Suicide in the Elderly Population

Statistics

The elderly (defined as those over 65 years old) have, historically and currently, the highest suicide rates in most, but certainly not all, countries of the world.

The death rate in adolescent suicide attempts is roughly 2%; among men over 45 years old, R. W. Maris found 88% of first-time attempts are fatal. Other estimates are lower, but still on the order of 25-50%, though psychiatrist Herbert Hendin, questioning these numbers, points out that there seem to be many more elderly survivors of suicide attempts than there are suicide deaths in this age group.

Despite recent decreases in old-age suicide frequency and increases in youth suicide, the suicide rate for the elderly in the U.S. is still more than 50% higher than that of 15-24 year-olds.

26 percent of the population is over 50 years old; 39% of suicides are from this group, a rate 1.5 times the national average. White males over 50 years old are about 10 percent of the population, but 33 percent of the suicides in the U.S. Elderly white males have a suicide rate 5 times the national average.

Among people over 65 years old (12% of the population), the suicide rate was about 22 per 100,000 (21% of suicides) in 1986, or almost twice the national average. The actual rate for the elderly is probably a good deal higher, since, "Many deaths from suicide are never investigated and are reported mistakenly as accidents or deaths from natural causes, particularly when the victim was old."

The annual suicide rate for elderly women (6.7/100,000) is lower than that for middle-aged women (7.9/100,000), and about one sixth that of elderly men (around 40/100,000); however the rate for women is relatively under-reported, since they tend to use methods (e.g. overdose) that leave room for other verdicts. Since American men most often use guns, these deaths are harder to attribute to "natural causes".

Nevertheless, the fact that American male suicide rates peak in old age while female rates are at their maximum during middle age is difficult to explain. The unpleasant realities of old age, increasingly poor health, death of a husband or wife, relegation to a nursing home, fall more frequently on women than men, due to the former's greater longevity.

On the other hand, women are generally better than men at maintaining social and family contacts. And men, due to the higher status and more competitive nature of their activities (e.g., business, sports, war) lose more social standing to the infirmities of old age than do women, who generally have lower rank and thus less distance to fall.

Reasons for these high rates seem to include:

(1) Social isolation and loneliness, especially among widowers.

(2) Physical isolation: because many old people live alone, a suicide attempt may not be discovered soon enough to survive it.

(3) The accumulation of losses, such as friends, physical and mental abilities, social status, and health.

(4) The elderly use more lethal methods than do younger people.

(5) Old people are less likely to survive any given level of injury than are younger, healthier, ones.

Some specific reasons were identified among elderly suicides from the Miami area. The single most-cited cause was "physical health concerns", which were more frequent than the next two reasons ("depression" and "unknown") combined.

Such health concerns are not necessarily accurate. In one study of 248 suicides, more people (8) killed themselves in the mistaken belief that they had cancer than the number of suicides who, in fact, had terminal cancer.

The real rates are probably a good deal higher than the official ones. This is because many drug overdoses have no witnesses, no wounds, and look like a natural death. Since serious pre-existing illness is common in the elderly, such deaths are particularly likely to be misdiagnosed as "natural." In one study, 15,000 autopsies in apparently-natural deaths were reviewed. 764 (5.1%) bodies contained enough poison to account for death.

About half of the elderly who commit suicide are "depressed", but depression is common amongst old people. Both psychiatric and physical illness are more common in elderly suicides than in younger ones, whose deaths are more often precipitated by relationship, school, job, or jail problems. Between 60 and 85 percent of elderly suicides had significant health problems and in four out of every five cases this was a contributing factor to their decision. On the other hand, non-suicidal elderly had similar rates of physical illness as the suicidal.

Does depression affect willingness to accept treatment for other medical problems? In one study, depressed patients were less inclined than non-depressed ones to want medical treatment when the likelihood for improvement in some physical disease was good, but there was no difference between the two groups when the prognosis was poor. It seems that both groups were equally realistic about a poor prognosis, but that the lower quality-of-life and hopes-for-the-future among depressed patients decreased their willingness to seek or accept help when the probability of improvement was good.

