PHILADELPHIA — Suicide is more common among the elderly, particularly older men, than it is in other demographic groups in the United States, Patrick Arbore, Ed.D., said at a conference sponsored by the American Society on Aging.
In California, reported suicides in 2004 occurred in 23 per 100,000 individuals aged 85 or older, or at a rate that is about 30% higher than for the 75–84 age group. In turn, people aged 75–84 had a suicide rate about 38% higher than younger groups in the California data, said Dr. Arbore, founder and director of the Center for Elderly Suicide Prevention at the Institute on Aging in San Francisco.
In addition, older people are more likely to use a lethal method and actually complete the act of suicide. For every four suicide attempts among the elderly, one is completed. In the general population, for every 8–25 attempts, one is completed. Women are three times more likely to attempt suicide than men in the United States, but men are four times more likely to actually complete the act, Dr. Arbore said.
An elderly person contemplating suicide often will see a physician before attempting the act, although suicidal ideation usually is not brought up by the patient, and the patient's depression is hidden or missed, Dr. Arbore said.
In fact, elderly patients are much less likely to communicate their depression than are younger patients. Covert depression is especially prevalent in elderly men. Even the occurrence of psychosocial risk events—recent losses—are of limited value for predicting suicidal feelings in the elderly because these events are much more prevalent in older people than in younger groups.
Assessment of an elderly person, then, should include consideration of depression, as well as cognitive function, demoralization, paranoia, substance abuse, psychopathology, personality, environment, social context, and suicide risk.
“The goal is not to predict suicide but to place a person on a risk continuum, to appreciate the basis for suicidality, and to allow for a more informed intervention,” Dr. Arbore explained.
Risk Factors
People are especially at risk if they are impulsive, anguished, unable to see a solution to their problems, or have access to a lethal weapon. Psychiatric disorders also boost the risk of suicide, including schizophrenia, personality disorder, posttraumatic stress disorder, bipolar disorder, and substance abuse. Depression is the most common factor of suicide. However, despite common belief, it is not a normal part of aging.
An evaluation of clients in Dr. Arbore's San Francisco program showed that changes in vision, hearing, and mobility often were accompanied by increases in depression and hopelessness. Furthermore, suicide risk was associated with physical illness and functional limitations and the interplay of these with depression.
One estimate is that 12%–20% of elderly people living in the community have significant symptoms of depression, although many do not meet current definitions of the severity threshold for major depression, Dr. Arbore said. A 1999 report said that major depression played a pivotal role in about 60% of all reported suicide cases and about 80% of suicides in the elderly.
“There is a pressing need for early identification of older adults who have treatable depression and can be helped,” he said, adding that elderly suicidal patients are more likely to have treatable depression and hopelessness than younger people who attempt suicide. However, depression often goes undiagnosed or untreated.
Intervention
Dr. Arbore recommends the Geriatric Depression Scale and the Geriatric Hopelessness Scale for assessing patients. He also uses the Michigan Alcohol Screening Test-Geriatric version for an assessment.
A key element to intervention is talking with the suicidal person about his pain, such as asking, “How much do you hurt?” Caregivers also should use active listening and convey hope, Dr. Arbore said.
One program of the Center for Elderly Suicide Prevention is a Friendship Line that handles about 1,800 calls a month. The program also checks on registered clients by phone or a monthly visit. The 24-hour service is available at 800-971-0016.