While some behaviors as a person ages signify a natural progression to let go as the body and mind prepare to leave the world as a result of illness or aging, others behaviors serve as a warning: that someone is contemplating hurting or harming him or herself; of taking their own life.

Perhaps the person has made other attempts to take their life. Perhaps there is a history of suicide in the family, or maybe a recent string of events has escalated feelings of hopelessness or worthlessness in the individual.  

In a recent reading of an online education document from the National Association of Social Workers, the author, Federico Grosso, DDS, PhD, MFT, BCFE, cites Achte (1988), who found that as individuals get older, their suicidal attempts decrease and the number of successful suicides increases. According to the research cited, risk factors for the elderly include losses and loneliness, aging and impoverished body image, trauma to their self-esteem, and depressive disorders

Use of alcohol and drugs, or a history of depression or other mental, emotional or even a longstanding physical illness can impact a person’s current mental state. A feeling of protracted helplessness can, too.  

Dr. Paula Clayton, medical director for the American Foundation for Suicide Prevention (AFSP) addressed these issues and more in written correspondence earlier this month. Dr. Clayton joined the  AFSP as their medical director in 2006. Her responsibilities include overseeing AFSP’s scientific council and facilitating the development and implementation of numerous programs in suicide prevention research and education.

Visit www.afsp.org. If you or someone you know is suicidal, please get help immediately by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). If this is an emergency, call 911.

To ask or not?  

“There is strong evidence that asking about suicide does not make the person think of harming himself.  If you know the symptoms of depression and substance abuse and you believe your parent, spouse, sibling  or friend is suffering from depression, say to him, “Bill, I am worried that you may be depressed. You are not yourself.  Lately you have been sleeping poorly and not eating as much and you are grumpy, irritable and short with all of us.  And you have quit going to the park for chess and are alone all the time.”  In other words, the person needs to tell the person she is concerned about what she has observed that raises her concern and suggest that they talk to the doctor about it.”

Listen to the words

“Usually for hospice services, the physicians of an ill person believe he or she will die within 6 months.   The symptoms of depression overlap with serious illness, so fatigue and weight loss occur in both as does sleep disturbance.  The psychological symptoms of depression, however, are specific to depression.  The depressed person looks sad and talks less, never smiles, is joyless, believes he is a burden, shouldn’t take up the time of the caregivers and may or may not say such things as “you’d be better off without me” or “I wish I were dead.” He takes no pleasure in giving away things, as the dying person might.  And he may be delusional, saying his life has been worthless or useless and he is draining the family resources, when he isn’t.”

If it is suicide you are concerned about, always tell the doctor that. The same is true if the concern is about increased use of alcohol or drugs, like excess pain meds or sleeping pills. 

“I assume that most caretakers are caring for dying person or a person with a serious medical illness, so that person is under the care of a primary doctor and probably many other doctors also.  The caretaker should ask permission of the patient to call the doctor and then call him/her and tell him/her the concerns, giving specific symptoms and even voice that she is worried about him being depressed. There is evidence that if the patient asks the doctor about whether he may be depressed, rather than just complain of certain symptom, like no energy or poor sleep; the doctor is more likely to ask about suicide.  But if it is suicide you are concerned about, always tell the doctor that. The same is true if the concern is about increased use of alcohol or drugs, like excess pain meds or sleeping pills.”

Accompany the individual to the doctor; request to sit in on the visit

“If the patient is well enough to go to the doctor himself, ask if you can accompany him and also talk to the doctor.  Depressed patients lack energy and will, so they probably need the caretaker’s intervention.”

If there is any history of mental disorder or suicide, be more observant. Notice odd things the patient says and does that may point directly to a plan to take his/her life, or suggest a symbolic reference to it: consult the physician or mental health professional at once

“Any past history of treatment for a mental disorder, such as depression or bipolar illness or an anxiety disorder also should make the caregiver more observant.  Like many chronic illnesses, mental illnesses can be recurrent.  Since these illnesses run in families, knowledge about the family history is also helpful and important.  Finally besides the common symptoms of depression, any odd thing the patient says, that the caregiver knows NOT TO BE TRUE (like, “My body is riddle with cancer” although the doctor has just said there was no evidence of recurrence or “We have no money” although the caregiver knows there are plenty of funds or “I’ve never amounted to much” although the person’s life has been quite remarkable, should alarm the caregiver.  Or if he does morbid things that seem out of character or out of proportion to the concern of the illness, like by a gun or buy a black suit to be buried in when he is not dying, the caretaker should become alert. The depressed person views the world with dark glasses and everything looks bleak and hopeless, and sometimes his mind slips into believing untrue things which makes him more susceptible to suicide.”

Considerations about medications: voice concerns directly to the physician or physicians

“One additional thing ... to add is that many medications that people are given when they have multiple chronic illnesses can cause depression, so if the caregiver is worried about the person being depressed and/or suicidal, she and the patient should voice that concern to the doctor and review with him/her all the patients medications to make sure that none of them could be responsible for the mood state or for being suicidal.”

Visit www.afsp.org. If you or someone you know is suicidal, please get help immediately by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). If this is an emergency, call 911.

Special thanks to Dr. Paula Clayton, and AFSP.

About the Author

Meredith Resnick, L.C.S.W.

Meredith Resnick, L.C.S.W., is a health writer and licensed social worker. She is also the mother of two adopted daughters.

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