This is consistent with other data. For example, a survey of elderly (60-100 years-old) visitors to senior centers in Indiana found that depression, low self-esteem, and loneliness were not associated with a decision to end their lives if faced with terminal, or debilitating chronic, illness. Again, both the depressed and non-depressed elderly were similarly pragmatic about their options under these circumstances.

However, when the severity of the depression is taken into account, differences appear. Elderly patients who were hospitalized for major depression were asked, before and after anti-depressant medication, whether they wanted life-sustaining treatment for their current physical health problems and for two hypothetical physical illnesses.

In the relatively "mild" to "moderate" cases, remission of their depression did not increase their willingness to accept medical intervention; however in the most severely depressed people, it did. This suggests that people in the midst of severe depression should probably not make life-and-death decisions, because their views are likely to change after anti-depressant treatment.

Poverty is not a good suicide predictor. Sweden and Denmark both have high per-capita income as well as comprehensive social welfare for the aged. They also both have high suicide rates among the elderly, as well as in the general population. Greece and Mexico, which have a far lower (economic) standard-of-living than Sweden and Denmark, have particularly low rates, though higher in the elderly than in the general population.

Interestingly, during times of economic prosperity, the elderly suicide rate goes down while the suicide rate of younger adults goes up in the U.S.

A final observation: suicide notes left by the elderly tend to show a desire to end their suffering, rather than dwell on interpersonal relationships, introspection, or punishing themselves or others, which are common themes in younger suicides.

Risk Factors for Elderly Suicide

Suicide can happen in any family. However, life events commonly associated with elderly suicide are: the death of a loved one; physical illness; uncontrollable pain; fear of dying a prolonged death that damages family members emotionally and economically; social isolation and loneliness; and major changes in social roles, such as retirement.

Among the elderly, white men are the most likely to die by suicide, especially if they are socially isolated or live along. The widowed, divorced, and recently bereaved are at high risk. Others at high risk include depressed individuals and those who abuse alcohol or drugs.

Contributing Factors of Elderly Suicide



Suicide is typically an outcome that can be attributed to any combination of acute factors. Where suicide is considered an impulsive act at any age, elder suicide is often a grim outcome derived from the manifestation of tendencies experienced over an extended period of time. In the United States, suicide is the eleventh leading cause of death in the nation. What is more alarming is that eleven deaths per 100.000 Americans are suicides carried out by white males aged 65 and older, almost triple that of the national average.



Loss and mourning

Life events can trigger suicidal thoughts and often involve the loss of a loved one and/or pet. In these situations, bereavement can last up to two years. It is during this period; elderly persons are most susceptible to suicide.



Irreversible changes in lifestyle

Changes in retirement, a move from one's home to a nursing facility or loss in mobility are it sudden or gradual, mechanical or physical, can also become a trigger for elderly suicide. In a broadcast for Northern Irelands BICNews 6 in December of 1997, Dr. Ivan Boksay stressed the importance of noticing early warning signs that may indicate suicidal tendencies in an elderly subject. Boksay further emphasized the heightened degree of risk elderly subjects were faced with given prior suicide attempts.



Sleep disturbances

Recent research has indicated an intrinsic link between elderly suicide and sleep deprivation. Excessive loss in sleep can result in the manifestation of several problems. Older adults who suffer sleep loss are more likely to suffer from depression, memory loss, problems concentrating excessive daytime drowsiness, more injuries accrued during evening hours and the abuse of over-the-counter sleeping aids. This of course results in a poorer quality of life. Insomnia is among the highest of sleep complaints from persons aged 60 and older.

Clues to Look For

There are common clues to possible suicidal thoughts and actions in the elderly that must be taken seriously. Knowing and acting on these clues may provide you the opportunity to save a life. In addition to identifying risk factors, look for clues in someone's words and/or actions.

It is important to remember that any of these signs alone is not indicative of a suicidal person. Bur several signs together may be very important. The signs are even more significant if there is a history of previous suicide attempts.

