Psychologist Explains Dynamic of Suicide Among Seniors and Lists Precautions Doctors and Family Can Take
by TERESA SCHIFFER
For many of us, when we think of suicide, we picture the tragedy of young lives cut short by overwhelming depression, or the unfathomable demise of a highly successful celebrity. While these stories are undeniably heartbreaking, there is an often overlooked segment of our society that is actually at greater risk of suicide – the elderly.
According to the American Association of Suicidality, as of 2018, older adults comprised 16 percent of our population but accounted for 18.8 percent of the suicides. The National Council on Aging says individuals over the age of 85 have the highest suicide rate of any age group. A suicide occurs among the elderly at the rate of approximately once per hour in the U.S. This is cause for concern not just among healthcare providers, but also for the families and friends of those who feel that this course of action is their only option.
There are many factors that can lead an older person to take their life. Psychiatric issues, neurocognitive disorders, or cognitive impairment may play a role. Depression can manifest differently in the elderly than in younger patients, so it may go unrecognized by those close to them. Physical problems, such as pain, illness, or lack of mobility, can contribute to depression and suicidal ideation. Social isolation, grief, or feeling a lack of purpose in life can be major triggers for self-harming behaviors.
Rebecca Schwartzberg, PhD, is a psychologist with Lakeland Regional Health who treats patients at the Grasslands Campus. In her 20 years of practice, she has specialized in women’s health, veterans’ issues, and working with the elderly. She tells us that from her experience, one of the most telling signs of potential suicidal behavior among elderly patients is loneliness. This does not mean that everyone who spends a great deal of time alone is at risk of suicide, though. Plenty of people are content in solitude, engaging in hobbies that keep their minds and bodies active. However, when “alone” becomes “lonely,” that’s when problems can arise.
There is a huge correlation between an elderly patient’s physical health and their risk of suicide. This is especially true if they are experiencing a significant amount of pain. “A lot of the elderly have chronic pain or have a new experience with pain, and if it’s ongoing, a lot of them just can’t handle it,” Schwartzberg says. Pain that is the result of a terminal illness, such as cancer, can greatly increase a patient’s level of stress.
Cognitive issues can also cause stress and suicidal ideation. Memory loss and dementia can increase the risk of suicide – up to a certain point. There is a threshold with dementia that, when crossed, takes the patient from high-risk to lower risk, as they basically forget about their suicidal tendencies.
Social connections are a vital part of suicide prevention for the elderly. Schwartzberg explains, “If you have a decreased sense of belonging, and an increased sense of loneliness, then this is a huge risk factor for suicidality.”
As we age, it is inevitable that we will lose some of our loved ones. Any type of ruptured relationship, whether it is due to death, distance, a falling out, or simply drifting apart, can impact the social isolation felt by the elderly.
Healthcare providers should be vigilant with their elderly patients when assessing for suicide risk. It can be a difficult topic to broach, but it’s important to remember that talking about suicide will not cause a person to commit suicide. Patients may feel uncomfortable bringing up such a dark topic, so the onus is on their caretakers to ensure that they feel connected, valued, and content. This is especially true if the patient is receiving a very bad diagnosis, such as terminal cancer. Caretakers should carefully assess how the patient is absorbing and processing such information.
Schwartzberg recommends all doctors perform depression screenings on their patients, especially the elderly, and gives some additional signs to watch for in older patients. Lethargy and lack of engagement are some red flags, as are changes in weight or sleep patterns. A sudden loss of interest in activities they previously enjoyed is a telltale sign of depression. Another thing to watch for is partaking in risky behavior, such as suddenly spending all of their money or requesting new medications that have a potential for overdosing.
There is one type of statement that always causes Dr. Schwartzberg to pay careful attention to a patient – when they say that someone close to them has died recently. It is normal to miss the deceased, but when that turns into a desire to join them, intervention may become necessary.
Social relationships are important for all of us, and this is no less true for the elderly. If an older patient seems lonely, isolated, or disconnected, their healthcare providers should take steps to help them connect with others in some way. This could mean referring them to a counselor, a support group, or simply recommending that they join a social club. Reinforcing social connections could mean the difference between life and death.