This paper examines the rising incidence of suicide among elderly adults and the key risk factors that contribute to suicidal behavior in this population. It identifies three primary risk categories — recent loss, serious medical diagnosis, and organic depression — and explores how social isolation, powerlessness, and the aging process compound these risks. The paper proposes a community needs assessment targeting residents of assisted living facilities and home assistance agency clients, using self-report questionnaires modeled on Lawton's (1984) well-being scales. It also addresses constraints inherent in self-assessment methods, access barriers to mental health services, and the complex interplay of federal, state, and local mental health policy that affects service availability for elderly individuals.
The paper effectively uses embedded block quotations from primary sources (Menninger, Osgood et al., Nussbaum & Coupland) to anchor its analytical points. Each quotation is contextualized before and after, showing how the evidence supports the broader argument rather than simply being dropped in without commentary.
The paper opens with epidemiological context and then categorizes suicide risk into three conceptual groups. It follows with a social-theory discussion of isolation and powerlessness, transitions into the proposed assessment methodology for two specific elderly populations, and concludes with an examination of systemic access barriers to mental health care. The closing section ties findings back to public health recommendations, providing a full policy-oriented arc.
The causes of death among the elderly are traditionally associated with the normal aging process — what might be called natural causes — as well as diseases linked to age and the physical debilitation it can produce. Yet other factors also contribute to the cause of death an individual might succumb to: widowhood, retirement, forced relocation, and loneliness, especially around the holidays (Huyck & Hoyer, 1982). Other studies are making it clear that murder and suicide rates are increasing dramatically among the elderly (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 progress has been made: 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 examining this statistic, consideration must be given to the increased incidence of disease among the over-65 population, since that reality skews the comparison considerably.
In assessing the needs of any elderly population and a community's ability to assist them on the issue of suicide risk, the population at high risk can be seen as falling into three general categories. All of these categories increase the risk of depression, which is often a precursor to suicide. Depression and suicide risk factors are particularly evident in the geriatric population.
The first category encompasses persons who have experienced a recent loss — usually the death of a spouse or child, but potentially also the loss of a home or possessions:
"There has 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 type of depression is normal in association with the natural grief process and only becomes clinically problematic when prolonged to a degree that it significantly impairs the individual's quality of life. Treatment becomes especially necessary when the individual shows suicidal tendencies.
The second general category includes people who have just received an unpleasant medical diagnosis — either a terminal diagnosis or a debilitating chronic condition. Impending issues of dependency, chronic physical discomfort, or pain are significant factors in this category. The likelihood of receiving such a diagnosis naturally increases with age. Once again, this depression linked to a life event is a normal response and does not become clinically abnormal until it significantly affects the person's quality of life.
The third category includes individuals who might be more closely associated with true clinical depression. Regardless of other environmental factors, these individuals seem to feel a general lack of usefulness or purpose that elicits depressive feelings and could result in a 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 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)
A person suffering from organic depression would nearly always benefit from mental health treatment, and intervention becomes imperative under conditions of severe life impairment.
R. C. Batchelor, M.B., D.P.M., F.R.C.P.Ed, Physician Superintendent at Dundee Royal Mental Hospital and Lecturer in Clinical Psychiatry at the University of St. Andrews, Scotland, in his contributing chapter "Suicide in Old Age" in the book Clues to Suicide, addresses the question of why this subject demands study. Batchelor discusses the possible layperson's dismissal of the aged as a population at high risk for suicide, suggesting that an uninformed person might assume the elderly are less likely to commit such an act.
"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)
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