Tamara McKlveen

June 11, 2013

CNS6050 Lifespan Development
Dr. Bursor
SUICIDE IN THE
ELDERLY
WHAT IS SUICIDE?
Suicide
Death caused by self-directed
injurious behavior with any
intent to die as a result of the
behavior.

Suicide attempt
A non-fatal self-directed
potentially injurious behavior
with any intent to die as a
result of the behavior. A
suicide attempt may or may
not result in injury.

Suicidal ideation
Thinking about, considering,
or planning for suicide.
UNITED STATES
SUICIDE TRENDS BY
AGE
1991-2009
0
5
10
15
20
25
1
9
9
1
1
9
9
3
1
9
9
5
1
9
9
7
1
9
9
9
2
0
0
1
2
0
0
3
2
0
0
5
2
0
0
7
2
0
0
9
10-24 yrs
25-64 yrs
65+ yrs
1.3% of all deaths in the
United States occur by
suicide, making suicide
the 11
th
leading cause of
death in America
People over 65 comprise
13% of population, but
account for 18% of
suicides
From 1950 to around
2003, people aged 65 and
older consistently had the
highest suicide rates in
the country, with the
highest rates accounted
for by white men over 85
On average, an elderly
person dies by suicide
every hour and a half


UNITED STATES
SUICIDE RATES
AMONG PERSONS
65 AND OLDER BY
ETHNICITY
2005-2009
0
5
10
15
20
25
30
35
Male
Female
White males consistently
have the highest suicide
rate among all age groups
and account for 73% of all
suicide deaths in the United
States.
Male deaths by suicide
outnumber female deaths
by suicide 4 to 1 and suicide
is the 8
th
leading cause of
death for all males
Female suicide attempts
outnumber male attempts 3
to 1
Older adults attempt
suicide less frequently than
younger adults, but are
much more likely to be
successful
WHY THE ELDERLY
POPULATION IS
PRONE TO SUICIDE
The number one
preventable cause of
suicide in the elderly is
depression.
About 1/3 of people over
65 will enter periods of
depression even if theyve
never had mental health
problems in the past. This
may be related to:
Grief
Isolation
Hopelessness
Increased medical burden
Loss of vision and other
senses
Caregiver Syndrome
Illness
Role Change (Retirement)
Financial Strain

MEDICAL COMPLICATIONS IN ELDERLY SUICIDE
It is a mistake to believe that depression is a common part of aging.
It is important to remember the physiological components of depression;
it is very possible that a persons depression is organic in nature and can
be successfully treated
Many kinds of medication create feelings of depression:
Blood Pressure
Arthritis
Hormones
Steroids
Many medical issues cause depression:
Thyroid Disorders
Diabetes
Parkinsons Disease
Multiple Sclerosis
Strokes
Tumors
Some Viral Infections

SUICIDE RISK
FACTORS
Family history of suicide
Family history of child
maltreatment
Previous suicide attempt(s)
History of mental disorders,
particularly clinical depression
History of alcohol and substance
abuse
Feelings of hopelessness
Impulsive or aggressive
tendencies
Cultural and religious beliefs (e.g.,
belief that suicide is noble
resolution of a personal dilemma)
Local epidemics of suicide
Isolation, a feeling of being cut off
from other people
Barriers to accessing mental
health treatment
Loss (relational, social, work, or
financial)
Physical illness including terminal
illness
Easy access to lethal methods
Unwillingness to seek help
because of the stigma attached to
mental health and substance
abuse disorders or to suicidal
thoughts

SUICIDE
PROTECTIVE
FACTORS
Effective clinical care for
mental, physical, and
substance abuse disorders
Easy access to a variety of
clinical interventions and
support for help seeking
Family and community
support (connectedness)
Support from ongoing
medical and mental health
care relationships
Skills in problem solving,
conflict resolution, and
nonviolent ways of
handling disputes
Cultural and religious
beliefs that discourage
suicide and support
instincts for self-
preservation
Sense of meaning and
purpose in life
Feelings of hope and
optimism


IMPACT OF SUICIDE
ON SOCIETY
Suicide and Suicide Attempts
Take an Enormous Toll on
Society
More than 38,000 people
per year die by suicide
Most people who engage
in suicidal behavior never
seek health services.
Costs to Society
Suicide costs society
approximately $34.6
billion a year in combined
medical and work loss
costs.
The average suicide costs
$1,061,170.

(CDC cost estimates based on 2005
data. Refers to people age 10 and
over.)

