Myth: Depression is a normal part of the aging process.
Fact: It is not normal for older adults to be depressed. Signs of depression in older people include a loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed or misdiagnosed.
Fact: One third of the seniors who are 65 or older will experience depression.
Fact: Depression is not synonymous with dementia. Elderly white males have the highest suicide rate when compared to all other groups (triple the overall rate). With the proper treatment and support, depressed older individuals can enjoy their golden years.
The Problem
Someone age 65 or over completes suicide every 80 minutes; an average of 18.2 deaths a day. Elders account for 18% of all suicides; but they comprise only 13% of the population. These rates are probably much higher than that, it is estimated that elderly suicide may be under reported by at least 40%. These so called “silent suicides” include deaths by medical noncompliance/overdoses, self-starvation or dehydration, and supposed accidents.
The elderly complete suicide one out of every four attempts; compared to one out of sixteen in younger adults. The reason for this discrepancy is that the elderly use more deadly means when attempting suicide using guns and hanging.
More Staggering Statistics - Based on 2012 Data (2014):
· Elderly white men were at the highest risk with a rate of approximately 32 suicides per 100,000 each year.
· White men over the age of 85 “who are labeled as old-old”, are at the greatest risk of all age, gender, and ethnicity groups. The suicide rate for these men was 45 per 100,000. That was 2.5 times the rate for men of all ages (18 per 100,000).
· White men over the age of 85 were at the greatest risk of all age-gender-race groups. In 2012, the suicide rate for these men was 50 per 100,000.
· 83.6% of elderly suicides are male. The rate of suicide for women typically declines after age 60.
· The elderly has the highest rate of completed suicides compared to any other age group
· Among the elderly there is 1 completed suicide for every 4 attempts. Whereas, 15-24 year olds complete suicide at a rate of 1 for every 100-200 attempts
· Firearms are the most common means of suicide among the elderly, accounting for 73% of all completed attempts.
· Suicides among the elderly are rarely impulsive. The elderly individual has thought about their suicide for months, or even years.
· Alcohol or substance abuse plays a diminishing role in later life suicides compared to younger suicides.
· Additionally, older adults have homicide-suicide rates that are twice as high as younger adults. Each year more than 500 homicide-suicides or 1,000 deaths occur in persons 55 years and older. Homicide-suicides in older people were previously considered to be suicide pacts, mercy killings or altruistic homicide-suicides, where both partners were old, sick, or both. This has been proven to be untrue. Homicide-suicide acts are a result of depression and desperation. Almost all homicide-suicides in older persons involve a husband who kills his wife before killing himself.
The Causes
The leading cause of suicide among all individuals is untreated depression. About 1/3 of individuals who are 65 or older will experience depression. It is important to remember that depression is not a normal process of aging. Depression is related to chemical imbalances in the brain. Many different factors in the elderly can lead to an increased prevalence of depression: severe chronic/intractable pain, debilitating and/or terminal illness, the loss of a loved one, financial stress, increased social isolation, serious physical and/or cognitive impairments, decreasing independence, major changes in social roles (retirement), and alcohol or narcotic dependence. Any elderly person showing the signs and symptoms of depression needs mental health treatment.
Additionally, any elderly person who exhibits symptoms of depression needs to have a thorough physical exam from a medical doctor to determine if there is a physical basis for the depression. Certain diseases/conditions may cause symptoms of depression: thyroid disorders, diabetes, Parkinson's disease, multiple sclerosis, strokes, tumors, and viral infections.
Ten Suicide Warning Signs in the elderly
1. Loss of interest in things/activities that are usually found enjoyable
2. Feeling hopeless and/or worthless
3. Decreasing social interaction
4. Not attending to personal self-care, grooming or dressing
5. Not following prescribed medical regimens: medications, medical treatments, exercise or diets
6. Loss of a significant other (especially a spouse)
7. Making final plans: giving away possessions, or making changes in finances and/or wills
8. Buying firearms or stock piling prescriptions
9. Saying good-bye to others that sound permanent
10. Any verbalization of suicidal ideation needs to be taken seriously. Intervene.
Law Enforcement Checklist for Assessing Suicidality in the Elderly
It is important to remember that many elderly people will hide their depression because they do not want to be seen as weak, crazy, or suffering from dementia. They are afraid that they will be placed in assisted living or nursing home facilities. Look for aforementioned warning signs
Take Action:
· If you suspect that the individual is depressed ask them directly if he or she is thinking of suicide or self-harm. If they acknowledge suicide ideation initiate a petition for a 72-hour psychiatric evaluation as a “danger to self”. Arrange transportation to the closest emergency room.
· Attempt to get collaborative information: family, friends, senior volunteers, medical providers, neighbors, etc. Third party information can be used to substantiate a psychiatric petition.
· Assess the living situation; can the individual maintain at their current location or are they unable to care for themselves
· Get help from in-house resources if you have any: a mental health team or elder team/detective
· Get help from outside resources: make a report to Adult Protective Services
· Encourage disposal of firearms in the home and promote safe storage of all firearms
· Train other officers, EMTs, and emergency workers to recognize possible suicide attempts that may be mistaken for accidents.
· Get the word out to elders and their families that late life depression is readily treatable condition that may lead to suicide if not addressed.
· Follow-up with the any depressed individual and/or their family if time permits
Suicide is society’s most preventable form of death. No matter what a person’s age maybe, suicide affects others. It is estimated that every suicide intimately affects at least 6 other people. Survivors of suicide have a significantly higher rate of suicide themselves. Law enforcement officers are often survivors of suicide. Debrief with other officers following all completed suicide calls.
National Suicide Prevention Lifeline: 800-273-8255
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
