Suicide Among the Elderly: Symptoms that are ignored
University of California, Irvine
Professor Webster P117D
November 27, 2007
Suicide among the elderly: Symptoms that are ignored
More than 30,000 Americans every year commit suicide. A suicide happens every eighteen minutes. The highest rate of suicide of any age group occurs among the elderly. The elderly make up 12.6% of the population, yet they account for almost 18% of all the suicides. An elderly suicide occurs every 100 minutes. Suicide ranks as the eighth leading cause of death among those aged 65 and older (Noffsinger, Knoll). Firearms consist of the main method in which the elderly take their lives. The next two in line are overdosing and suffocation. White men over the age of 85 are at the greatest risk of all groups. In 1999, the suicide rate for these individuals was 59.6 per 100,000. 84% of all elderly suicides are men. The rate of suicide for women declines after age 60. Although older adults may attempt suicide less often, they have a higher completion rate. Contrary to popular belief, only about 2-4% of suicide victims were diagnosed with terminal illness at the time of their demise. 80% of all elderly victims of suicide have seen a primary care physician within six months of their suicide. Why is it that the suicide rates for older adults are much higher than every other age group? Depression is a key factor for the rates of suicide in the elderly. Depression is most commonly associated with the pain of loss. Suicide rates are definitely higher for those who are divorced or widowed. The suicide rates of older divorced male adults was 3.4 times more than for married men. As for widowed men, the rates are 2.6 times more. It is often the case that old adults who have committed suicide were stricken by at least one psychiatric illness. The most common illness was depression. Contrary to myth, depression actually decreases with age, with young adults most likely to contract depression. The main reason why suicide rates remain high for older adults even though depression rates are low is due to how symptoms of depressions are perceived in older adults. Suicide remains high because symptoms of depression among older adults are mistakenly seen as part of the aging process and also due to the fact that older adults do not seek mental health services to help them with their problems. Thoughts of suicide among older adults usually go unnoticed. Major factors that account for suicide ideation include psychiatric distress, major depression, poor physical health, and poor social support. In an experimental study done by P.J. Raue et al, participants from a large certified home health agency were randomly selected and assessed for psychiatric symptoms. The study used a Structured Clinical Interview for Axis I DSM-IV Disorders and the Hamilton Rating Scale for Depression. They were asked questions regarding suicidal plans and thoughts, reasons for living, and the capacity to carry out suicidal actions. Of the participants, 11.7% showed signs of suicidal ideation with 2 patients requiring emergency care. Some reports indicated that these patients were thinking of suicide via overdose and firearms. The participants with suicidal ideation met the criteria of major or minor depression. Around 25% of participants with suicidal ideation did not show any signs of mood, anxiety, alcohol, or substance abuse disorder. A one year follow up interview assessed whether these patients still exhibited signs of suicidal ideation. About 5% of the whole sample with no suicidal tendencies at the first interview now showed signs of suicidal ideation. Among those who reported suicidal ideation in the beginning of the study, 35% continued to report symptoms of suicidal ideation. Although the rates of suicidal ideation are relatively low and no one committed suicide over the course of the study, older adults are still at high risk for suicide. Depression accounted for the main reason why these patients had suicidal ideation to begin with. Monitoring these symptoms of suicidal ideation in older adults may be difficult to achieve. Perhaps due to poor monitoring of such symptoms can lead to older adults exhibiting self neglect or to prolong the time in which they have suicidal ideation. Depression often precedes suicide in older adults. What is particularly disturbing is that older adults are more likely to succeed in their suicide attempts, especially men. Men are more likely to use violent methods in order to end their lives, usually through the means of a firearm. Men who lose their spouses are at higher risk for depression. The death of a significant other can further lead older adults into social isolation. If perceived social support is relatively low, then depression is also more likely to happen. Older men do not have as many close network of friends that they can confide in compared to women. Most men heavily rely on their spouses for social and emotional support. Due to this, a male losing his spouse would be very detrimental to his psychological well being. Also, older men are more likely to not report depressive symptoms which leads to higher risks of completed suicide. A majority of older adults who do complete their suicide have recently seen a health care provider at least six months before their suicide. Most of older adults with some signs of depression seek out their primary care physicians. Unfortunately, the primary care physicians do not recognize depression among the elderly nor do they treat it effectively (Pearson, Conwell, Lindesay, Takahashi, & Caine, 1997). One major problem is that the elder diagnosed with depression may see depression as a “normal” aspect of aging. Worse, their family members may come to view a socially isolated elder as “normal.” Primary care physicians focus more on the physical symptoms of their elderly patients but largely ignore any psychological and emotional problems. Not all elderly report symptoms of depression to their primary care physicians, partly because they themselves may see it as a normal part of aging. In a time era where family structures are beginning to fall apart and where elderly are slowly viewing themselves as a “burden” to society, people tend to look at suicide as a more voluntary and rational decision for the elderly (Ruckenbauer, Yazdani, & Ravaglia 2007). People as well as primary care physicians seem to share an idea that being an older adult is inherently a sad time to be living in. This type of thinking is fatal especially for those older adults who truly have depression. Even though rates of depression for the elderly are low compared to other age groups, their rates of suicide are high as well as more successful compared to other age groups. The large rates of suicide for the elderly can be explained through their depression. Specifically, it is depression that goes ignored by primary care physicians and American society in general. More primary prevention efforts should be employed when dealing with the elderly. Depression, is by no means, a “normal” part of old age. Increasing the recognition and treatment of depression among the elderly is an excellent way in helping to reduce the high suicide rates. Also, the elderly themselves should seek more help through mental health services rather than focusing on physical illnesses; the importance of mental illness is largely ignored. Physical concerns are highly salient when treating an elderly patient; primary care physicians should pay careful attention to psychological symptoms as well. Indeed, “just as geriatricians now screen for cognitive impairment, it was suggested that screening for depression also become commonplace” (Pearson et al, 1997).
At a Glance – Suicide Among the Elderly (2007). Retrieved November 25, 2007 from
http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp. Pearson, J.L., Conwell, Y., Lindeasay J., Takahashi Y., & Caine E.D (1997). Elderly suicide: a multi-national view. NIMH. Retrieved November 24, 2007, from CINAHL. Raue, P. J., Meyers, B. S., Rowe, J. L., Heo, M. & Bruce, M. L. (January 2007). Suicidal ideation among elderly homecare patients. International Journal of Geriatric Psychiatry. 22(0885-6230), 32-37. Retrieved November 23, 2007, from
https://vpn.nacs.uci.edu/+CSCO+c0756767633A2F2F6A6A6A332E7661677265667076726170722E6A7679726C2E70627A++/cgi-bin/abstract/1127750 34/ABSTRACT?CRETRY=1&SRETRY=0 PsycINFO.
Ruckenbauer, G., Yazdani, F., & Ravaglia, G (2007). Gerontology and geriatrics. Suicide
In old age: Illness or autonomous decision of the will? Retrieved November 23,
2007, from http://cat.inist.fr/?aModele=afficheN&cpsidt=18620702.