The causes of death among the elderly are traditionally associated with the normal aging process or what would be called natural process, diseases associated with age and the debilitations it can cause. Yet, other factors also contribute to the cause of death an individual might succumb to, widowhood, retirement, forced relocation, and/or loneliness especially around the holidays. (Huyck Hoyer 1982) Still other studies are making it clear that murder and suicide rates are increasing dramatically among the elderly. (cf., Birren, Schaie, 1977) (Nussbaum, Pecchioni, Robinson & Thompson, 2000, p. 294) Suicide was the eleventh leading cause of death among persons over the age of 65 in 1982. (Riley, 1983, p. 144) Some strides have been made and between the years 1983 and 1998 suicide averaged as the fourteenth leading cause of death for persons over the age of 65, lower than the average for all ages over those same years. (Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC, 2001) When looking at this particular statistic consideration must be made for the increased incidence of disease among the over 65 population. The reality of which skews the comparison considerably.
In assessing the needs of any elderly population and community ability to assist them, on the issue of risk for suicide, the population at high risk can be seen as falling into three general categories. All of these categories increase risk of depression often a precursor to suicide. Depression and suicide risk factors are particularly evident in the geriatric population.
The first category being those persons who have had a recent loss, usually the death of a spouse or child but could also be a loss like a home or possessions:
There had been considerable research on the effects of loss of spouse in old age, especially through widowhood. Studies have found that persons without a spouse have lower morale (Gurin et al., 1960; Kutner, 1956), have lower incomes (U.S. Census), have higher rates of institutionalization (Palmore, 1976b), and higher mortality and suicide rates. (Palmore, 1981, p. 79)
This sort of depression is normal in association with the natural grief process associated with loss and only becomes problematic when prolonged to a degree that it significantly impairs the individual's quality of life. It then becomes clinically necessary to treat and treatment is especially necessary when that individual shows suicidal tendencies.
The second general category is people who have just received an unpleasant medical diagnosis, a terminal diagnosis or a debilitating chronic diagnosis. Impending issues of dependency or chronic physical discomfort or pain are significant factors in this category. The chances for the occurrence of such diagnoses naturally increase as one ages. Once again this depression linked to a life event is normal and does not become abnormal until the time that it affects the person's quality of life.
The third category is a category that includes the group who might be more closely associated with true clinical depression, regardless of other environmental factors they seem to feel a general lack of usefulness or purpose that elicits feelings of depression and could result in higher risk for suicidal thoughts or actions. "Organically-based major depression, also referred to as primary depression, results from various biological and chemical changes in the brain and nervous systems or from changes in the endocrine system." (Osgood, Brant & Lipman, 1991, p. 101)
Recent investigations of mental illness after the age of sixty have reemphasized the close link between depressive illness and old age, and recent psychiatric studies of cases of attempted suicide have also demonstrated the significance of depressive illness as the common setting of suicidal acts in this age group. At all ages, both individual and social factors contribute to the genesis of suicide. In old age, individual factors are the more important, and mental illness of a clearly recognizable kind plays a leading role. (Menninger, 1957, p. 144) person suffering form organic depression would nearly always benefit from mental health treatment but once again it becomes imperative under conditions of severer life impairment.
IR.C. Batchelor, M.B., D.P.M., F.R.C.P.Ed Physician Superintendent, Dundee Royal Mental Hospital; Lecturer in Clinical Psychiatry, University of St. Andrews, Scotland in his contributing chapter "Suicide in Old Age" of the book Clues to Suicide can answer the question of the necessity of this study. In this chapter Batchelor discusses the possible layman dismissal of the aged as a population at high risk for suicide. Conjecturing that an uninformed person might think that the elderly are less likely to commit an act of such a rash nature.
Yet the facts are that, in many countries of Western civilization, suicide is relatively more common in the higher age groups, and with the exception of extreme old age, it becomes a progressively more frequent reaction both in men and women, as they grow older. Male and female attempted suicide and suicide rates vary according to the culture in which the individual lives, but there appears to be a general tendency in old age for male rates for suicidal acts to be higher. As the proportion of old people in our communities becomes larger, suicide among them is likely to become an increasing medical and social problem. (Menninger, 1957, p. 143)
The target population in this assessment will be the residents of an assisted living facility as well as individuals who use the services of a home assistance agency. Neither population requires outside assistance for personal physical care but only requires assistance for specific activities of daily living. These needs include but are not limited to, meal planning and preparation, general house keeping duties such as a weekly maid service might provide, they also require assistance with household maintenance and general upkeep. All of these services have a twofold purpose in an assisted living environment and in a home assistance situation, they prove that the individual has made a decision to remain independent of family for these daily needs and/or that the individuals family is unwilling or unable to provide them. Additionally the combined results of these group study choices both those living at home with assistance and those living in an assisted living facility is not necessarily to compare and contrast the two environments but to eliminate the soft constraint associated with the true differences in the availability of social interaction, which has been shown to greatly increase or decrease signs and symptoms of depression in a significant way. This social contact theory has been a commonly suspected source of general unhappiness associated with some elderly persons and has recently begun to be studied in a significant way. One set of theories associated with it is:
The prevalent decremental model of aging (N. Coupland & J. Coupland, Chapter 3, this volume) that predicts decline in sensory, mobility, and cognitive thresholds of ability, with ensuing problems in interpersonal communication resulting in isolation from social interaction and increasing social distance from younger people. Written from a sociological-critical theory perspective, a theme of power and powerlessness can be traced through this chapter. (Nussbaum & Coupland, 1995, p. 2)
There are several other theories associated with this model and some theorists like Hepworth (see below) that associate the theoretical and real decline of the above mentioned factors with a feeling of powerlessness:
In relation to depictions of elderly communicative powerlessness, Hepworth makes reference to social exchange theory, which captures the belief that the older person becomes costly to interact with (see also Bourdieu, 1991). The perceived costliness of communicating with older people might lead to avoidance and marginalization, or to deindividualization (see also Harwood, Giles, & Ryan, Chapter 5, this volume). (Nussbaum & Coupland, 1995, p. 2)
Hepworth points out that the young person's assumption of cost related to interaction with the elderly person has more to do with their own perceptions of the social norms regarding elderly needs. Regardless of the theory or theories used to understand this decline and also the associated decline in general feelings of well being that might be a precursor to depression and/or suicidal behavior, there is strong evidence that these factors of social isolation do significantly effect the geriatric population.
Goals for such a study would be to determine the risk level of elderly individuals in The target population for suicide attempts, in an attempt to help similar populations obtain more timely access to mental health treatment and possibly prevent the increase in incidents of suicide among the elderly. The relative weights for such a study would be a statistical decrease in the number of suicides and suicidal thoughts among the test population and hopefully a broader result from a better understanding.
There will be a set of constraints that are inherent to the process. The first constraint lies in the assessment process. Self-assessment is inherently a weak developmental tool as individuals might misrepresent information based on known or unknown falsehoods. The type of assessment tool used would be a self-report tool that consisted of a questionnaire to be administered in the assisted…