Suicide in the Elderly Leading

Suicide in the Elderly

Leading Cause of Death, Rising Incidence

Suicide as one of the 10 leading causes of death in the United States was surpassed by Alzheimer Disease and septicemia more than a decade ago (McKeown 2006). However, it remains a leading cause of death among those aged 10-64 and higher in older persons. Studies showed that suicide rates are highest among older White men (Busko 2008). Suicide rates among White females and Black males and females reach a peak during their midlife. Last year's statistics said that those aged 60-65 comprised 5.1% of the national population; 65-69, 3.9%; 70-74, 3.1%; 75-79, 2.7%; 80-84, 2.3%; and 1.8%, 85 and older. Other recent data also revealed that suicide has been increasing fastest in the 85 years old and older group (McKeown, et al.).

How Aging is Viewed

Suicidal feelings and hopelessness often accompany the process of ageing, which is associated with physical disabilities (O'Connell 2004). The belief has been that people who reach a certain age no longer have meaningful purpose or role in life. True or not in all cases, the elderly have a higher risk of completed suicide than any other age group worldwide from psychological, physical, social and economic factors. Psychological factors include psychiatric illnesses, especially depression and certain personality traits. Physical factors include neurological conditions and malignancies. Physical health factors very often produce or entail mental health factors. Social factors include social isolation, divorce, widowhood or unmarried status. Economic factors equate the elderly with lost productivity (O'Connell).

Factors

First is the economy. There were lower unemployment rates in the 90s when the stock market was stronger (McKeown 2006). Many older persons who depended on investments during their retirement had wealth and enjoyed security. But the recent economic downturn raised suicide rates among older persons aged 45-64. Another factor is healthy life expectancy. As a person gets older and lives longer, he or she needs to maintain close relationships and better health. If this happens, his or her feelings of loneliness, depression and of being a burden to the family are delayed. The risk of suicide decreases (O'Connell 2004). But this is not usually the case. Substance abuse is another factor. From a marked decline in the late 70s to the early 90s, the use of drugs went up in the latter half of the decade. The increase in suicide rates among older adults has been linked with the introduction of selective serotonin reuptake inhibitor or SSRI, an anti-depressant, particularly fluoxetine by 1999. SSRIs were among the top 10 most frequently used drugs in the United States. A report contradicted the hypotheses on the benefits of SSRIs with a finding of increased risk for violence and suicide from SSRI use. Suicide among older persons was also highest in the West at 14.7 per thousand people (McKeown et al.).

Psychological

Psychological autopsy studies found that 71-95% of older people who took their own lives suffered from a major psychiatric disorder at the time of their death (O'Connell et al.

2004). The most common and the strongest predictors are depressive illnesses. Others are excessive drinking and sleeping for 9 or more a night; recurrent major depressive disorder with single episode major depression, dysthymia, minor depression, psychotic depression, anxiety disorders, psychotic disorders and substance use disorders (O'Connell).

Physical

More than three physical illnesses and a history of peptic ulcer disease in 85-year-old and older could predict increased suicidal feelings (O'Connell 2004). A review of 235 prospective studies found a connection between the "death wish" and HIV / AIDS, Huntington's disease, multiple sclerosis, peptic ulcer, renal disease, spinal cord injury and systemic lupus erythematosus. Researchers also concluded that serious physical illnesses tended to affect more men than women to resort to suicide (O'Connell).

Social

Research found that older people who took their own lives experienced severe stresses before suicide (O'Connell 2004). Oftentimes, these consisted of physical illness and a sense of loss, such as bereavement, interpersonal conflict, decreased social support or social isolation. Loneliness and low social interaction were also predictive of suicide. Widowed, single and divorced elderly persons appear to have a higher risk of suicide. Elderly men, in particular, seem especially vulnerable to the loss of a spouse. This is not the case with widows 80 years old and older (O'Connell).

Predictors of Completed Suicide in the Elderly

A 50-year longitudinal study concluded that repeat attempts at suicide by older persons increase the risk of completed suicide (Anderson 2009). The finding should alert those who attend to older persons to take extra care and caution that there will be no further attempts. Researchers surveyed the records of 1,206 patients suffering from depression with melancholia or psychosis. The patients were followed up after 50 years. In that span of time, 116 of the 1,206 patients committed suicide. Of the 116, 16 were excluded as their depression was alcohol-related. Of the remaining 100, 60 attempted suicide 133 times, mostly close to hospital admission. Most of them took an overdose of pills. The research found that suicide attempts decreased with age (Anderson).

Some studies suggested that middle-aged women who stopped taking or never took hormone replacement therapy are more susceptible to depression (Busko 2008). Baby boomers are thus at a higher risk for drug abuse and depression as well as to increasing prescription drug abuse (Busko).

Methods

Most middle-aged White women committed suicide by poisoning at 19.3% per year

(Busko 2008). Suicide by hanging was 2.3% per year and by firearms, 1.9% per year. These were sourced from the web-based Injury Statistics Query and Reporting System mortality reports from the National Center for Health Statistics of the Centers for Disease Control and Prevention. On the other hand, middle-aged White men took their lives mostly by hanging or suffocation at 6.3% per year; by poisoning at 2.8% per year; and by firearms at 1.5% per year (Busko).

Another study conducted on examiner-certified suicides in New York City from 1990-1998 revealed that those 65 or older committed suicide by falling from tall buildings where they lived more than by other means (Abrams et al. 2005). Other places were bridges, health care facilities, hotels and public transit (Abrams et al.).

One more method is for competent, terminally ill patients to ask their physician to prescribe lethal amounts of medication (Walker 2001). This is called physician-assisted suicide or euthanasia, based on the "right-to-die" concept. A study conducted on the legality of the practice found significant public support for legalizing this method and voluntary euthanasia in the United States. The only ground against it is an adherence to traditional physician morality and treating voluntary euthanasia legally as homicide. But if voluntary euthanasia is a medical choice, then legalization possibly exists. The study concluded that if the courts will allow physician-assisted suicide as a fundamental personal right of the patient, similar to the right to refuse treatment, they will likely extend this form of suicide to voluntary euthanasia and non-voluntary euthanasia. This means that the method may be applied to incapacitated patients who are able or not able to express a choice due to the incapacity (Walker).