Suicide and depression are serious problems among the elderly, and there is some concern that increasing worries about Medicare and Medicaid cuts, Social Security reductions, a poor economy, loss of retirement funds, and medical issues will contribute to a rise in the numbers of both areas.
Although people 65 years and older comprise just over 12 percent of the US population, they account for a disproportionate percentage of suicides. According to the National Institute of Mental Health, of every 100,000 people ages 65 and older, 14.2 died by suicide in 2006 (the latest available figures). This is higher than the national average of 10.9 suicides per 100,000 in the general population. The rate is highest among non-Hispanic white men age 85 and older, with 48 suicide deaths per 100,000.
Depression among the elderly increases as other illnesses develop and have an impact on people’s ability to function. Estimates of major depression in older adults living in the general community ranges from about 1 to 5 percent, but this number rises to 13.5 percent among those who need home healthcare and about 11.5 percent in hospitalized elderly patients.
Although prescription medications can be helpful in relieving depressive symptoms and thus also reduce the risk of suicide among the elderly, depression is often not recognized or diagnosed in older adults, which means it remains untreated. For many elderly individuals, depression is a sign of weakness or failure, so they do not talk about it or try to hide how they feel. Even if they are diagnosed with depression, some refuse to take the medication and/or seek therapy, which has proved helpful in the elderly population. The National Institute of Mental Health offers information about depression and suicide for elderly individuals, “Older Adults: Depression and Suicide Facts.”
In a ten-year retrospective study, researchers evaluated the effectiveness of antidepressant use among elderly depressed patients. They found that use of selective serotonin reuptake inhibitors (SSRIs) among elderly depressed adults may reduce the risk of attempting suicide.
Use of some prescription medications may actually increase the risk of suicide in older people. A study published in BMC Geriatrics notes that sedative treatment was associated with an almost 14-fold increase of suicide risk among the elderly, while use of hypnotics was associated with a four-fold increased risk.
In a timely study published in the September 2009 issue of International Psychogeriatrics, the researchers asked “why suicide?” and analyzed 23 suicides among people 65 years and older. Their results lead them to argue that the suicides “should be considered as existential choices.” They noted that “the sum total of the different forms of strain had made life a burden they could no longer bear,” and that for these individuals “age meant that they were in a phase of life that entailed closeness to death, which they could also see as a relief.” Many will of course disagree with this conclusion.
The point, however, is that depression and suicide among the elderly are realities that are a growing concern and need to be recognized and discussed with the affected individuals and healthcare professionals. If you know of an elderly individual who is showing signs of depression and/or who has talked about suicide, he or she should see a healthcare professional as soon as possible. Psychotherapy, medications, and various support organizations and groups, including area councils on aging, can offer referrals and assistance.
Barak Y. Neuropsychopharmacology 2006 Jan; 31(1): 1878-81
Carlsten A, Warrn M. BMC Geriatrics 2009 Jun 4; 9:20.
Kjolseth I et al. International Psychogeriatrics 2009 Sept. 14: 1-10
National Institute of Mental Health
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