Elder Suicide: A Needless Tragedy

By Barbara Worthington

Older adult suicide is often triggered by elders’ loss of control over health conditions or financial circumstances that results in feelings of hopelessness.

By the time older adults enter their seventh decade of life, their thoughts inevitably turn to life assessments. What achievements or accomplishments have marked life’s journey to this point? What opportunities does life present over the upcoming decades? Has life fulfilled expectations? Are there goals still to be attained?

At the threshold of older adulthood, thoughts often turn to satisfaction in the past and confidence— emotionally, financially, and socially—in the life events yet to unfold. Unfortunately, for some older adults, such satisfaction and confidence are elusive or nonexistent. And in the face of hopelessness in the prospects for a satisfying future, some older adults choose to end their lives prematurely.

In 2005, the most recent year for which statistics are available, there were 5,404 suicides in the United States among those aged 65 and older, according to the American Association of Suicidology. That figure translates into nearly 15 elder suicides per day, or one suicide every hour and 37 minutes. Although in 2005 older adults comprised only 12.4% of the population, they represented 16.6% of all suicides.

Who and Why?
Older men are at higher risk of committing suicide than older women. White males aged 85 and older are at the highest risk among all older adults.

Challenges placed on aging individuals can result in depression, which can easily evolve into clinical depression, according to Patrick Arbore, EdD, director of the Center for Elderly Suicide Prevention and Grief Related Services Institute on Aging in San Francisco. “An older person who is diagnosed with a complex illness such as cancer, Parkinson’s, diabetes, dementia, etc. can trigger a depression,” he says.

Likewise, losses that include the death of loved ones, pets, and even the potential loss of self can become extremely difficult to manage for elders, he says. Fears surrounding the ability to maintain an independent living status “can arouse enormous anxiety, especially when the older person values autonomy above all else.”

Just as research in gerontology has shown a pattern in older adulthood associated with greater happiness in later life with activity and flexibility, the lack of such attributes or styles may be associated with unhappiness and possibly suicide in late life, according to John L. McIntosh, PhD, a professor of psychology at Indiana University South Bend. “Health, finances, and social support are extremely important issues in life satisfaction and almost certainly suicide and depression in late life as well,” says McIntosh.  “Studies consistently show the tremendous relationship between suicide and depression.”

Unfortunately, however, depression among older adults is underdetected, according to Iris Chi, DSW, Golden Age Association Frances Wu Chair for Chinese Elderly School of Social Work & Davis School of Gerontology at the University of Southern California in Los Angeles. She notes that older adults with personality types that are less open and more inward display a greater proneness toward committing suicide.

Among other personality traits associated with older adult suicide cited by Arbore are timidity, shyness, seclusiveness, a tendency toward hypochondriasis, hostility, and a rigid, fiercely independent lifestyle.
Other factors associated with suicide are frustration and anger, both of which can lead to aggressive behavior toward oneself, says Arbore. Other contributing elements may include physical or psychological pain, frustrated psychological needs, and feelings of helplessness or hopelessness.

“Attitudes and beliefs can be significant factors in suicide, particularly autonomy, dignity, and responsibility,” says Arbore. “Alcohol and other substance use disorders also place older people at significantly increased risk for suicide.”

McIntosh suggests that suicide among older adults is “the result of several factors working in combination. Rarely, if ever, would a single factor produce a suicide.” Problems within the medical, psychological, or social realms or combinations of difficulties in several areas may contribute to thoughts of suicide in older adults.

Unlike suicides among young people, “Older adult suicide is not an impulsive act,” says Chi. “Elderly suicide is contemplated for a long period of time.”

“While it may appear that suicide is an impulsive act, people may have contemplated suicide for many years prior to their initiating a suicidal act,” says Arbore.

Most older adults who have experienced stressors and problems throughout their lifetimes have developed successful coping mechanisms and responses that have enabled them to deal with distressing or burdensome situations. But elders who experience an elevated risk for suicide embrace a psychological perspective of inability to tolerate the level of psychological pain they are experiencing, believe there are no solutions for their problems, perceive themselves as powerless to change their life circumstances, feel that they are a burden to others, or find that life has no meaning, according to McIntosh.

Detecting the Warning Signs
Family members and professionals need to be alert to any change in behavior among older adults, says Arbore. “In our ageist culture, many family members think that depression is part of normal aging,” he says. Sleep problems, either sleeping too much or too little, eating problems, or other signs of depression should be taken seriously, he adds.

Of course, the presence of firearms in the household certainly increases the risk. “When verbal statements of wanting to die or kill oneself are heard, they should be taken seriously and mental health help sought immediately,” McIntosh says.

He laments the fact that there are “few resources designed specifically for older adults who are suicidal,” but, he says, “every community will have mental health professionals as well as hotlines or even suicide prevention centers available to which they can turn for help for the older adult.” He suggests a national hotline number, 800-273-TALK (8255), that older adults can call.

Additionally, according to Arbore, the Center for Elderly Suicide Prevention and Grief Related Services operates the only 24-hour hotline for older adults in the country. This “Friendship Line for the Elderly” has been providing around-the-clock assistance to depressed, isolated, bereaved, lonely, and/or suicidal older adults since 1973.

Looking Ahead
Successfully addressing the issue of older adult suicide in the United States faces significant hurdles, according to the experts. “In our ageist, death-denying culture, many older people, particularly men, slip into hopelessness and suicidal behavior because they believe that older age is a descent into loss and suffering,” says Arbore.

“Because men have been conditioned since childhood not to acknowledge feelings, they have no way of expressing their fears about the inevitability of death,” he says, adding that the concept of life’s impermanence terrifies them. He suggests one way of expressing this fear is by acting to take control of this experience by committing suicide. “The inability to accept life on life’s terms propels suicidal ideation,” he says. “Unfortunately, I find that we have a long way to go as a society when it comes to decreasing the risk of suicide for older people.”

The large cohort of baby boomers moving toward older adulthood has prompted thoughts as to their impact on suicide rates. “There is some expectation that as the large number of baby boomers reach old age in the upcoming years, that suicide rates will increase among the old,” says McIntosh. However, he says, “This increase is anything but certain to occur.” He suggests that, although such an increase is possible, boomers are better educated, expected to have more financial resources associated with that education and higher pay over their lifetime, and are in better health than most earlier generations.

Chi notes the necessity of improving healthcare and mental health services to older adults and increasing awareness through public education. The National Institute of Mental Health is one organization that has designed a program for healthcare clinics to improve recognition and treatment of depression and suicidal symptoms in older adults.

— Barbara Worthington is associate editor of Aging Well.