On All Souls Day, many Christians will commemorate loved ones who have died. Those remembering the deceased may be comforted by pleasant memories of the time spent with them or thankful if their loved ones lived a long and fulfilling life. The feelings may be different, however, if their death was by suicide.
Many people may not know that suicide rates remain higher among older than younger adults, especially older men — who are about 85 percent of suicide victims aged 65 years or older. It’s time that we give this issue the attention it deserves.
We have just completed an analysis of 10 years (2005-2014) of data on all older adults who died by suicide in 16 states. These findings can help us take steps to prevent suicide.
One striking finding is that a higher proportion of older than younger adults’ suicides involved a gun, and the firearm use rates (80 percent among older men and 40 percent among older women) have not changed for a decade. The lethality of firearms makes the chance of rescue slim and contributes to higher rates of completed suicides among older adults.
Also important is that longer life expectancies have not translated into longer disease-free lives. In a rapidly aging society, increasing numbers of older adults, especially those 85+ years, will have debilitating and painful health conditions and associated mental health problems. As our study shows, untreated depression and other psychiatric illnesses are often significant drivers of suicide in all age groups. Physical health problems also often influence older adults’ decisions to end their lives.
Our analysis showed that in 50 percent of cases of those aged 65+ years, and 60 percent of all those aged 85+ years, coroner or medical examiner reports noted physical health problems as a suicide precipitant. Most commonly, suicide notes mentioned inability to endure chronic/unremitting pain from cancer, arthritis and other diseases and musculoskeletal conditions. They also noted despondency from cognitive and/or functional decline, fear of becoming a burden on their loved ones, loss of independence, and fear/refusal of nursing home placement. We also found that almost a quarter of older adults who died by suicide had disclosed their suicidal intent, mostly to family members.
A recent study reported that some older adults, especially men, tend to view suicide as acceptable and rational under conditions of physical illness. Rather than a reason for making suicide acceptable, this is a call to take measures to relieve the pain and suffering that precedes suicide.
Here is what we can do to prevent suicide among older adults who suffer from untreated depression and/or debilitating and painful health conditions.
First, families, other social support systems and health care providers should learn about and discuss suicide warning signs and how to provide support. Older adults will more likely disclose if they trust that their disclosure will not be dismissed or lead to unwanted/forced hospitalization and medications.
Second, restricting access to guns and large amounts of drugs/medicines can help. Third, recent research demonstrates the usefulness of safety planning as a suicide risk management approach. Using this approach, health care providers can help patients at risk identify personal warning signs of a developing suicide crisis and learn strategies to cope with it. Finally, health care and social service systems must ensure that older adults have access to services that address their mental and physical health needs, such as therapy for ongoing emotional turmoil and crisis counseling and palliative care for chronic pain and other distressing symptoms such as depression and anxiety.
Simply put, we need more attention to providing uniform access to long-term and palliative care for older adults with physical, mental and cognitive health problems at an affordable cost. Family members also need access to resources to aid them in better caring for older adults who suffer from conditions that may precipitate suicide. On this All Souls Day, let’s all remember that suicide is preventable.
Diana M. DiNitto is a Distinguished Teaching Professor and the Cullen Trust Centennial Professor in Alcohol Studies and Education in the Steve Hicks School of Social Work at The University of Texas at Austin. Namkee G. Choi is the Louis and Ann Wolens Centennial Chair in Gerontology in the Steve Hicks School of Social Work at The University of Texas at Austin.