IMPACT OF SUICIDE
ON SURVIVORS
A survivor of suicide is a family
member or friend of a person
who died by suicide.
Surviving the loss of loved one
to suicide is a risk factor for
suicide.
Surviving family members and
close friends are deeply
impacted by suicide, and
experience a range of complex
grief reactions including, guilt,
anger, abandonment, denial,
helplessness, and shock
No exact figure exists, but it is
estimated that a median of
between 6 and 32 survivors
exist for each suicide,
depending on the definition
used.
According to another estimate,
approximately 7% of the US
population knew someone who
died of suicide during the past
12 months.

SUICIDE WARNING
SIGNS
REMEMBER: IS PATH WARM

I IDEATION AND ISOLATION
S SUBSTANCE USE

P PURPOSELESSNESS
A ANXIETY/AGITATION
T TRAPPED
H HOPELESSNESS/HELPLESSNESS

W WITHDRAWAL
A ANGER
R RECKLESSNESS
M MOOD CHANGES
PERFORMING SUICIDE ASSESSMENTS
Establish rapport
Always respect the dignity of the
client. Acknowledge their experiences
and validate their feelings.
Evaluate suicide risk factors (discussed
in slide 7)
Assess for psychological resiliency
(discussed in slide 8)
When possible, assess collateral
information (medical or family reports)
Be mindful of ambivalent ideation
Develop a risk management plan
Seek consultation or assistance if you
are not specifically trained in suicide
prevention
REMEMBER:
Talking about suicide DOES NOT
mean someone is suicidal. You must
perform a proper assessment.
Take any specific threat of suicide
or wish to die seriously. Do not
leave someone alone when they are
making specific threats about
suicide.
PERFORMING SUICIDE ASSESSMENTS:
KEY QUESTIONS TO ASK
Ask about their feelings
Do you feel tired of living?
Have you been thinking about harming yourself?
Determine if they have made a suicide plan
Have you thought of specific ways of harming yourself?
Have you made any specific preparations? (Examples: giving away prized
possessions, tying up loose ends)
Have you asked someone to help you or join you in your plan?
Do you have access to lethal means? (Examples: guns, medications)
Have you made any moves to put your plan into action?
Ask about their reasons to live
What has kept you from harming yourself, now or in the past?
What makes your life worth living?
Who gives your life meaning?

RISK MANAGEMENT STRATEGIES:
IMMEDIATE RISK OF DANGER
IF YOU BELIEVE SOMEONE IS MAKING SERIOUS THREATS OF
SUICIDE, DO NOT LEAVE THEM ALONE UNTIL YOU CAN ARRANGE
ANOTHER APPROPRIATE CARE PROVIDER
Establish a safety plan
Family support
Homecare support
24-hour care providers
Police intervention (if appropriate)
Consider any care needs
Emergency services
Crisis support services
Medical services
Social and community supports
Ensure that proper follow-up care is arranged
When possible, restrict access to lethal means
RISK MANAGEMENT STRATEGIES:
NONIMMEDIATE RISK OF DANGER
Address any underlying issues
Medical illnesses/pain management
Mental health problems
Social problems, concerns, transitions
Environmental factors
Continually re-assess suicide risk, resiliency, and warning signs
Consider a suicide contract
Continue to build and sustain the therapeutic relationship
Look for ways to foster hope and enhance connectedness
Develop a safety plan that includes after-hours support
Work within a culturally competent model of care
Consider the humanistic approach
Consider appropriate ancillary services
Be aware of community resources and referral processes
CLOSING THOUGHTS
BE ACTIVE IN THE COMMUNITY
VOLUNTEER
PARTICIPATE IN CLUBS
CONSIDER A PET
MAINTAIN GOOD PHYSICAL HEALTH
EXERCISE
PURSUE ENJOYABLE HOBBIES
Short video if time permits:
https://www.youtube.com/watch?v=Jpq0Sn0Tqy4
DEPRESSION IS NOT A NORMAL PART OF
AGING
THE LEADING CAUSE OF SUICIDE IN SENIORS
IS DEPRESSION: DEPRESSION IS TREATABLE!
REFERENCES
Centers for Disease Control and Prevention. (2013). Suicide.
Retrieved June 10, 2013, from
http://www.cdc.gov/violenceprevention/suicide/index.html
Suicide.org. (2013). Elderly suicide. Retrieved June 10, 2013 from
http://www.suicide.org/elderly-suicide.html
Suicide Prevention Resource Center. (2012). Professionals providing
social services. Retrieved June 10, 2013 from
http://www.sprc.org/forprofessionals
TyneRose Media. Reach out speak up - Suicide in the elderly. You
Tube. N.p., (2009). Web. Retrieved June 10, 2013.
<https://www.youtube.com/watch?v=Jpq0Sn0Tqy4>.