Elderly suicide rates: the importance of a non-linear relationship with distal risk and protective factors (original) (raw)
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Risk Factors and Prevention Strategies for Suicide Among the Elderly
Alabama Counseling Association Journal, 2012
Suicide is a preventable public health concern affecting the nation as the 10th leading cause of death. The prevalence of suicide among the elderly is higher than any other group. Risk factors attributed to this phenomenon are depression, social isolation, substance abuse, poor physical health or function, financial stress, and access to lethal means, among others. Protective factors have been identified, as well. Prevention of suicide among the elderly is of utmost importance, and national and state-level task forces and prevention strategies are leading prevention efforts. Suicidality is considered to be "a state of total pain, which, coupled with neurological impairment, limits the perceived options to either enduring (suffering through) or ending utter agony." This represents an important paradigm shift in the way researchers believe suicide occurs. This article provides an overview of factors that contribute to suicide among the elderly, prevention strategies, and examples of national, state and community-based prevention programs. Risk Factors and Prevention Strategies for Suicide Among the Elderly An example of a suicide note written by an elderly man follows: "Death is as much a reality as birth, growth, maturity, and old age-it is one certainty. I do not fear death as much as I fear the indignity of deterioration, dependence, and hopeless pain…Dear family, I cannot stand it anymore" (Holmes & Holmes, 2005, p. 51-52). Suicide among the elderly has been described sequentially. As older adults continue to age, they may experience multiple losses, then stress, followed by depression, pain, and, finally, suicide (Alabama Department of Public Health [ADPH], n.d.; Osgood, 1985). The group at highest risk for suicide is that of elderly men; however, elderly women are also affected (Szanto, Prigerson, & Reynolds, 2001). Major losses occur while aging, such as in physical health, social interaction, mental status, loss of job through retirement, financial loss, loss of close relationship ties through changes in family structure, and cognitive loss (Osgood, 1985). The elderly are less resilient and more vulnerable to the stress of loss. Many coping mechanisms fail with age, and depression may result. Helplessness, hopelessness, anxiety, decreased self-concept, lowered self-esteem, loneliness, and loss of control may accompany a previous suicide attempt nor displayed warning signs. According to Conwell and Thompson (2008), 72% of attempters over the age of 65 used firearms to complete the suicide attempt. Researchers reported that suicidal firearm usage is on the increase among both Blacks and Whites, increasing the likelihood of successful suicide completion (Joe & Niedermeier, 2008). Risk and Protective Factors Risk factors for elderly suicide exist in mental, physical and social domains. These risk factors may be grouped into four categories: individual, relational, community, and societal. Individual factors include psychiatric illness/depression, substance abuse, financial stress, and physical health and function (
Suicides have increased by 60% worldwide during the last four decades and are now among the leading cause of death in some age groups (Wasserman et al., 2005; www.Suicide.org). In fact, the World Health Organization estimates that every 3 seconds someone makes a suicidal attempt, and every 40 seconds, one of these attempts succeeds (International Association for Suicide Prevention, 2008). In the EU, the number of deaths by suicide is higher than the ones caused by car accidents (Wahlbeck and Mäkinen, 2008, 10). Suicidal behavior is a challenge and of great concern within most societies. It is obvious that action needs to be taken, as well as to understand the factors that may influence the suicidal behavior within each age group. To-date most of the initiatives and strategies for suicide prevention have focused on teenagers and youth. However, as it will be emphasized, there is serious evidence indicating that the elderly populations must not only be included, but be paid a special attention to, since recent research suggests that it may no longer be true that teenagers and young adults have higher suicide rates than the elderly.
2 Epidemiology of Suicide in the Elderly
Suicide and Life-Threatening Behavior, 1992
Suicide rates in the United States and most other countries are higher among the elderly than among the population as a whole. Typically, rates peak in older adulthood. Epidemiological data for the current levels and trends in suicide among the elderly are presented with a focus on United States figures. Age, sex, race, marital status, and methods of suicide as factors in suicide among the old are detailed, followed by a discussion of past trends and future predictions of changes in elderly suicide rates. In addition to fatal suicidal behaviors, the data and literatures on parasuicide and survivors of elderly suicide are briefly noted.
Suicide of elderly persons: Towards a framework for prevention
Suicide is an act of intentionally terminating one’s own life. Although suicide rates vary across demographic categories, they have increased by approximately 60% in the last 50 years. Many studies of adolescent suicidal behavior have noted impulsivity to be a common feature in the younger age group, while with older people there is evidence of planning and a strong intent to die. In fact, older people are most successful as an age group with approximately one in four attempts resulting in death. While very comprehensive statistics are available on many aspects of this problem for the Turkish population as a whole, this data does not include physical factors like illnesses, legal domiciles like nursing homes, economic standards and history of attempted suicides. This necessary data would add greatly to the available data and accuracy of research in this area. Whereas Turkish national risk factor procedures are available, precaution procedures and suicide attempt data is not. There is no way of knowing how many deceased had a history of repetitions. It is suggested that this could be attributed to routine failure to observe and mitigate risk factors. The size of this problem is being demonstrated with this presented case report about a planned complex suicide with multiple sharp forced injuries and substance intoxication; a completed suicide that was potentially preventable with timely detection and intervention. In accordance, suicidal risk factors in the old age population, precautions, along with the characteristics of this suicidal case, are evaluated within existing published work.
Socioeconomic Risk Factors in the Precipitation of Suicide in the Elderly
The Open Geriatric Medicine Journal, 2009
Suicide among the elderly is a critical public health problem. Large socioeconomic inequalities are present in suicide mortality cases, but the association is complex and may be different for elderly men and women. Reducing these differences could significantly reduce the burden of excess mortality, at least in elderly men. The aim of the present paper is to review research concerning the socioeconomic risk factors associated with suicide in the elderly. It is noted that the association between suicide risk and socioeconomic factors is likely to be overestimated when the effect of psychiatric status is not considered.