Depression and Suicide in the Elderly

Douglas Bloch
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In a few days, I will turn 65. Aside from asking myself, “Where did the time go?” I am reminded that my becoming a senior citizen is a part of a greater phenomenon–the aging of the baby boomer generation. While much attention has been focused on the rise of dementia and Alzheimer’s that will accompany the graying of America, there exists another equally significant hazard of growing old in our culture – the increasing number of older Americans who are attempting suicide – and succeeding. Given that I have battled depression my entire life, this trend takes on personal significance for me.

There are many reasons why an older person might want to commit suicide—failing physical health, chronic pain, the loss of a loved one, or an unwillingness to be a burden to the family. How significant is the suicide problem in the elderly? According to a recent article in the New York Times among those over sixty-five, 14.9 per hundred thousand take their own lives, compared with the national average of 12.9 per hundred thousand. Eighty percent of older people who commit suicide are white males, and most use firearms. Other suicides go totally unreported. For example, many elderly people may kill themselves by refusing to eat or by stopping their medications. On the death certificates, these deaths are usually blamed on pneumonia or heart failure. With proper treatment, their lives could have been saved.

Fortunately, the elderly rarely kill themselves on impulse; hence there is a better chance to identify and to help those at risk. People who have recently retired, who have lost a loved one, or who have entered a nursing home (thereby losing their home, privacy and personal freedom) are among the groups who are most likely to become depressed—and then suicidal. If you have an older friend or relative you think might be suicidal, here are some signs to look for:

  1. Changes in behavior.  Symptoms include more drinking and less interest in friends, family, hobbies or churchgoing, giving away money and prized possessions; buying a gun or stockpiling guns.
  2. Carelessness about personal appearance.  Symptoms include hair uncombed, clothes not cleaned or pressed, lack of personal hygiene.
  3. How they feel.  Symptoms include lethargy, loss of appetite (many people simply stop eating), having no joy in life, anger expressed towards self or others, a sense of hopelessness and despair.
  4. What they say.  Words include “I’d be better off dead,” “My family would be better off without me” and “I won’t be around much longer.”

Experts fear that elderly suicides will soar as the baby boom generation ages. Fortunately, when older people are treated for depression, they often get well quickly and go on to more years of productive living. This is why it is critical to recognize the early signs of depression so that the tragedy of suicide can be averted.

I believe the the holistic mental health recovery program that I have written about in this blog can be used to treat depression in the elderly. For example, we know that social support is conducive to good mental health. Unfortunately, many seniors find themselves isolated—a consequence of our youth-oriented culture and the diminishment of the extended family. In traditional societies, elders were venerated and taken care of by the community. Now many seniors live in understaffed, sometimes abusive nursing homes or alone in run-down apartments. The good news is that we are seeing a trend towards co-housing – a situation where people pool their resources and live in individual dwellings on a shared piece of land. Perhaps, out of economic necessity, aging baby boomers will begin to recreate community. And what is good for the pocketbook will be beneficial for the emotions and spirit as well.

Other holistic strategies that can promote mental health are exercise (a proven modality for reducing depression), good nutrition, and finding a sense of purpose and meaning. Many people experience emptiness in their lives after retirement. One antidote for this is mentoring young people. When I visited my parents in their Florida retirement community, I observed that residents spent their days golfing, playing tennis, and going to “early bird specials” at the local restaurants. There were no children anywhere in sight. Compare this to my former math professor who after retirement traveled to neighborhood elementary schools and introduced the children to her “math games,” which taught them the fundamentals of math in fun and engaging ways. Another retired friend became a swim instructor at my local community pool. Both these people told me that working with children kept them young and optimistic.

Thus, as I join the millions of baby boomers who are entering the last third of their life, I realize that there is nothing in getting older that automatically dooms us to experience emotional or cognitive decline. Remaining active, staying connected and engaging in meaningful activities are keys to aging gracefully. And for those of us who have had a history of depression and anxiety, there exists a variety of excellent tools that we can use to treat and manage these symptoms if they reemerge.

More information about alleviating the symptoms of anxiety and depression can be found at http://www.healingfromdepression.com

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5 COMMENTS

  1. Douglas,

    I always appreciate your blog posts. And as a fellow baby-boomer, especially this one. You wrote:

    “… holistic strategies that can promote mental health are exercise (a proven modality for reducing depression), good nutrition, and finding a sense of purpose and meaning.”

    I agree, 100 percent, especially in finding a sense of purpose and meaning.

    Best,

    Duane

  2. I would assume from my short stint as a nursing home ombudsman that the rate of “antidepressant” drugs given to seniors has climbed steadily over time. It is important to take that into account when looking at increasing suicide rates, as the drugs themselves may be contributing.

    Additionally, the drug approach that is so common and so accepted really invalidates the reasons you mention above for so much of the depression we see in the aging population – loss of community, loss of purpose, loss of housing and possessions, loss of friends and connections, loss of status, loss of control over our bodies, and in the case of nursing home residents, loss of control over most aspects of our lives. All these things make a sense of sadness or loss or even hopelessness or despair a pretty normal and common experience, but instead of being listened to, understood and supported, most elderly folks continue to get the “drug ’em and forget ’em” message that essentially says, “You should feel good, and if you don’t, it’s because your brain is messed up.” It is the opposite of the holistic approach you are recommending, and yet it is standard practice in the care of aging Americans.

    — Steve

  3. Many people who battle depression are victims of child abuse. I appreciate your concern about the elderly, but do we really need to be watching each other for “signs” and turning each other in for “treatment”? There is no effective psychiatric treatment for depression except talk therapy and trauma therapy, which is too expensive and labor-intensive to be offered. As a woman of sixty, I don’t appreciate the idea that I need people “helping” me if I haven’t explicitly asked for help. Let’s think about the concept of freedom and letting people die if they wish to do so. Is death so terrible? Isn’t that a value judgement of the most personal and profound kind?