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How To Recognize Older Adults Who Are At Risk For Suicide And How To Intervene

This information is for health and mental health professionals including:

  • psychologists
  • psychiatrists
  • psychotherapists
  • physicians
  • psychiatric nurses
  • clinical social workers

This information is for reference only.  Actual recommendations will depend on the needs of individual patients and resources available.

Prevelance
Risk Factors
Diagnosis
Management

Prevelance

  • Although they represented only 13 percent of the U.S. population, individuals age 65 and older accounted for 18 percent of all suicide deaths in 2000.
  • White men age 85 and older had the highest rates of suicide (by gender and race): 59 deaths per 100,000 persons in 2000; this rate was more than five times the U.S. rate of 10.6 per 100,000.

Source: Office of Statistics and Programming, NCIPC, CDC. Web-based Injury Statistics Query and Reporting System (WISQARSTM): http://www.cdc.gov/ncipc/wisqars/default.htm

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Risk Factors


Risk Factors for Suicide among Older Adults:


Male Gender

Men are 3 times more likely than women to commit suicide because they usually pick more lethal methods such as guns, hanging, stabbing, or jumping from buildings. Women, who often choose to commit suicide by taking pills, have a greater chance of being rescued.

Ethnicity

Among elderly men, Cuban Americans and whites are at greatest risk of committing suicide; native-American men are also at high risk . Among women, Asian Americans have the highest suicide rates. Native-American elders commit suicide less than whites and African-American seniors have the lowest rates of suicide for both men and women.

Other Factors:


    Health concerns:

    • Multiple chronic illnesses; chronic and/or severe pain that is not appropriately managed or controlled; a cancer diagnosis or fear of having cancer; terminal illness
    • Psychiatric disorders: depression, schizophrenia, bipolar disorder, gambling addiction
    • Alcohol abuse or dependence

    Financial concerns:

    • Financial difficulties due to business decisions, bankruptcy, excessive gambling debts, or medical bills

    Family makeup:

    • Family history of suicide and/or mental illness
    • Being married and not wanting to be a burden to family members

    Personal history of:

    • Psychiatric problems, especially a mood disorder or alcohol abuse, and/or prior suicide attempts; admission to a psychiatric hospital
    • Thinking about or voicing suicidal thoughts
    • Low self-esteem
    • Complicated bereavement

    Other risk factors:

    • Protestant, but seldom attends church
    • Residence in an urban area
    • Recent relocation

Warning Signs for Suicide among Older Adults:


    Overt comments such as:

    • ”I wish I were dead.“
    • ”I‘d like to just go to sleep and never wake up.“
    • ”Everyone would be better off without me.“

    Signs of intention such as:

    • A previous attempt at suicide
    • ”Accidents“ that may have been suicide attempts (e.g., medication overdoses or noncompliance with drug regimens)
    • Purchasing excessive amounts of medication
    • Buying a gun

    Putting one‘s “affairs in order”:

    • Making or changing a will
    • Giving money or possessions away, especially those with sentimental value
    • Making funeral plans
    • Registering to become an organ donor
    • Interest in or rejection of religion

    Subtle clues such as:

    • Changes in sleeping and eating patterns
    • Self-neglect; deterioration of health; irritability
    • Difficulty with activities of daily living
    • Breakdown of relationships
    • Doctor&lsqup;s visits for vague symptoms or somatic complaints

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Diagnosis


Older adults who tell friends, family members, or health professionals that they are considering suicide should be taken seriously. A diagnostic interview that is conducted with respect, empathy, and sensitivity can help the health care provider determine the individual‘s intent and risk to himself or others.

Interview guidelines

A diagnostic interview to evaluate an older adult‘s risk for suicide may include open-ended questions about the individual‘s:

  1. Physical complaints (pain, insomnia)
  2. Symptoms of depression (e.g., feelings of hopelessness, changes in sleep patterns, weight gain or loss)
  3. Concerns and stressors
  4. Family relationships
  5. Family and personal history of alcoholism, depression, anxiety, and attempted suicide
  6. Thoughts and beliefs about suicide; frequency of these thoughts
  7. Plan for suicide, if there is one
  8. Thoughts about killing others
  9. Access to lethal means
  10. High-risk behaviors (e.g., accumulating medications, buying a gun)
  11. Coping abilities and protective factors. The interviewer might ask: ”What are the factors that would keep you from hurting yourself?“ The most common factors are the effect of death on family and close personal relationships; religion and fear that one would ”end up in hell“; not wanting family members to ”have to clean up the mess“; and not wanting to abandon pets.
  12. Consideration of options besides suicide

Specialized assessments

Some individuals also require evaluation for:

  • Medical problems
  • Psychological issues
  • Substance abuse

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Management

If the diagnostic interview reveals the older adult s intention to commit suicide, management should include referral to a hospital emergency department because the individual may require an acute psychiatric admission. A mental health plan that involves medication and psychotherapy; and/or other services such as support groups may be indicated for those patients with suicidal thoughts without intent. These referrals depend on the urgency and degree of risk (e.g., on whether the individual has a specific plan and the means to carry it out) and whether or not the person can agree to a verbal contract for safety.

Crisis Intervention

    Older adults at a high risk for suicide may have:

    • Made a firm decision to commit suicide.
    • Lethal means of carrying out the suicide attempt.
    • High stress levels.
    • Perceived little family or social support.

    Older adults who are at high risk for suicide:

    • Should not be left alone.
    • And who present immediate safety risks to themselves or others should be referred to a hospital emergency department.
    • Should not drive themselves to the hospital.

    Before taking a suicidal older adult to the hospital emergency department:

    • He or she should be informed about the decision to go there. The professional making the recommendation should explain the primary concern for his or her welfare. It is important to emphasize the individual’s value and entitlement to treatment in order to feel better.
    • The health care provider and the older adult should consult with a mental health crisis line or a provider within the emergency department of the hospital by telephone.
    • A family member or friend should be contacted to take the individual to the hospital.
    • If a family member or friend is not available, the health care provider may need to call 911 to ask a police officer to take the older adult to the emergency room.

Medication and Psychotherapy

If the older adult who is at risk for suicide is determined to be able to receive treatment as an outpatient, he or she must continue to be closely monitored to ensure his or her safety. Most older adults who consider suicide are suffering from a medical disorder: major depression. For information on how depression can be managed with medication and psychotherapy, visit PARC’s provider guidelines for treatment of depression:Overview of Depression

Other Services

Older adults who have been at risk for suicide may benefit from ongoing support. In addition to referrals for medication and psychotherapy, they may be helped by:

  • Individual or group therapy to teach alternative coping strategies and techniques to deal with stress.
  • Support groups to allowexpression of feelings and concerns in a supportive environment.
  • Community programs for older adultsto minimize the risk of social isolation.

Adapted from: