When Golden Years Are Tarnished With Despair

The elderly, not teens, at highest risk of suicide

THURSDAY, July 15, 2004 (HealthDayNews) -- When it comes to suicide and efforts to prevent it, the headlines often focus on teenagers.

But the group of Americans most likely to kill themselves is at the other end of the age spectrum.

While many people don't realize it, the elderly face the greatest risk of suicide in the United States, with older men the most likely to take their lives.

The problem is "grossly underrecognized and grossly undertreated," said Dr. Anand Kumar, a professor of psychiatry at the University of California, Los Angeles. "Things are changing, but they should be changing faster."

Suicide is the 15th leading cause of death among Americans aged 65 to 74, making it almost as deadly as Alzheimer's disease in that age group, according to federal statistics. And while the elderly make up just 13 percent of the population, they account for 18 percent of suicides.

While the stark statistics make the problem clear, researchers are still trying to pinpoint reasons behind the epidemic of elderly suicides.

"It's really a question that we don't understand," said Dr. Yeates Conwell, a professor of psychiatry at the University of Rochester in New York. "Clearly, it must have something to do with cultural and social factors. But those patterns don't [occur] in many other parts of the world."

Major factors contributing to suicide among the elderly include social isolation, a loss of spouse or partner, mental disorders and substance abuse.

"In general, it's associated with a sense of hopelessness, a feeling that things are not going to get better," Kumar said.

Depression, one of the most common conditions associated with suicide in older adults, is also widely underrecognized and undertreated.

Of the 35 million Americans aged 65 and older, an estimated 2 million have a depressive illness and another 5 million may have depressive symptoms that fall short of full-blown depression, the National Institute of Mental Health reports.

Depression also often accompanies other serious illnesses such as heart disease, stroke, diabetes, cancer and Parkinson's disease -- illnesses that afflict older people in disproportionate numbers.

Conwell thinks several factors usually work together to drive people to want to end their lives. "We know there are a number of things that place older people at greater risk, but we know that no one of them is sufficient," he said. "We have to think of combinations of circumstances that make the older person decide their life is not working."

The gap between female and male suicides may offer a glimpse at more effective prevention efforts. Why is there a difference?

"People have suggested it's related to the greater ability women have in general to build social support networks and maintain confidential relationships with other people," Conwell said.

Another factor may be the tendency of women to turn to less-lethal methods when they attempt suicide, Conwell said. While women are less likely than men to succeed with suicide, they do have a higher rate of attempting it. That could change, however. Women who kill themselves are now more likely to have used firearms than poison and drug overdoses, he said.

Meanwhile, a surprising statistic has piqued the interest of researchers. One group of elderly people hardly ever commits suicide -- older black women. According to one report, fewer than 20 older black women committed suicide in the United States in 1998.

Both Conwell and Kumar said better treatment of depression in the elderly would help reduce the threat of suicide. Routine treatments such as ntidepressants and "talk therapy" can make a big difference, Kumar said.

Earlier this year, in fact, a study in the Journal of the American Medical Association reported that training of doctors and the use of case managers reduced rates of both depression and suicidal thoughts among seniors who visited doctors' offices in Pennsylvania and New York.

Unfortunately, doctors are often too busy to look for possible symptoms of depression in their older patients, Kumar said, and even if doctors do make a diagnosis, it may be incorrect.

"It's not just about putting [patients] on treatment," Kumas said. "It requires monitoring and making sure they're taking an adequate dose." Doctors also need to call in psychiatrists when needed, he said.

Relatives and friends can play an important role, too. "There's tremendous stigma associated with [depression and suicide], and patients are often reluctant to seek help," he said. "If you have a neighbor or friend who's depressed, talk to them about getting help."

More information

The U.S. Department of Health and Human Services has more about suicide and the elderly.

SOURCES: Yeates Conwell, M.D., professor, psychiatry, University of Rochester, N.Y.; Anand Kumar, M.D., professor, psychiatry, and director, Division of Geriatric Psychiatry, University of California, Los Angeles, and president, American Association of Geriatric Psychiatry; March 3, 2004, Journal of the American Medical Association
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