Suicide and the Elderly
Risks of suicide can increase in retirement, through loss of purpose and meaning that was provided by employment, as well as from entering a Nursing Home.
- Suicidal behaviour and depression are closely linked
- Sound advice on suicide prevention and how to help those who are depressed and suicidal.
- Community Care Teams offer expert help and advice.
- First-hand experiences of suicide in the elderly
- Read reviews of fascinating books
- Relevant New Zealand statistics
Our main concept of age in Nursing homes, is the terrifying image of incontinent, senile old age.
Indeed today's elderly may often feel that they have no place left to fit. No purpose, no acceptance, no esteem. The transition from working to retired is a journey in life that may be fraught with frustration, loneliness and even hopelessness. Depression can become a reality and for some, thinking about suicide can become an attractive option.
Suicide Risk And Older Adults
Research in New Zealand and internationally suggests that suicide in this age group shares many of the risk factors for suicide in youth and in adults.
The risk is greater amongst older people with:
- mental disorders
- histories of mental disorder
- mental health treatment
- prior suicide attempts
- limited social interaction
- recent relationship stresses
- recent financial stresses
Focus for suicide prevention in older adults:
- To improve identification, treatment and management of major depression
- To prevent and better recognise the life events, social, family and related factors that may contribute to the development of depression in older adults.
How to Help Aged People who are Depressed and Suicidal
Talk and listen, talk and listen! Older people can be forgotten in the midst of other people's busy schedules. We need to connect with and hear the person clearly.
Ask yourself questions about what could be contributing to depression in this person:
- What is giving this person meaning and a reason to live?
- Are there good friendships here bringing this person pleasure and social relationships?
- What loss has this person experienced that is causing grief?
- What activities is this person involved in to fill in time and meet other social needs?
- What sources of stress are affecting this person?
- Is there financial stress that needs looking at?
- What history do they have of mental illness?
- Does a GP need to be involved with assessing this person?
- Are they taking a medication that could be causing side effects?
- Have they stopped taking a medication that they need?
They might be a GP, friends and family, or people from a club, group or church. Citizens Advice Bureau may have the numbers for agencies and groups to deal with specific issues and GPs are often equipped with many such contacts too.
Community groups can be very worthwhile to become involved in and bring friendship and meaning to lives. Older people often need to continue to feel useful in the world and becoming involved in groups that help and support others is an excellent way to achieve this.
Care Team - community team employed by the Mental Health Department to assist the elderly
This team works for the New Zealand Mental Health Department.
Their role is to visit older people in the community with signs of age-related mental illness like depression, dementia and Alzheimer's. They assess these people and recommend a plan of action, or write a care plan for them.
The team is made up of psychiatrists, psychologists, occupational therapists and mental health nurses.
They visit Europeans aged 65 or older and Maori and Pacific Island people aged 55 or older.
Referral may come from family, friends and the person themselves, or a GP. The team prefer GP involvement so that they can access medical history and medication information easily.
They are not a crisis team that responds in a few hours. However, community and mental health services will give you crisis team numbers if this is needed.
Contact details are in the front of your local white pages. Look for Hospitals, then Community and Mental Health Services. Ask for the CARE team phone number. Your GP will also have the number.
Interview with Nurse Manager - experienced in geriatric care
Jan Esler, has worked as Nurse manager in Geriatric care for 28 years. We interviewed her about suicide and the elderly.
Could you comment on the process of moving from the workforce to retirement and the adjustment required. I understand that this process can be more difficult for men than women.
"Many men find the adjustment to retirement very difficult. They loose their purpose, and feel devalued and depressed. Many men have no outside interests beyond their jobs and may be uninterested in developing greater participation in their houses and gardens. This triggers depression. These men may feel that they have nothing left to live for. I have seen a lot of it.
They may find themselves at home with a woman that they have become estranged from and feel incompatible with. Some men retire and in a short period of time face sudden illness or heart attack. It seems as if the immune system has given up, along with their hope.
Other men, when experiencing failing health, or perceiving that it is coming, find it impossible to accept that they may need to be cared for. This triggers depression and thinking about suicide."
"Women are prone to depression in old age too, but not to the same extent. This is because often they make the transition to a new part of their lives more easily. Those who have had a professional career, have usually run a home as well, to which they can now devote more time. Women have usually developed other interests that they can carry on with and friendships feature more strongly throughout their lives. So they have meaningful relationships to carry on with.
They usually have a better connection with their families and children, and grandchildren become the light of their lives. All this helps with supporting better mental health. "
What about people in Nursing Homes. What have you observed?
"Those who enter nursing homes often become depressed. This major change in life is often very difficult to accept. Social contact with family and outside friends tends to drop dramatically. Outside interests are often ended. All contact with the outside world can be reduced to the odd trip out in the nursing home minivan, unless family make the effort to take them out. Failing health can prevent this even being possible. This can trigger depression and a desire to die, as you can imagine. Anti-depressant medication is commonly prescribed.
