1. The Elderly and Suicide Debbie Merkel, BA Lincoln Health Care Center Mobile Crisis Specialist

2. The Elderly and Suicide- Facts Elderly- people over the age of 65 Elderly- people over the age of 65 13% of the population 13% of the population Account for 1/5 of all suicides Account for 1/5 of all suicides Individuals born between 1946-1965 are expected to commit suicide more than any other generation Individuals born between 1946-1965 are expected to commit suicide more than any other generation 30,000 suicides annually 30,000 suicides annually

3. The Elderly and Suicide- Facts Every 97 minutes a person age 65 and over dies from suicide Every 97 minutes a person age 65 and over dies from suicide Tend to be violent deaths Tend to be violent deaths Senior suicide rates are most effective; 1 in every 4 attempts as compared to youth rate of 1 in every 150-200 attempts Senior suicide rates are most effective; 1 in every 4 attempts as compared to youth rate of 1 in every 150-200 attempts Alcohol plays a diminished role in later life suicide Alcohol plays a diminished role in later life suicide

4. The Elderly and Suicide- Facts White males over 80 are six times more likely than the national average to commit suicide than other groups; twice that of the general population White males over 80 are six times more likely than the national average to commit suicide than other groups; twice that of the general population 15 elderly suicides occur each day, resulting in 5,421 suicides in among those 65 and older each year. 15 elderly suicides occur each day, resulting in 5,421 suicides in among those 65 and older each year. The rate of suicide for women typically declines after age 60 (after peaking in middle adulthood ages 45-49) The rate of suicide for women typically declines after age 60 (after peaking in middle adulthood ages 45-49)

5. The Elderly and Suicide- Facts The elderly are the LEAST likely to reach out to a crisis hotline than any other age group The elderly are the LEAST likely to reach out to a crisis hotline than any other age group Elder suicide may be under reported by Elder suicide may be under reported by 40% or more (silent suicides)- deaths for medical non-compliance- overdoses, self-starvation or dehydration which occur in nursing homes, or deemed accidents 40% or more (silent suicides)- deaths for medical non-compliance- overdoses, self-starvation or dehydration which occur in nursing homes, or deemed accidents

6. The Elderly and Suicide- Facts Fastest growing segment of the US population is 85 or older; 2% of the total population Fastest growing segment of the US population is 85 or older; 2% of the total population In 1990 there were 4 million people age 85 +; in 2040 there will be 40 million In 1990 there were 4 million people age 85 +; in 2040 there will be 40 million

7. The Elderly and Suicide- Depression Depression: serious medical condition that negatively affects how one FEELS, ACTS, and THINKS. It does not discriminate. It affects people of all ages. Depression: serious medical condition that negatively affects how one FEELS, ACTS, and THINKS. It does not discriminate. It affects people of all ages. Depression IS NOT a normal sign of aging Depression IS NOT a normal sign of aging Depression occurs in about 15% of those 65+ (6 million seniors) no different than the general population as far clinical depression occurs Depression occurs in about 15% of those 65+ (6 million seniors) no different than the general population as far clinical depression occurs Only 10% of elderly sufferers actually seek out medical help Only 10% of elderly sufferers actually seek out medical help

8. The Elderly and Suicide- Depression *80% of elders who go into a clinic, go in with physical issues which are psychiatrically driven *80% of elders who go into a clinic, go in with physical issues which are psychiatrically driven Tends to last longer in elderly adults Tends to last longer in elderly adults It doubles their risk of cardiac diseases and increases their risk of death from other illnesses It doubles their risk of cardiac diseases and increases their risk of death from other illnesses It reduces an elderly person’s ability to rehabilitate It reduces an elderly person’s ability to rehabilitate

9. The Elderly and Suicide- Factors that Increase Depression Being female Being female Being single, unmarried, divorced, or widowed’ Being single, unmarried, divorced, or widowed’ Lack of a supportive social network Lack of a supportive social network Stressful life events Stressful life events Lack of spirituality Lack of spirituality

10. The Elderly and Suicide- Factors that Increase Depression Family history of major depressive disorder Family history of major depressive disorder Living alone / social isolation Living alone / social isolation Past suicide attempts Past suicide attempts Presence of severe or chronic pain Presence of severe or chronic pain Previous history of depression Previous history of depression Recent bereavement Recent bereavement Substance abuse Substance abuse Insomnia Insomnia

11. The Elderly and Suicide- Depression Physical conditions and use of medications may actually lead to symptoms of depression. Diseases Diseases Thyroid Disorders Thyroid Disorders Diabetes Diabetes Parkinson’s Disease Parkinson’s Disease Multiple Sclerosis Multiple Sclerosis Strokes, Cancers Strokes, Cancers Tumors Tumors Arthritis Arthritis Visual Impairments Visual Impairments Medications Blood pressure meds Arthritis meds Hormones Steroids

