Although suicide has finally found a place in the public spotlight, it remains a concern associated almost exclusively with teens and young adults. In reality, however, suicide is a crisis which affects all ages. To address this disparity, the National Council on Aging (NCOA) held a session on suicide in older adults amid their day-long web conference for Older Adult Mental Health Awareness Day. Speakers included Jeffrey Shultz, Dr. Yeates Conwell, MD, and Dr. Mary Chase Mize, Ph.D., LPC, NCC.
Shultz opened with a personal story behind his work in suicide awareness advocacy, wherein he recounted the long struggle that preceded his son’s suicide in 2012 and his own subsequent mental health spiral and struggle with suicidal ideation, worsening depression, and PTSD. “To say that being a suicide survivor was difficult for me for the first several years is a gross understatement,” Shultz said. Describing the ramifications of such a traumatic event, such as the work it took to keep his marriage in good shape and the deterioration that led to him parting ways with his workplace, Shultz set the stage for the real human suffering underlying suicide in older adults.
Though he has since found support through successful therapy, a healthier lifestyle, and closer connections with his wife and friends, Shultz emphasized the human toll of suicidality in all ages. Now an active participant in suicide awareness advocacy, Shultz said, “All this training has highlighted for me the increased risk factors in the lives of aging Americans.”
An especially insidious cultural phenomenon about suicide specifically in older adults is a tendency to think suicide in older adults can be “okay” under certain circumstances. When an older person commits suicide, their family members may often reframe the suicide as an “autonomous, healthy decision” or taking matters into their own hands, thereby making peace with the suicide. However, this tendency is rooted in the widespread idea that depression is a normal, expected part of age, instead of treating depression and suicide in older adults as avoidable and treatable. Older adults do not have to be miserable; age does not prohibit a person from experiencing joy in life, and every effort should be made to make that possible. An older adult’s suicide is not merely an autonomous decision. It is a tragedy.
Dr. Conwell followed with an uncompromising call to action: “Suicide prevention is everyone’s business.” In America, suicide rates do not decrease with age, most especially not for white men. By age 75, suicide rates in white men are nearly double that of the next-highest demographic, Native American men — and they only rise with age. Contributing to this phenomenon are factors such as age-related frailty, typical isolation, and determination to see their suicidal ideations through. Consequently, intervention in suicidality in older adults must be aggressive and preemptive.
Five variables, referred to as the “Five Ds,” are reliable indicators of how much risk a given elderly individual may be at for suicide: depression, disconnectedness, disease (mental illness), disability, and deadly means. Together, these risk factors can seem nearly insurmountable, but several countermeasures are proven to be effective, such as routine screening for depression and suicidal ideation, identifying motivation to assure safety, and diagnosis and treatment, with both psychotherapy and medication.
Specific preventative measures addressing some of these risk factors should be implemented to stem suicidality in older adults, said Dr. Conwell. Both disease and disability can be mitigated through easy access to acceptable primary care, integrated care models merging mental and physical health, and rehabilitation. Disconnectedness is most readily addressed with community engagement and outreach events. By proactively engaging with older adults, communities can fend off elderly isolation. Firearm safety is an especially important factor, one of the only ways to address access to lethal means.
Although COVID-19 and social distancing have clearly impacted some of these key risk factors, Dr. Conwell said it may not all be bad news. “We have insufficient data, but there’s reason to be optimistic that the resilience that most older people bring to a challenge, like the COVID pandemic, is actually greater than it may be for younger and middle-aged people.”
For more information, visit https://www.ncoa.org.
The National Suicide Prevention Hotline is 800-273-8255.