Mental Health special section

Great-aunt Annie got her gun

Many elderly people are turning to suicide, and no,
it's not just another 'senior moment'

By Toss Taylor

Eileen McKenna broke her hip in early 2002 when she was 83-years-old. She could no longer walk or care for herself, and recovery was complicated by arthritis. She lived in small-town Nova Scotia, and her three children had left the province. But Eileen wasn't keen to move. The only option was to go to a local nursing home. Once there, Eileen's situation deteriorated. She was on a floor with demented and AD patients, many of them aggressive, which frightened her. She began staying in bed more and more. Soon she couldn't get up at all. One morning when the nurses came into her room they found Eileen dead. It was later discovered she'd saved up a month's worth of sleeping pills and downed them all in one go.

Suicide is always shocking, but somehow when elderly people take their lives it seems incomprehensible. A common perception is that many seniors naturally get down in the dumps as a result of losing a spouse, decreased mobility or other health problems, so depression and signs of suicidal tendencies are often overlooked as normal — another kind of 'senior moment.'

SHOCKING STATISTICS
However, recent studies and statistics tell us that the problem is real and needs to be addressed. Though seniors make up 12% of Canada's population, and 12% of suicides, a closer look at the numbers reveals some alarming trends. The suicide rate among men over 85 is 35 per 100,000, and 30 per 100,000 for men 80-84. The next highest rate is among the classically highest rated group, young men aged 20-24 (28 per 100,000). In Quebec alone, suicides among the elderly are up 85% in just two decades. Elderly suicide may also be under-reported by 40% or more. Usually omitted from statistics are 'silent suicides,' ie, deaths from medical non-compliance and overdoses, self-starvation or dehydration, and 'accidents.'

Early intervention is key to suicide prevention, but until recently elderly depression has been poorly understood. New research is at last ploughing that furrow. Perhaps not surprisingly, Scandinavians lead the field of suicide research. A Finnish study in the International Journal of Geriatric Psychiatry (IJGP) of suicides in nursing homes, found that only a third of the victims had been diagnosed with depression before their death. In the January IJGP, the same researchers found that among elderly suicide attempters, only 4% were diagnosed with depression, even though all had been in regular contact with primary care in the 12 months before their attempt.

OFTEN UNDERDIAGNOSED
So why is depression so often undiagnosed in the elderly? The February issue of the American Journal of Geriatric Psychiatry (AJGP) ran a series of articles on suicide, depression, and frailty to find some answers. One study using data from the 15-year National Institute for Mental Health Collaborative Depression Study found that among those suffering from major depressive disorder, elderly people were quicker to relapse into depression after a bout was resolved.

Another study in AJGP looked at methods of elderly suicides, particularly the impact of gun availability. In a gun culture like the US firearms are the leading method of suicide, at 55.1% on average (it goes up to 67% for elderly suicides). But the problem in Canada is nearly as grim: among male suicides, 35.6% used a gun to do the job. The study concludes that though gun ownership was not per se a predictor for suicide in the elderly, having a gun in the home greatly increases the likelihood of a successful suicide attempt.

A University of Toronto study in the same issue looked at elderly Holocaust survivors and found that they are at a very high risk for suicide. The authors surmise that a long life of dealing with their experience leaves survivors worn out and more susceptible to suicidal thoughts. The authors did note the value of lending your ear, pointing out that those with a confidante were less likely to commit suicide.

All this bleak research is spurring healthcare providers to action. Alarmed by the high stats for elderly suicide in Quebec, Montreal social services have begun a program to train letter carriers, pharmacists, bank tellers, and others to alert local CLSCs to any signs of depression or suicidal tendencies. One Montreal pharmacist has already had a chance to reach out a helping hand. "I had a lady who seemed very down in here to pick up a prescription," she says. "I decided to call the local clinic to let them know. The lady told me they've got her involved in a senior's day centre and she seems a lot more upbeat now."