A suicidal person may show signs of depression, such as:

• changes in eating or sleeping habits


• unexplained fatigue or apathy


• trouble concentrating or being indecisive


• crying for no apparent reason


• inability to feel good about themselves or unable to express joy


• behavior changes or are just "not themselves"


• withdrawal from family, friends or social activities


• loss of interest in hobbies, work, etc.


• loss of interest in personal appearance

A suicidal person also may:

• talk about or seem preoccupied with death


• give away prized possessions


• take unnecessary risks


• have had a recent loss or expect one


• increase their use of alcohol, drugs or other medications


• fail to take prescribed medicines or follow required diets


• acquire a weapon.

Immediate Action Is Needed If The Person Is Threatening Or Talking About Suicide If you have contact with older adults, look for these clues to a potentially suicidal person. Your observing, caring about, and a suicidal older adult the difference between life and death.

You See the Warning Signs of Suicide. What Now?

Some DOs and DON'Ts include:

1. DO learn the clues to a potential suicide and take them seriously.


2. DO ask directly if he or she is thinking about suicide. Don't be afraid to ask. It will not cause someone to be suicidal or commit suicide. You will usually get an honest answer. But don't act shocked, since this will put distance between you. (Some people may deny feeling suicidal but may still be very depressed and need help. You can encourage them to seek professional help for their depression. It's treatable.)


3. DO get involved. Become available. Show interest and support.


4. DON'T taunt or dare him or her to do it. This "common remedy" could have fatal results.


5. DO be non-judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.


6. DON'T be sworn to secrecy. Seek support. Get help from persons or agencies that specialize in crisis intervention and suicide prevention. Also seek the help of the older person's social support network: his or her family, friends, physician, clergy, etc.


7. DO offer hope that alternatives are available but do not offer glib reassurance. It may make the person feel as if you don't understand.


8. DO take action. Remove easy methods they might use to kill themselves. Seek help.

Sources and additional information:

http://www.a1b2c3.com/suilodge/facovr1a.htm

http://www.healthyplace.com/depression/suicide/how-to-help-a-suicidal-older-men-and-women/menu-id-68/

http://edis.ifas.ufl.edu/fy101

http://www.associatedcontent.com/article/2208091/the_social_psychology_of_elderly_suicide.html?cat=12

Youth Suicide: Risk Factors and Prevention

Facts and Statistics

Teenagers attempt suicide roughly 10 times more frequently than adults, although their fatality rate of 11.1 per 100,000 people is about the same as adults'. This is the third leading cause of death among 15-19 year-olds. For this age group, there were 5,174 motor-vehicle deaths in 1994, compared to 1,948 suicides.

According to U.S. national data released in September 1991, about one million teens (out of about 25 million) attempt suicide each year, of which an estimated 276,000 sustained injuries serious enough to require medical treatment.

Some other estimates (these are total, not per-year) are considerably higher: 3% of elementary-school, 11% of high-school, and 17% of college students. However, "Most were low-lethality attempts for which medical or other attention was not sought. Accordingly, the vast majority of [these] suicide attempts will not be uncovered by investigations dealing solely with clinical or medically identified populations." Thus, estimates or calculations of teenage suicide-attempt rates are particularly unreliable.

About four times more girls than boys make suicide attempts, but boys are much more likely to die: about 11% of (reported) males' attempts were fatal, compared to 0.1% of females', a ratio of more than 100:1. This also gives a ballpark average of about 50 attempts for every fatality in this age group.

This low fatality rate might be taken to mean that most of these adolescents don't want to kill themselves (true) and that there is generally one or more "warning" attempts before a lethal one (not true). In a study from Finland, only 30 percent of male, and 68 percent of female suicides 13 to 22 years old had made a previous (known) suicide bid. This suggests that many of these lethal first-time-attempters intended to die.

Compared to those of older people, adolescents' suicide-attempt statistics show two significant differences. First the fatality rate for boys is a hundred times that of girls, a much greater gender difference than with any other age group. The immediate reason is clear enough: most teenage girls use relatively low-lethality methods like drugs and wrist cuts, while a substantial number of boys use guns and hanging. The reasons behind these choices are not known.

