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Suicide More Prevalent in the Elderly

Studies show why they're more likely to take their own lives

MONDAY, July 1, 2002 (HealthDayNews) -- Every minute and a half in America, a senior citizen commits suicide.

Elderly people with depression, a lack of confidantes and poor sleep are more likely to kill themselves. Those with firearms in the house, particularly handguns, are at significantly greater risk, too.

Those are some of the findings from a group of studies released today in the American Journal of Geriatric Psychiatry, which is devoted to the topic of suicide in the elderly.

People over 65 made up 13 percent of the population in 1999, but they accounted for nearly 19 percent of the nation's suicides, taking their own lives at rates higher than those among any other age group.

Dr. Yeates Conwell, a psychiatrist at the University of Rochester who co-authored several of the papers, says the problem of suicide among the elderly is likely to loom even larger in the coming years as "baby boomers" reach seniority. This group is entering old age with a propensity for suicide, says Conwell, who notes baby boomers have had higher suicide rates across all ages than previous generations.

Add to that the sheer number of boomers, Conwell says, "and we need to prepare ourselves as a society" for many more suicides among the elderly.

Conwell, who guest-edited the theme issue, says people tend to think of suicide among seniors in oversimplified terms -- he killed himself because his wife died, or she took her own life before cancer could. While cancer indeed doubles the risk a person will commit suicide (owning a gun has a similarly powerful effect), only a small fraction of cancer patients and the terminally ill -- and widowers, for that matter -- do so.

The suicidal impulse acted upon is better thought of as "a coalescence of circumstances at a particular point in time," Conwell says.

The circumstance with the most momentum is clearly depression; depressed elderly people are between 20 and 40 times more likely to kill themselves than those with a healthy mood. Sleep disturbances may be a marker of depression or anxiety, Conwell says, since the three often appear together.

Suicide takes an uneven toll on the nation, researchers have found.

Whites, and especially white men, are much more likely to kill themselves than blacks. Elderly white males, for example, do so at three times the rate of older black men and at seven times the rate for black women. In 1998, there were fewer than 20 suicides among elderly black women.

Part of the difference may be that blacks typically have strong ties to religion, which combines faith with a powerful social structure to support them during difficult times.

One study in the geriatrics journal, for example, found that only 3 percent of 835 elderly blacks living in Baltimore public housing said they'd ever contemplated suicide. Nine in 10 said the comfort they derived from their religious beliefs eased their emotional burdens -- often despite crushing poverty, illness and depression.

Another study, involving more than 2,200 men and women over age 65, examined behaviors linked to suicidal thoughts. Ten percent overall said they'd entertained the prospect of killing themselves, but 18 percent of those with depression and anxiety disorders said they'd considered doing so. Potential alcohol abuse wasn't a significant indicator of suicidal ideation.

Blacks were least likely to think about death and suicide (27 percent), while at the other end of the scale 57 percent of Asian-Americans entertained such thoughts.

A related study showed that the elderly who lose mental agility are also more inclined to consider suicide.

Another study conducted "psychological autopsies" on 86 suicides of upstate New Yorkers over age 50. Almost three-quarters were men, 98 percent were white, and 48 percent chose a firearm to carry out the act.

Nearly 63 percent had guns at home when they died, which for men raised the risk of suicide more than fourfold. Keeping a weapon unlocked and loaded also substantially hiked the odds of taking one's life.

Less common means of committing suicide included ingesting a poison (16 percent) and hanging (15 percent).

Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention, says the problem of suicide for the elderly has been largely ignored. "The attention and the focus has been on the young, even though the rate among the elderly is much higher," he says.

That's going to change as the nation ages, Hendin says. However, it has already undergone a shift in recent years, thanks to a growing understanding that depression isn't a normal part of growing old, and that it's treatable in seniors with not only drugs but talking therapy.

Hendin says the flowering of palliative care to help the terminally ill stay comfortable has also made suicide seem less unavoidable to many sick older people. And the realization by doctors that depression complicates illnesses common to the aged, such as heart disease, offers "a major area where you could do suicide prevention," Hendin says.

What To Do

For more on suicide in America, try the Centers for Disease Control and Prevention or the National Institute of Mental Health.

SOURCES: Yeates Conwell, M.D., professor, psychiatry, University of Rochester Medical Center, Rochester, N.Y.; Herbert Hendin, M.D., medical director, American Foundation for Suicide Prevention, New York City; July/August 2002 American Journal of Geriatric Psychiatry
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