PHILADELPHIA – Older Americans are more likely to use lethal means in suicide attempts, Patrick Arbore, Ed.D., said at a conference sponsored by the American Society on Aging.
In addition, he said, the elderly are more likely to complete suicides. For every four suicide attempts among the elderly, one is completed. In the general population, for every 8–25 attempts, 1 is completed. Suicide attempts to completion are about 4:1 among the elderly, compared with a rate of about 8:1–25:1 in the general population.
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.
However, there is no distinctive type of elderly suicide. The range of episodes among this group is the same as it is for younger people. The elderly can have protest suicides, often because of an inability to adjust to physical decline; preemptive suicides, in which a person observes and perceives the death of a loved one to be a terrifying experience and chooses to end his own life; or murder-suicides, in which a person first murders someone else (such as a spouse), then takes his or her own life.
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 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 said.
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.
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