Suicide and Older Adults

• Frailty - the injuries may cause more physical damage and their recuperative abilities may be less.

• The social isolation of many  leaves less opportunity for rescue.

• Older people tend to use more lethal methods and they often have stronger suicidal intent.

• Causes of death may be less rigorously investigated in older persons (some "accidental" overdoses may not be accidents)

• Increasing age (more common among "old" seniors)

• Being male, especially for Caucasians

• Being single or divorced, or living alone

• Alcohol use problems

• Social isolation/closed family systems which do not encourage discussion or help-seeking

• Having poor physical health or the belief that is ill

• Chronic pain that is inadequately managed

• Hopelessness and helplessness

• Loss of health, status, social roles, independence, significant relationships

• Depression

• Fear of being forced to move to a nursing home (institutionalization)

• Ageism

It is apparent that several of these risk factors are also common for older adults with alcohol or other drug use problems. People who counsel older adults with alcohol problems note that suicide tendencies may be active in nature, where the person says  "I want to die", or may be expressed through more passive feelings,  "I don't want to live".

Depression and suicide are closely related. As with depression, it is very important to screen older adults for suicidal thoughts and plans. For most older adults, suicide is not a rational plan to "die with dignity", but a serious cry for help when the person's world feels unbearable.

Suicide notes are traditionally considered as markers of the severity of a suicide attempt and these are said to provide valuable insight into the thinking of suicide victims before the fatal act.  However, researchers note only about half of seniors who commit suicide leave notes. They point out many older adults contemplating suicide "are isolated and may have no one to write a note to, while others have lost the ability to express themselves." They also point out that "Although only a proportion of elderly suicide victims leave suicide notes, the absence of a suicide note must not be considered an indicator of a less serious attempt."

Alcohol Problems and Suicide Among Older  Adults

During the 2003 conference of the American Association of Suicidology, research was released from two new studies linking suicide with alcohol problems.

The studies, "Risk Factors for Suicide and Medically Serious Suicide Attempts Among Alcoholics" and "Moderators of the Relationship Between Alcohol Dependence and Suicide and Medically Serious Suicide Attempts,"found a need for suicide-risk recognition and prevention efforts targeted at middle-aged and older Americans. 

The authors  (Conner et al.) state that "increased age could serve as a marker for more chronic, treatment-refractory alcoholism, which is associated with greater risk for suicide."  In line with what has been mentioned above ("Risk Factors"), people with alcohol problems who complete suicide are older and more likely to be male. They often have a mood disorder, relationship difficulties, and other interpersonal life events than control subjects.
 

The researchers recommended enhanced suicide-prevention efforts for people with alcohol problems that include a focus on depression and interpersonal factors, such as partner-relationship difficulties.

Other research indicates that the risk ratio of suicide among people with substance use dependence or substance abuse problems is 5.5 times higher, compared to people without these problems. The relative risk of suicide for

-people with opioid dependence/ abuse is 10 times higher;

-people with dependence/ abuse of legal drugs (prescription drugs) is 30 times higher;

- people using a combination of legal drugs and  alcohol, it is 39 times higher;  

People with major depression are 21 times more likely to commit suicide and people with bipolar disorder are 19 times at  higher risk compared to people without these mental  health problems. (CSP, Alert #51)

References

Centre for Suicide Prevention, (February, 1998). Suicide among the aged. SEIC Alert #28   Online www.suicideinfo.ca/csp/assets/alert28.pdf

Centre for  Suicide Prevention. Suicide Information and Education Collection. (May, 2003) Substance abuse in combination with mental illness, do they increase suicide risk? SIEC Alert #51.  www.suicideinfo.ca/csp/assets/alert51.pdf

Centre for Suicide Prevention: www.siec.ca/ The Suicide Information & Education Collection (SIEC) is a special library and resource centre providing information on suicide and suicidal behaviour.

Conner, K.  Beautrais, A.L.  &  Conwell, Y. "Moderators of the Relationship Between Alcohol Dependence and Suicide and Medically Serious Suicide Attempts: Analyses of Canterbury Suicide Project Data." Alcoholism: Clinical and Experimental Research (2003), 27(7), 1156-1161.

Conner, K. R.  Beautrais, A.L.  &  Conwell, Y.  ( July, 2003)    Risk Factors for Suicide and Medically Serious Suicide Attempts among Alcoholics: Analyses of Canterbury Suicide Project Data,   Journal of Studies on Alcohol,  Volume 64 (4), 551-554.

Quan H., Arboleda-Florez J., & Fick, G.H., et. al  (2002). Association between physical illness and suicide among the elderly. Social Psychiatry & Epidemiology 37(4),190-197.
 

Salib E, Cawley S, & Healy R. (2002) The significance of suicide notes in the elderly. Aging and Mental Health, 6(2),186-190.
 

Waern M, Rubenowitz E, Runeson B, &  Set al. (June 8, 2002), Burden of illness and suicide in elderly people: case-control study. British Medical Journal, 324 (7350), 1355-1358.

Resources on Suicide

Suicide Prevention for Older People.

Australian manual designed to improve the awareness of suicidal behaviour in older people.  Information about early intervention and assessment strategies, and how to refer older people to appropriate services.  To download this PDF go to: www.health.nsw.gov.au/pubs/s/pdf/suicide_prevent.pdf

Suicide Hotlines in Canada  http://depression.about.com/library/hotlines/blcanada.htm

The American Administration on Aging carries several online resources for consumers and practitioners. See: www.aoa.gov/prof/notes/Docs/Suicide_and_Elderly.doc

Information for Service Providers

Elder Suicide & Post-acute Care: Gatekeeper Role for Providers

Provides an "Elder suicide primer".  Covers the nature of the problem, causes, warning signs, and "Provider Misconceptions" (such as the erroneous belief that if someone is intent on killing themselves, no one can stop them), plus gives specific ideas on what providers can do. Also an awkwardly titled, but useful resource called "Preventing Elder Suicide for Dummies".

Among the several online and offline resources it gives, there are quite interesting resources:

Cancer and Suicide Among Older Men

Geriatrics Depression Scale: www.stanford.edu/~yesavage/GDS.html

www.psycom.net/depression.central.elderly.html

The National Guideline Clearinghouse in the United States provides a summary on evidence based practice protocols for dealing with suicide risk among older adults  (secondary prevention). See: www.guidelines.gov/summary/summary.aspx?doc_id=3308&nbr=2534&string=alcohol

Page last updated Sunday July 10, 2005

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