Suicide Among the Elderly Suicide

Suicide Among the Elderly Suicide and the Elderly Why do older people, especially those suffering from depression and other illnesses, give consideration to suicide, leaving their loved ones (children and grandchildren) and friend behind to grieve? What are the signs that an elderly person may be considering suicide? What can be done to prevent these aging citizens from harming themselves? These questions and others will be examined and reviewed in this paper.

AVAILABLE LITERATURE REFLECTING PERTINENT STUDIES: Meanwhile, according to an article in the American Psychiatric Nurses Association Journal (Fitzpatrick 2005) nurses who care for the elderly should watch for signs that patients may attempt a "silent suicide." That form of suicide is also referred to as "passive suicide," "hidden suicide" and "chronic suicide." It usually involves "indirect self-destructive behaviors" or indirect "life-threatening" behaviors such as quitting medications that are vital for survival.

It also can take the form of delaying treatment for certain important medical conditions, taking "increased health care risks," or just simply refusing to eat or drink. The article also investigates how well nurses document specific signs and signals that older (geriatric) patients are learning towards "silent suicide." The charts used by nurses to identify which seniors were clinically depressed and had other symptoms related to depression were reported as part of this project.

The results showed that of 200 patients' charts reviewed, 50 of those patients had "Geriatric Depression Scale scores" that reflected "depression"; 82.9% of the 200 charts indicated that the nurses had recorded five or six signs of silent suicide.

But even though such a huge majority of the 200 charts reflected that the elderly patient was perhaps on the verge of suicide only 2 of the 82.9% were referred by nurses to the proper professional for "psychiatric consultation." The bottom line, Fitzpatrick reports, is that there is a need for "more awareness of the signs of silent suicide" among elderly people who suffered depression to some degree.

In another study, this one reported by the journal Mental Health Practice (Curran, 2006), researchers investigated the "demographic and clinical characteristics" of 681 patients in hospitals in the UK over a 20-year period. All of the patients had been reported to have engaged in incidents called "deliberate self-harm" (DSH); the purpose of the study ("Deliberate self-harm in over 60s) was to look closely at the relationship (connection) between DSH and suicide.

In other words, when a patient engages in DSH, what are the chances that he or she will actually later be successful in a suicide attempt? And when there are "multiple" DSH attempts, they should be taken "very seriously," the author states, and there should be "mandatory general hospital admission" and "multidisciplinary clinical intervention." professional in the mental health and physical health fields can see that an older person engaging in DSH more than once is crying out for help, the article implies.

Of those 681 patients, the most common problems facing them prior to causing harm to themselves were "physical illness, social isolation, problems with family members," are relationship-related issues. In 84.5% of the cases of DSH, the patient attempted to poison himself (herself) though the abuse of tranquilizers, antidepressants and sedatives. And in 11.8% of the 681 cases, "self-injury" was acted out: attempted drowning, self-cutting, jumping from a high place and attempted hanging.

Those sound like attempts at suicide, and technically they obviously are; but since they did not result in death, or very close to death, they are termed "deliberate self-harm" (apparently to take the sting out of the "suicide" concept; and also, to make it less frightening for friends and relatives perhaps?). There are health problems suffered by the elderly - not related to psychiatric issues - that are also linked to risks of suicide, according to an article in the journal Clinician Reviews (Juurlink, et al., 2004).

Some of these issues include lung disease, congestive heart failure, seizures, urinary problems, and "moderate and severe pain," according to the Juurlink research. The article shows that the odds of committing suicide are greater for older people with medical problems; for example, seniors with bipolar disorder are 9.2 times as likely to attempt suicide than seniors who are healthy.

Elderly people (living in Ontario, Canada) with seizure disorders are 2.95 times more likely to attempt suicide; elderly with depression are 6.44 times more likely to try suicide; with urinary "incontinence" 2.02 times as likely; with heart failure, 1.73 times as likely; with chronic lung disease, 1.62 times as likely; and seniors with Parkinson's disease are 1.60 times as likely to try to kill themselves, according to the article.

It is interesting to note that 73% of suicide patients in Ontario had visited their health care providers in the month prior to their death; up to 45% of those who committed suicide in that province (according to the research) had visited their doctors within a week of their demise. That clearly backs up the thesis of this article, which older people with health problems not related to psychiatric issues are also among those who give consideration to committing suicide.

Taking that point further is an article in the British Medical Journal (Runeson, et al., 2002), which points out that elderly people with "severe vision disorders, neurological disease, and cancer" have a higher risk of committing suicide than elderly people who are not suffering from those problems. Moreover, cardiovascular disease and musculoskeletal disorders are reported to be "common among elderly people who committed suicide," Runeson writes.

The problem, beyond the obvious medical problem that might lead to suicide for an older person, is that many elderly folks - while they go to their doctor before attempting to kill themselves - fail to communicate their despair with their health care provider, the article explains.

It is worth mentioning that in the article the writers discovered that "relatives [of the elderly who later committed suicide] observed suicidal feelings twice as frequently as doctors." And moreover, doctors were "less likely" to talk to elderly patients (in poor health) about their suicidal feelings than they were to patients who were not in poor health. All of these findings by Runeson et al.

are based on interviews with next of kin of those who committed suicide, on necropsies (forensic exams of cadavers) of people suspected of having killed themselves, and on "randomly selected" healthy people of the same birth year and same sex living in the same area as some of those who committed suicide.

INTERVENTION PROGRAMS: It's all well and good to understand what medical and psychological and psychiatric problems older people have that leads some of them to suicidal thoughts; but health care professionals need to take that information and put it to use in the sense of preventing older people from killing themselves. An article in Nursing Standard (Bruce, 2004), a journal, explains that a U.S. intervention program (2004) showed that when capable professionals are given an opportunity to work with seniors who are at risk for suicide, lives could be saved.

In this particular program, 598 people over age 60 - who suffered from some depression - were brought into an intervention program. Depression care managers gave advice to the physicians on what antidepressants to prescribe for these 598 individuals, and the depression care managers offered "interpersonal psychotherapy" in the event that the project participants turned down antidepressants. Side-by-side with that intervention group was another "control group" of patients from a "usual care group" who were recruited from other primary care practices nearby.

The severity of depression severity and the "suicidal ideation" of people in each of the two groups was monitored ("assessed") at baseline, at four, eight, and 12 months into the research project. The results of this study showed that the rates of suicidal ideation (having the idea or thought of suicide) "declined faster in the intervention group" compared with the control group. After the first four months, the intervention group rates of suicide ideation declined 12.9%, the article reports, compared with a 3% decline in the control group.

At eight months, the intervention group reflected a 70.7 decline in suicide ideation, compared with just 43.9%.