Those who study suicide identify that age, gender, race, living arrangements, and life events are important factors in the epidemiology of suicide. Butler and Lewis identify that the suicide rate increases in white men as they age, with an especially high incidence in the eighth decade of life; white women on the other hand have a higher rate of suicide during middle age.1 This is not to conclude that elderly white women or persons of other races do not commit suicide in their later years, but that the elderly person at higher risk of committing suicide is a white male of increasing age who has suffered some significant loss, such as the loss of health.
All men at earlier ages, who suffer a loss of power such as that associated with job loss, are at higher risk of suicide. Moreover, persons of all ages and races who find themselves living alone and who have suffered a significant loss are more at risk. Hatton, et al, stated that religiosity and educational level do not appear to change these figures, that in essence people who commit suicide are of all religious and educational backgrounds.2
There are many ways to commit suicide. Some methods are more slow than others. Although only the more sudden ways of doing away with one's self are referred to here, it is important to realize that, for example, refusing to follow a diabetic diet can also be considered a form of suicide. Nurses and other care professionals should not consider suicide among the elderly as expected and therefore not worthy of intervention.
Suicidologists explain that those who are considering taking their own life are most often victims of "tunnel vision," or in other words do not see other alternatives. People who are in this state of mind cannot reason clearly and cannot identify or understand even simple or seemingly evident actions which would change or improve their situation. Related to this, depressed people most often commit suicide, and it is well known that cognitive function slows during depression. In other words, just as caregivers need to function for persons who cannot care for themselves, due to a physical condition, those who are thinking of suicide are not usually thinking clearly and need someone to take necessary actions, notably, to prevent the suicide.
Before discussing the "early warning signs" of suicide there is a moral issue to consider. Some believe that suicide is acceptable when it is a reasoned moral decision related to a life of pain or meaninglessness. Not many depressed people contemplating suicide in the view of suicidologists, however, are able to reason clearly and decisions based upon decreased problem solving ability are more often related to depression than to any reasoned moral position. Because of this, suicidologists recommend intervention when signs of suicide appear.
In the elderly the first signs may be as innocuous as giving away treasured possessions, or a sudden happiness which follows a particularly depressed state or a depressing event. Other signs may be more obvious such as wishes for death and statements about death as a solution to a problem. When these signs occur a questioning of the intent is recommended, such as "I'm worried that you are considering harming yourself. " Although at first glance some may think this will "put ideas into heads" - the opposite is probably true. That is, bringing this vague notion into focal consciousness is probably the best way either to dispel the notion or to identify persons who need help from mental health professionals. Taking someone who contemplates suicide to a Community Mental Health Crises Center is one way to address a lethal situation. In any case, letting the person know of your concern, and that you will help them address the troubling situation, is indicated.
In summary, most elderly people who commit suicide are alone, lonely, depressed and troubled by a situation and no one seems to want to help them. Health care professionals need to be aware of this and to understand that suicide is usually not a reasoned decision but often a desperate attempt to solve a troubling problem.
- 1 . Butler R , Lewis M : Aging and Mental Health . St. Louis. Mosby. 1982.
- 2. Hatton C, Valente S, Rink A: Suicide: Assessment and Intervention. New York. AppletonCentury-Crofts, 1977.