While we do not commonly associate suicide with aging, it is a substantail mortality risk factor. Suicide is one of the top 10 causes of death in seniors. It most often effects those over 85 yeras of age, blue collar workers and those isolated in urban settings. One study said that 75% of victioms of suicide had seen a physician with in 1 month for a generic complaint. That means that as clinicians we are not asking the right questions.
The Amrerican Society of Geriatric Psychiatry recently noted that primary drivers of suicide in the elderly are physical disability, pain, sleep difficulties, social isolation and loneliness. Those most at risk were those with high functional disabilty, those who had experienced a stroke and those with physical pain. Most of the seniors that had suicidal feelings or thoughts did not fulfill criteria for major or minor depression. The fact that they had suicidal toughts or feelings was not related to any depressed mood so that screening, while important, does not identify the senior with suicidal thoughts or feelings.
The message for the healthcare provider and family is to ask the question. It is never easy to ask someone if they wish they were dead, if they feel hopeless and helpless, if they have thought about harming themselves or if they have made plans to do away with themselves. If we ask those questions, we have to be prepared to deal with the response that might not be positive.
Resolving the issue leading to the suicidal feelings may not be easy, but in most cases once the issue has been rasied a plan or solution can be executed. Psychothreapy can help address the feeling. Pain medication regmiens can be modified to be more effective. Social isolation can be modified with adutl day care, volunteer visits from churchs or friends or caregivers in the home. The solutions are all related to addressing the issue by first asking the question.