12. The Elderly and Suicide- Risk Factors Differ for suicide among older person than among the young Differ for suicide among older person than among the young Social Isolation- no social network; friends passing away; loneliness; loss of driver’s license Social Isolation- no social network; friends passing away; loneliness; loss of driver’s license Physical Illness- or fear of prolonged illness; perceived poor health Physical Illness- or fear of prolonged illness; perceived poor health Highest among divorced or widowed Highest among divorced or widowed Economic Pressures- living on fixed incomes Economic Pressures- living on fixed incomes

13. The Elderly and Suicide- Risk Factors Single, male, advancing in age Single, male, advancing in age Significant life events- loss of a loved one; a move from their home to a facility; loss of independence / mobility; loss of health- don’t want to be a “burden” on family; retirement Significant life events- loss of a loved one; a move from their home to a facility; loss of independence / mobility; loss of health- don’t want to be a “burden” on family; retirement Medications Medications Severe and Chronic pain Severe and Chronic pain Alcohol abuse and/ or dependence Alcohol abuse and/ or dependence Access to Firearms Access to Firearms

14. The Elderly and Suicide- Warning Signs Statements of hopelessness or helpless/ or about death- “I don’t know if I can go on”. Statements of hopelessness or helpless/ or about death- “I don’t know if I can go on”. “You’d be better off without me. I’m such a burden”. “You’d be better off without me. I’m such a burden”. Failure to take care of self or follow medical orders Failure to take care of self or follow medical orders Stockpiling medications Stockpiling medications Sudden interest in firearms Sudden interest in firearms Social withdrawal Social withdrawal

15. The Elderly and Suicide- Warning Signs Elaborate goodbyes Elaborate goodbyes Giving away personal items Giving away personal items Rush to complete or revise a will Rush to complete or revise a will Suddenly happy / peaceful after a period of gloominess or depression Suddenly happy / peaceful after a period of gloominess or depression Overt suicide threats Overt suicide threats

16. The Elderly and Suicide- What to Look For Look for a change in usual activity-Is there a change in function / activities? Not enjoying activities once enjoyed? Look for a change in usual activity-Is there a change in function / activities? Not enjoying activities once enjoyed? Changes in sleep pattern? Insomnia? Oversleeping? Changes in sleep pattern? Insomnia? Oversleeping? Changes in appetite that result in weight losses or gains not related to dieting. Changes in appetite that result in weight losses or gains not related to dieting.

17. The Elderly and Suicide- What to Look For Loss of energy / increased fatigue Loss of energy / increased fatigue Restlessness or irritability Restlessness or irritability Frequent headaches, stomach aches, chronic pain, somatic complaints Frequent headaches, stomach aches, chronic pain, somatic complaints Changes in personal hygiene/ housekeeping Changes in personal hygiene/ housekeeping Not eating properly Not eating properly

18. The Elderly and Suicide- How to Help Be aware of warning signs/ risk factors Be aware of warning signs/ risk factors Don’t be afraid to ask THE QUESTION/ QPR Don’t be afraid to ask THE QUESTION/ QPR Ask if they have a Plan Ask if they have a Plan Keep them talking Keep them talking Encourage them to get help/ Offer to make the call with them Encourage them to get help/ Offer to make the call with them Immediate danger, call 911 Immediate danger, call 911

19. The Elderly and Suicide- How to Help Encourage Senior to get involved with the local Senior Center Encourage Senior to get involved with the local Senior Center Volunteer Volunteer Contact the Aging Disabilities Resource Center ADRC Contact the Aging Disabilities Resource Center ADRC Grief Support Groups Grief Support Groups Attend Church groups / Affiliations Attend Church groups / Affiliations

20. The Elderly and Suicide- How to Help Encourage Seniors to get check out / hook then up with Interfaith Volunteers Encourage Seniors to get check out / hook then up with Interfaith Volunteers Help them obtain Meals on Wheels/ encourage them to go to MOW sites Help them obtain Meals on Wheels/ encourage them to go to MOW sites Ask them about their faith- Parish visitors, pastors, church volunteers, interests Ask them about their faith- Parish visitors, pastors, church volunteers, interests Get them tied into school or community groups that do outreach Get them tied into school or community groups that do outreach

21. The Elderly and Suicide- How to Help Encourage Seniors to eat a Healthy Diet Encourage Seniors to eat a Healthy Diet There is HOPE! There is HOPE! Help seniors find a purpose in life Help seniors find a purpose in life

22. The Elderly and Suicide- How to Help Medical needs- help them talk to their nurse or doctor (improve communication) may involve ROI Medical needs- help them talk to their nurse or doctor (improve communication) may involve ROI Assist seniors in obtaining transportation for appointments (or shopping) Assist seniors in obtaining transportation for appointments (or shopping)

23. The Elderly and Suicide - Treatment Psychotherapy- Behavioral Cognition Therapy Psychotherapy- Behavioral Cognition Therapy Medications- Antidepressants Medications- Antidepressants Combination Combination Support Groups- Grief/ Bereavement Support Groups- Grief/ Bereavement

24. The Elderly and Suicide References: Office of the Surgeon General Center for Disease Control and Prevention American Association of Suicidology National Institute of Mental Health Department of Mental Health