Elderly Depression and Suicide

• Elderly white men were at the highest risk with a rate of approximately 31.1 suicides per 100,000 each year
• White men over the age of 85 “who are labeled as old-old”, are at the greatest risk of all age, gender, and ethnicity groups. In 2007, the suicide rate for these men was 45.42 per 100,000. That was 2.5 times the current rate for men of all ages (18.3 per 100,000).
• 84.4% of elderly suicides are male
• The elderly have the highest rate of completed suicides compared to any other age group
• Among the elderly there is 1 completed suicide for every 4 attempts.  Whereas, 15-24 year olds complete suicide at a rate of 1 for every 100-200 attempts 
• Firearms are the most common means of suicide among the elderly, accounting for 73% of all completed attempts. 
• Suicides among the elderly are rarely impulsive.  The elderly have thought about their suicide for months, or even years

Additionally, older adults have homicide-suicide rates that are twice as high as younger adults.  Each year more than 500 homicide-suicides or 1,000 deaths occur in persons 55 years and older.  Homicide-suicides in older people were previously considered to be suicide pacts, mercy killings or altruistic homicide-suicides, where both partners were old and sick.  This has been proven to be untrue. Homicide-suicide acts are a result of depression and desperation.  Almost all homicide-suicides in older persons involve a husband who kills his wife before killing himself.

The Causes

The leading cause of suicide among all individuals is untreated depression.  About 1/3 of individuals who are 65 or older will experience depression. It is important to remember that depression is not a normal process of aging.  Depression is related to chemical imbalances in the brain.  Many different factors in the elderly can lead to an increased prevalence of depression: severe chronic/intractable pain, debilitating and/or terminal illness, the loss of a loved one, financial stress, increased social isolation, serious physical and/or cognitive impairments, decreasing independence, major changes in social roles (retirement), and alcohol or narcotic dependence. Any elderly person showing the signs and symptoms of depression needs mental health treatment. 

Additionally, any elderly person who exhibits symptoms of depression needs to have a thorough physical exam from a medical doctor to determine if there is a physical basis for the depression. Certain diseases/conditions may cause symptoms of depression:  thyroid disorders, diabetes, Parkinson's disease, multiple sclerosis, strokes, tumors, and viral infections.  Additionally certain medications can cause symptoms of depression: antihypertensives, hormones, steroids, and arthritis medication.

Ten Warning Signs

1.       Loss of interest in things/activities that are usually found enjoyable

2.       Feeling hopeless and/or worthless

3.       Decreasing social interaction

4.       Not attending to personal self care, grooming or dressing

5.       Not following prescribed medical regimens:  medications, medical treatments, exercise or diets

6.       Loss of a significant other (especially a spouse)

7.       Making final plans: giving away possessions, or making changes in finances and/or wills

8.       Buying firearms or stock piling prescriptions

9.       Saying good-bye to others that sound permanent

10.   Any verbalization of suicidal ideation needs to be taken seriously 

Law Enforcement Checklist for Assessing Suicidality in the Elderly

It is important to remember that many elderly people will hide their depression because they do not want to be seen as weak, crazy, or suffering from dementia.  They are afraid that they will be placed in assisted living or nursing home facilities.

• Look for  aforementioned warning signs
• If you suspect that the individual is depressed ask them directly if he or she is thinking of suicide or self-harm.  If they acknowledge suicide ideation initiate a petition for a 72 hour psychiatric evaluation as a “danger to self”.  Arrange transportation to the closest emergency room.
• Attempt to get collaborative information:  family, friends, senior volunteers, medical providers, neighbors, etc. Third party information can be used to substantiate a psychiatric petition.
• Assess the living situation; can the individual maintain at their current location or are they unable to care for themselves
• Get help from in-house resources if you have any: a mental health team or elder team/detective
• Get help from outside resources:  make  a report to Adult Protective Services
• Encourage disposal of firearms in the home and promote safe storage of all firearms
• Train other officers, EMTs, and emergency workers to recognize possible suicide attempts that may be mistaken for accidents.
• Get the word out to elders and their families that late life depression is readily treatable condition that may lead to suicide if not addressed.
• Follow-up with the any depressed individual if time permits