The forgotten ones

Focus is on curbing elder suicides

By Taryn Plumb

GLOBE CORRESPONDENT MAY 22, 2014

What group of people in the United States has the highest suicide rate? If you had to answer, some groups might come to mind.

Bullied teenagers? Overloaded college students? Baby boomers who lost their livelihoods, houses, or savings during the recent recession?

The answer might surprise you: In 2010 (the most recent data available), the top group was the elderly, with about 16 suicides each day, resulting in 5,994 deaths among those 65 and older, according to the American Association of Suicidology. In comparison, among youth age 15 to 24 there were 4,600 suicides recorded nationally.

While efforts to protect teens have been stepped up, especially since Phoebe Prince took her own life in 2010 as a result of bullying in South Hadley — the elderly at risk are often forgotten.

“This is who we are most concerned about,” said Mary Quinn, a licensed social worker with the Lawrence-based Samaritans of Merrimack Valley, a local arm of a worldwide suicide prevention movement.

Anyone who — whether through work, volunteer efforts, or personal relationships — has daily interactions with the elderly is considered a gatekeeper, Quinn said during a recent training season at the Amesbury Council on Aging. They must educate themselves, help pinpoint and alleviate risk factors, and spot warning signs.

The Samaritans offered free Department of Public Health-funded training for gatekeepers to reduce the incidence of suicide among the elderly in the region and throughout the state. The workshop included a PowerPoint presentation, handouts, vignettes, small group exercises, role playing, and group discussions.

“It’s important to know about it – how to identify, how to help,” said Amy Au of Lowell, a military veteran who works for the Massachusetts Army National Guard and attended the training.

In 2010, 38,364 people in the United States took their own lives, according to the American Association of Suicidology. Of the 15 percent in the over age 65 category, 84 percent were male, and 71 percent used a firearm.

The reasons for suicide among the elderly directly correlate to the aging process itself, as well as ingrained generational values, Quinn said. The physical and social changes of aging can cause stress and affect mental health, she added.

Limitations in physical function; lack of physical activity; chronic pain, diseases, or disabilities; memory problems; new and changing medications; poor nutrition; exhaustion; and self-consciousness about appearance are all risk factors. Also, loss of independence and economic status; isolation; deaths of longtime partners and friends; role changes in family, society, and housing; and loss of status in the workforce all can lead to depression and feelings of worthlessness, Quinn said.

Risks are even higher if there is a history of mental illness or substance abuse in the individual or the family, she said.

Older adults are very often reluctant to talk about emotional issues, Quinn noted, making them less likely to seek help if they’re feeling suicidal or depressed. This is particularly true of older men, who tend to have fewer social networks in place than women.

Because they grew up in a time when psychological issues were not fully understood, there’s “that fear, that shame, that stigma,” said Quinn. “Many were raised with the idea that ‘It’s a weakness,’ ‘It’s a character flaw.’ ”

Some who attended the eight-hour workshop in Amesbury said it’s time to pay attention to elders who may be in danger.

“It’s ageism,” said Asher Bruskin, who is studying for his master’s degree in social work at Simmons College and interns at the Amesbury Council on Aging.

There’s an attitude that “youth or young folks are more valuable,” he said. “Seniors and aging populations don’t get enough social support.”

There’s also the perception, Quinn pointed out, that it’s much more tragic when a teenager takes his or her own life, compared with someone who has lived a so-called “full life.’’

But that mindset is unsettling to many who work with older populations.

Au, for instance, who is Chinese by ethnicity, pointed out that elders have long been revered and respected in Asian societies. “They’re knowledgeable, they have so much life experience, they can tell you so much,” said Au, who connects service members and their families with support services at the Massachusetts Army National Guard.

When an older person dies, whether by their own hand or not, “it’s such a loss,” she said.

The simplest and easiest way to help at-risk elders is to show compassion, Quinn said. Ask older people how they’re doing, try to keep them engaged, connect them to services and communities, and help them identify the good aspects of their lives: pets, family, faith, and hobbies.

Beyond obvious statements expressing a desire to die or “no longer be a burden,” warning signs for suicide risk can include anger, irritability, hostility, reckless acts, and engaging in risky activities; increased drug or alcohol use; loss of interest in personal appearance; inability to sleep or sleeping all the time; and dramatic mood changes.

Key indicators include giving away prized possessions on a whim, or impulsively making a will when there has been no previous discussion of doing so, said Quinn.

“Suicide and depression have come up with a lot of my clients,” said Bruskin, noting that he has a caseload of about 10 troubled seniors at the Council on Aging.

For him personally — as is the case with other gatekeepers — the topic can be just as difficult to discuss as it is for the person who is suffering. Caregivers and others have to figure out the best way to broach questions about depression and loss of purpose.

“It helps to develop more comfort to ask the question, because it is really important,” he said.

Elderly suicide epidemic

The American Association of Suicidology reports the following for 2010, the latest year data are available:

■Those age 65 and older made up 13% of the population, but accounted for 15.6% of all suicides.

■There was one suicide of an elderly person every 90 minutes, 16 each day, resulting in 5,994 among those 65 and older.

■For all ages, there is estimated to be one suicide for every 100 to 200 attempts; for the elderly, there is one suicide for every four attempts.

■Firearms were the most common means (71.3%) used for committing suicide among the elderly.

■One of the leading causes of suicide among the elderly is depression, often undiagnosed and/or untreated.

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