Second, the fatality rate among adolescents, less than 2%, is much lower than that among the elderly, variously reported to be between 25% and 50%. This may be because the young, however miserable, usually have more reason for optimism about the future than do the old, who are too often without friends, family, job, and health.

Nevertheless, their suicide rate is increasing, and approaching the national average.

This corresponds to about 2000 suicides among 15-19 year-olds per year. While it's true that the suicide rate is substantially higher among old people, suicide is a relatively more frequent cause of death in the young, who have few deaths from illness. That's why it's the third leading cause of death among 15-24 year-olds, but ranks ninth or tenth for those 55-74.

The reasons for this rise are also in dispute. Besides the usual social rationales (e.g. higher divorce rates), "Some statistics indicate that suicide attempts among younger persons have not increased, but the methods and means they are using are more lethal, making the attempts more successful," says CDC's [centers for Disease Control] Dr. Alexander E. Crosby.

Risk Factors Related to Adolescent and Youth Suicide

Mental health professionals have identified those factors that pose the greatest risk to adolescents and youth suicides. Youths who attempt and commit suicide generally have several risk factors, which are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Social and economic environments

The family is one of the earliest and most significant influences in a young person's development. There have been numerous studies of family troubles associated with youth suicidal behavior, including early parental loss, parental mental health problems, parental abuse and neglect, and a family history of suicide. In addition to chronic family troubles, there are usually precipitant events closer in time to a suicide attempt, many of which involve the family. These precipitants include serious conflicts with family members or divorce of parents, perceived rejection by one's family, and failure of family members to take an adolescent's talk about suicide seriously.

The school constitutes an important influence on youth. It is therefore not surprising that a history of school problems and the stress of disruptive transitions in school are potential risk conditions for youth suicidal risk behavior, as well as failure, expulsion, and overwhelming pressure to succeed.

Bullying is an extremely serious problem in schools and can result in the victims becoming depressed and suicidal, and even taking their own lives.

The influence of peers on young people's behavior can sometimes be greater than that of family and school. There is a risk of copycat suicidal behavior in adolescents who have been exposed to a peer's suicide. This contagion effect is most pronounced for vulnerable youths who tend to identify strongly with someone who has committed suicide in their environments or in mass media. Common precipitating events in youth suicidal behavior include rejection from peers, the breakup of a significant relationship, or the loss of a confidant. Furthermore, adolescents and young people who fail to act when confronted with a suicidal peer, by dismissing it as insignificant or failing to inform an adult, can increase the risk of suicide.

Poverty in children and youth heightens the risk conditions for suicide, including school problems and failures, psychiatric disorders, low self-esteem, and substance abuse, all of which can increase vulnerability to suicide and suicidal behavior.

Physical environment

Having immediate and easy access to lethal means to kill oneself increases the risk that a suicide will occur. Firearms are common methods of male suicides in the United States, and young women are increasingly using guns to kill themselves. Having such an instantly lethal method available increases the risk that vulnerable young people may kill themselves impulsively.

Additional risk factors

The researcher Jerome Motto suggested that the increased use of alcohol and drugs might have been a significant factor related to the rise of youth suicide since the 1970s. According to David Brent, at least one-third of adolescents who kill themselves are intoxicated at the time of their suicide and many more are likely to be under the influence of drugs.

A history of previous suicide attempts and the presence of a psychiatric disorder are among the most important and well-established risk factors for youth suicidal behavior. As many as 10 percent of suicide attempters eventually die in a later suicide attempt. Depression is a major mental health problem associated with suicide. In addition, impulsive behavior, poor problem-solving and coping skills, alcoholism, and homosexual orientation also increase the likelihood of suicidal behavior.

