair, walker, or cane. Going upstairs or attending events outside of the home is impractical. Being homebound may cause them to feel isolated and lonely.
How Suicide Impacts the Family Survivors
There are so many emotions that come with losing a loved one to suicide. Even though realistically you know it is not your fault, you carry the pain that there was something you could have done to stop it. Suicide can also be a family epidemic. It hurts those left behind and leaves them full of unanswered questions. Below is a list of these impacts and how they affect family survivors:
Traumatic aftermath: Survivors are often required to identify their loved ones or answer questions about the scene. Sometimes the location may be violent or traumatic for the loved one to witness. Loved ones are already in shock about the incident, only to be met with questions from police and medical personnel.
Stigma and isolation: Suicide can isolate survivors from their community and other family members. If there is a history of mental illness, survivors may struggle with the ongoing stigma surrounding mental illness. Each family member will respond differently; conflict may arise about what and how much to tell others. This may result in arguments and finger-pointing instead of supporting each other.
Mixed emotions: The loss of a loved one to suicide can result in a range of emotions that can be difficult to navigate. While suicide results from a mental illness, the act can often leave those left behind feeling abandoned and rejected by their loved one who has passed.
Need for a reason: People search for explanations, it's part of being human. Survivors of suicide loss often play the “What if” game wondering if there was something they could have done and often overestimating the role they could have played. They will repeatedly play the event in their heads, asking what they missed. They often want to know everything they can about the circumstances to make sense of their feelings and grief.
A risk for survivors: As with any loss, losing a loved one to suicide can bring questions to those left behind. They may wonder if life is worth living. For those who have lost a loved one to suicide, the risk is heightened, especially if there is a history of mental illness. Professional help must be sought if these feelings persist or become intense.
Suicidal thoughts in older adults may be linked to several important risk factors and warning signs. These include, among others:
Recent onset of depression.
History of suicide attempts or suicidal ideation.
Marked feelings of hopelessness or a lack of interest in plans.
Feelings of loss of independence or sense of purpose.
Medical conditions that significantly limit functioning or life expectancy.
Impulsivity due to cognitive impairment (may be present in those who are compulsive gamblers, hypersexual, binge eaters, etc.).
Social isolation (either by choice or situational).
Family discord or losses (the recent death of a loved one or divorce).
Inflexible personality or marked difficulty adapting to change.
Access to lethal means (having firearms in the home, other weapons).
Daring or risk-taking behavior.
Sudden personality changes.
Alcohol or medication misuse or abuse (this includes the hoarding of medications that should be disposed of).
Verbal suicide threats include, “You’d be better off without me” or “Maybe I won’t be around."
Giving away prized possessions.
Strategies for Prevention
Let's be completely honest, if someone is determined to attempt suicide, they will find a way. However, there are some specific steps to try and prevent suicide by reducing access to means commonly found in a place of residence and increasing support around them. They include:
Developing a solid connection to the senior and include community support.
Encourage family members to look out for warning signs of suicide. Again, these signs include hoarding medication, talking about being with dead loved ones soon, being preoccupied with death, withdrawing from friends and/or activities they once enjoyed, and increased use of alcohol or pain medications.
Educate older adults on ways to develop skills in problem-solving and conflict resolution.
Remove firearms from the home. If the older adult will not allow this, unload the firearm, store the ammunition in another part of the home, and place a trigger lock on the gun.
Dispose of out-of-date medications. If necessary, medications should be monitored by someone who can recognize potentially lethal dosages or combinations of medications and can properly dispose of them if needed.
Consider removing the car keys if necessary. The car can also be a tool for suicide. But this is an extreme step because doing this limits the senior's access to the outside world and can also be a trigger. This step requires a discussion with the family and other professionals involved with the senior.
A Final Thought
"Friends and family of older adults must identify signs of suicidal thoughts and take appropriate follow-up actions to prevent them from acting on these thoughts," said Attorney Connelly. "Suicidal thoughts are often a symptom of depression and should always be taken seriously."
Passive suicidal thoughts include thoughts of being “better off dead.” They are not necessarily associated with an increased risk for suicide but are a sign of significant distress or depression and should be addressed immediately.
In contrast, active suicidal thoughts include thoughts of taking action toward hurting or killing oneself and having a plan in place. An example of active suicidal thinking would be answering yes to the question, “In the past week, have you had any thoughts of hurting or killing yourself?” If these thoughts are present, immediate clinical assessment and intervention by a mental health professional is needed.
Attorney Connelly reminds everyone that if someone you know has a suicide plan with intent to act, you should not leave them alone and make sure to stay with them until emergency services are in place.