Completed suicide, fortunately, is a fairly uncommon event, but when it does occur it can have a devastating effect on the victim's survivors. Grief following a death by suicide is distinct from the 'normal' bereavement process and involves a complex combination of depression, guilt and anger. Just as in the suicide deaths of younger people, immense shock is experienced by the families and friends of elderly people who decide to take their own lives. Due to the fact the elderly population is the fastest growing segment of the population, the number of individuals at risk is also climbing. The implications of this are huge.
Sadly, suicide rates are generally higher after the age of 65 than at any other time in the life course. Studies have shown that the suicide rates of women usually rise from adolescence to midlife, where-after they plateau or sometimes drop, while for men it looks slightly different. Among black men, suicide rates tend to reach a peak in young adulthood, diminish through middle age, and peak again in late life. However among white men the rate seems to rise precipitously with age.
There are a variety of reasons for this. Two factors that seem to have a large impact are the real loss of social support that elderly people experience and declining health. One of the risk factors for suicide in the elderly is bereavement, especially for the loss of a spouse. Physical illness has been repeatedly implicated in the suicides of older people with studies showing that medical illnesses directly contributed to suicide in up to 70% of victims over 60 years of age. The disorders that seem to place people at greatest risk are disorders of the central nervous system like Huntington's disease, multiple sclerosis and epilepsy; cancers; peptic ulcer disease and problems of the urogenital tract in males; hepatic cirrhosis; diseases of the heart and lungs and rheumatoid arthritis. Not all people with these illnesses, even when they are life-threatening, commit suicide, so other factors have to be considered when assessing suicide risk, like the amount of pain the person experiences, how much the illness interferes with their ability to function, disfigurement, how the person perceives their condition and their ability to overcome or adjust to it, and the presence of other stressful life circumstances.
Another risk factor includes having a hostile or neurotic personality style, which may make it more difficult to relate to others, but recent studies have shown that no single factor places an older person at greater risk than psychiatric illness, with between 76 and 91% of elderly suicide victims having had one or more diagnosable psychiatric disorder. Depression, substance abuse and the combination of the two were the most common. For more information on these illnesses, counselling or referrals, the Depression and Anxiety Support Group can be contacted, Monday to Friday, 8am to 7pm, and on Saturdays from 8am to 5pm, on (011) 783-1474/6.
Sadly though, despite the presence of symptoms of depression or substance abuse, very few of these people were receiving treatment. This could be due to the fact that elderly people have been shown to be far less likely to seek treatment in the mental health sector than younger people, probably due to the fact mental illness held a greater stigma when they were growing up and seeing a 'shrink' meant you were 'crazy'. This then leads to most elderly people being more likely to express their emotional distress through physical symptoms and presenting rather to their GP. Unfortunately though, many primary health care providers do not know the suicide risks associated with age and what to look for. A number of studies have shown that 70% or more of elderly suicide victims had been to see a primary health care provider in the last month of their lives and 40% in the last week..
According to Professor of Psychiatry and Oncology, Yeates Conwell: "The clinical interview is the cornerstone of suicide risk assessment for the elderly. It must provide sufficient time for the person to express his fears and concerns, not only medical, but also psychological and social. Maintaining an index of suspicion for suicide risk, particularly among older men, the physician should systematically inquire about the presence of risk factors beyond physical illness. If the patient reveals or one suspects suicidal intent, we must be prepared to intervene. Just as in younger people, suicide of the elderly is invariably an ambivalent act. Even those people in the greatest pain, either physical or psychological, will choose to live if offered an alternative means to relieve their suffering."
* taken from 'Suicide among older people' - Prof. Yeates Conwell