Prevention

No single risk factor alone is sufficient to result in a suicide. Youths who attempt and commit suicide generally have several risk factors that are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Primary prevention consists of actions to prevent suicidal behavior before people develop a high-risk or a suicidal crisis. Most youth and adolescent suicide prevention programs have focused on school-based activities where adolescents receive training in identifying signs of suicide risks and how to best react to suicidal peers. Some programs also identify resources to help with suicide and encourage young people to talk with adults if they feel that they or their friends are feeling suicidal. Young people are specifically encouraged not to keep a "secret" confession of suicidal intentions to themselves. Controversy surrounds the usefulness and effects of school-based suicide prevention programs. Few programs have been the subject of rigorous evaluations and not all programs have had positive results. Research indicates that programs that provide a variety of resources within the school and community, including specially trained teachers, mental health services and counselors, and information and training for parents, may be of more benefit in preventing suicidal behavior.

In addition to school-based programs, many primary prevention approaches have focused on key persons who may come in contact with potentially suicidal youth. These persons, called "gatekeepers," include school staff, child welfare workers, community volunteers, coaches, police, family doctors, and clergy members. Training usually involves information on taking suicide threats seriously and asking specific questions to assess suicide risk, identifying behavior changes that may indicate increased suicide risk, better identification and treatment of depression and other mental health problems, and providing information about resources to help with suicide and other community youth problems.

Emergency Help

If you or someone you know is in immediate danger because of thoughts of suicide

Please call 911

There is help for you. Stay on the phone with the operator and wait for help to arrive.

Do not hesitate to call. Your life is extremely valuable, and people care about you.

Please reach out for help. Never act on your thoughts of suicide. Never… Remember, when you die, you cannot change your mind. And if your attempt fails, you might become physically or mentally impaired for all your remaining life!

Sources and Additional Information:

http://www.deathreference.com/Sh-Sy/Suicide-over-the-Life-Span.html

http://www.a1b2c3.com/suilodge/facovr1b.htm

http://www.suicide.org/bullying-and-suicide-information.html

http://www.suicide.org/teen-suicide-and-youth-suicide.html

http://www.cdc.gov/ncipc/dvp/suicide/youthsuicide.htm

Depression and Suicide: Background and Statistics

We, the Depressed, in our darkest hours have

No energy to move

No reason to live

No will to survive

No hope in a cure

No reason to try.

We roam the earth as the living dead

Wanting only to extinguish

That persistent heart that beats,

That ceaseless breath that enters,

That pain that never relents.

 

Every cell of our being wants to die,

Yet Do We Live.

Melody Clark

Background

Throughout the world, about 2000 people kill themselves each day. That's about 80 per hour, three quarters of a million a year. In the U.S., there are more than 80 deaths from suicide every day, 30,000 every year. This is the equivalent of a fully loaded jumbo jet crash every fifth day. From another perspective, you are more likely to kill yourself than be killed by someone else.

Another estimated 300,000 (or more) Americans a year survive a suicide attempt. A majority have injuries minor enough to need no more than emergency room treatment. However, about 116,000 are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 10 days; the average cost is $15,000.

"...without knowledge of proper dosages and methods, suicide attempts are often bungled, leaving the victim worse off than before. Many intended suicides by gunshot leave the person alive but brain-damaged; drug overdoses that are not fatal may have the same effect. One eighty-three-year-old woman obtained an insufficient number of pills and lost consciousness but did not die; her daughter ended up smothering her with a plastic bag."

Seventeen percent, some 19,000, of these people are permanently disabled, restricted in their ability to work, each year, at a cost of $127,000 per person. Such injury is tragic, either if someone were trying to kill herself and failed, or, perhaps even sadder, if the suicide attempt was intended as a "cry for help".

About 1.4% of Americans end their lives by suicide. This is the eighth leading cause of death in the U.S., and ranks fourth in years of lost life. The largest increase in the last 30 years has been among people between 15-24 years old, but the highest rates are still among the elderly. Men kill themselves at about four times the rate for women (19.8/100,000 vs 4.5/100,000 in 1994). Around 3% of adults make one or more suicide attempts.

There are more suicides than the official numbers show, but there is no general agreement as to how many more. Estimates of under-reporting range from around 1% to 300%...

Reasons for under-reporting include:

(1) Families or family physicians may hide evidence due to the stigma of suicide. For example, "Physicians and surviving relatives have told me in confidence of many deaths which were suicides, but which had been certified as natural or accidental deaths by a physician, either through error, misinformation, or deliberate falsehood....My own estimate is that there were an additional 10,000 deaths yearly [in the U.S.] which would have been certified as suicides if there had been complete and impartial investigations."