A few residents regularly "run away" to escape the situation.
I do not remember nursing a suicidal person - that is someone in a nursing home that was actively trying to find means to kill themselves. I have nursed those who have previously attempted suicide and survived, afterwards being place under my care.
Dave became depressed after the death of his wife. On the anniversary of her death he hung himself. He was discovered before he had died and cut down. He lived, but suffered serious neurological damage. He was then placed in my care in a nursing home. He was mentally affected in a way that he never seemed to consider suicide again. He was able to function adequately in the nursing home, but required the aid of two sticks to walk and had slurred speech. He was prescribed anti-depressants.
A similar case was Harry. He was only in his fifties when he became depressed and attempted suicide. Also discovered hanging and cut down, he too suffered neurological damage and was placed in my nursing home. He was prescribed Prozac to help elevate his mood. He is still alive now some 20 years later.
Do you have other comments?
Yes. I did care for a resident who was suicidal in a retirement village. He would not be dissuaded and did complete suicide. He had lived through a long and active, healthy retirement. When his health began to fail, he could not accept the idea that he may become worse and have to be cared for. This triggered depression and hopelessness. Despite a loving and involved family, he was desperate to escape life and did so.
What about cultural considerations. Is this mainly a white phenomenom?
"Yes I think so. Most of the people that I have cared for have been in white neighbourhoods. But more recently I have cared for several Polynesian and Maori residents. I have to say that because of the cultural attitudes to aging, these people probably suffer a lot less depression and suicidal feelings. I have noticed that Polynesian and Maori families esteem their elderly. They look up to them and give them a place of honour and a role of guidance. This makes their later years happy and meaningful.
I recently nursed an elderly Maori man. He came to the hospital with renal failure and near to death. His family created a roster of 14 people to be with him around the clock. Some months later he is still in hospital but not dying. His family roster is still there, around the clock!"
Jan's comments reflect her personal experience of caring for the aged in retirement villages, homes and hospitals. Across the whole population in NZ, statistics indicate that aged men are indeed more at risk. But Maori do not figure as less at risk. In fact statistics put them most at risk. The numbers of Maori men completing suicide are less than for white men. But in proportion, when you take numbers in the population into account, the rate is higher.
NZ Graphs of relevant statistics
Suicide deaths by age, sex and ethnicity, 2002, numbers and rates
(The rates are age-specific for age groups, and age-standardised for total; rates per 100,000 estimated usually resident population, and standardised to Segi's world population.)
|Numbers, total population|
|Numbers, Maori population|
|Numbers, non-Maori population|
|Age group (age-specific rate)||Total
|Rates, total population|
|Rates, Maori population|
|Rates, non-Maori population|
Source: Tables from New Zealand Health Information Service. More statistics can be viewed there at www.nzhis.govt.nz
The Fountain of Age
Read about suicide to avoid "burdening"
The aged should "bow out"
Why more elderly men than women commit suicide
The subtle pressures of "rational suicide"
Betty Friedan, U.S.A. author of "The Feminine Mystique", is well know for her lobbying and writing in the cause of women's rights and roles in society. In 1993, when approaching old age herself, she wrote "The Fountain Of Age" which defies accepted wisdom about conventional male and female roles as we get older and shows how important purpose and choice are to human vitality.
Ms Friedan makes reference in several places to depression and suicidal tendencies in the aged and explores statistics, pointing to some key causes. Quotes from "The Fountain Of Age" can be read read by linking here-->
Relevant NZ Statistics can be viewed further down the page.
Colin Pritchard - Suicide of the Elderly
Author Colin Pritchard argues that suicide among the elderly over the age of 75 is a sign of neglect and isolation.
The extended family does provide a support system in Latin countries. However, "in those Latin Countries, if you don't have children, or you are unmarried, then you are worse off than in Britain."
"Our findings were completely unexpected. Suicide amongst elderly people is usually associated with ill health, social isolation and exclusion. With elderly people in Catholic and Orthodox countries tending to hold more traditional views on the family and religion, we might have assumed that this would be reflected in lower suicide rates, not higher...However, these results show that we need to rethink views on suicide, and continue to improve provision of services for elderly people and rid ourselves of ageist stereotypes. The majority of elderly suicides die because they are inadequately supported, or have poor medical care"
Source: "Suicide: The Ultimate Rejection: A Psycho-Social Study by Colin Pritchard. Open Univ Pr, 1995"
Available from Amazon.com and some libraries.
Link to a review of the book here -->
Recent developments: Suicide in older people
BMJ 2004;329:895-899 (16 October), doi:10.1136/bmj.329.7471.895