(2) The determination of cause-of-death is judged by local standards, which vary widely. In one egregious instance, a coroner would cite suicide only in deaths where a suicide note was found, and suicide notes are only found in around one quarter of known suicides.

(3) There are lots of ambiguous situations, some of which are suicides, but which almost always end up classified as "accidental" or "undetermined" the single-car "accident" with no skid marks; the "fall" off the night ferry; the "stumble" in front of the train; the "inadvertent" overdose; the gun-cleaning "mishap".

(4) Compared to the "accidental" or "undetermined" motive categories, there is a much larger number of deaths officially classified as "ill-defined and unknown causes of mortality," where even the actual cause of death is uncertain, and some of which are undoubtedly suicides.

(5) The frequency of physician-assisted suicide for the terminally ill is unknown, but, based on anecdotal evidence, is probably both substantial and increasing.

On the other side of the ledger, some doubtful cases may be classified as suicides as well. These usually occur in institutions, such as prisons, hospitals, religious orders, and the military, which control their population more-or-less completely.

For such institutions a verdict of suicide is likely to be the least embarrassing (after "natural") cause of death: homicides must be investigated and a murderer sought; accidents may be the basis of negligence lawsuits.

The number of suicide attempts is also subject to dispute. Based on a range of studies, there are probably between 10-20 attempts for every suicide, or roughly 300,000-600,000 attempts per year in the U.S. Yet more than half of suiciders kill themselves on their first try.

Race

Suicide rates among American Indian and Alaskan natives between 15 and 34 years are almost twice the national average for this age range. Hispanic females make significantly more suicide attempts than their male or non-Hispanic counterparts.

The risk of suicide is increased by concurrent alcohol and drug abuse, access to lethal means, hopelessness, pessimism, and impulsivity, and is reduced by help-seeking behavior, access to psychiatric treatment, and availability of family and other social supports.

Sex

More women than men seek treatment for depression, but this is not necessarily reflective of the true incidence of the disease.

• Although depression is more often diagnosed in women, more men than women die from suicide by a factor of 4.5:1. White men complete more than 78% of all suicides, and 56% of suicide deaths in males involve firearms. Poisoning is the predominant method among females.


• An estimated 8-25 attempted suicides occur for every completion. Many of these are never discovered or never reported. It is important to understand that the majority of suicide attempts are expressions of extreme distress, not merely bids for attention.

Age

The highest suicide rates are found in men older than 75 years. However, suicide is also a selective killer of youth. It is the third leading cause of death among people aged 15-24 years, after unintentional injuries and homicide, and the second leading cause of death in college students. The mean age for successful completed suicides is 40 years.

For adolescents, the attempt-to-fatality ratio may be 50:1; but this average masks the fact that the death rate for boys is a hundred times higher than for girls: around 10 percent and 0.1 percent, respectively. About 11% of high school students have made at least one suicide attempt. Ninety percent of adolescents' suicide attempts occur at home, and parents are home 70% of the time.

Risk Factors

Risk factors for thoughts of suicide can vary with age, gender, and ethnic group. And risk factors often occur in combinations.

Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Many times, people who die by suicide have a substance abuse problem. Often they have that problem in combination with other mental disorders.

Adverse or traumatic life events in combination with other risk factors, such as clinical depression, may lead to suicide. But suicide and suicidal behavior are never normal responses to stress.

Other risk factors for suicide include:

• One or more prior suicide attempts.


• Family history of mental disorder or substance abuse.


• Family history of suicide.


• Family violence.


• Physical or sexual abuse.


• Keeping firearms in the home.


• Incarceration.


• Exposure to the suicidal behavior of others.

Sources and Additional Information:

http://emedicine.medscape.com/article/805459-overview

http://suicidal.com/depressionandsuicide/

http://www.webmd.com/depression/guide/depression-recognizing-signs-of-suicide

http://www.a1b2c3.com/suilodge/facovr1.htm