If you were to guess which age group has the highest rate of suicide, which age group would you pick? You might be inclined to guess that teenagers and young adults have the highest rates of suicide. However, this is not the case. In actuality, older adults have the highest rates of suicide of any age group. According to Mental Health America, in 2013, the highest rate of suicide (19.1 percent) occurred in people aged 45 to 64. The second highest rate (18.6 percent) occurred in people ages 85 or higher. The CDC estimates that 10,189 Americans aged 60 or older died by suicide in 2013 (Mental Health America).
According to the World Health Organization, suicide rates rise as a function of age for older men and women. Studies estimate that as many as 200 young adults attempt suicide for each young adult who dies by suicide, according to the NIH. Among older adults, suicide attempts are far less common, yielding a ratio of about four attempts per completed suicide, according to the National Institutes for Health. However, older adults are much more likely to die from a suicide attempt because they are often more isolated, and therefore less likely to be found or rescued (NIH). They are also more likely to have a suicide plan and to be more determined to die by suicide than young adults (Mental Health America).
Risk Factors and Warning Signs for Suicide in Older Adults
Depression is a major risk factor for suicide in older adults. According to the NIH, mental illnesses are present in 71 to 97 percent of suicides, with affective disorders, particularly major depression, being most commonly present. Other illnesses commonly present in older adults who have died by suicide include schizophrenia, schizoaffective disorder, delusion disorder and anxiety disorders.
Physical health and functional impairments also contribute to risk for suicide in later life, but because the presence of these issues is so high in older people, it is very difficult to identify those who warrant intervention (NIH). A Canadian study found that people with “three physical illnesses had approximately a threefold increase in estimated relative risk for suicide compared with subjects who had no diagnosis, whereas older adults who had seven or more illnesses had approximately nine times greater risk for suicide (NIH).”
A lack of social interaction is another significant risk factor for suicide in older adults, according to the NIH. Older people tend to lose loved ones and those within their support system and peer group more than younger people, significantly affecting older adults’ happiness and abilities to adjust and cope. It was found that there was a 50 percent increased likelihood of survival for participants with stronger social relationships. Those who die by suicide tended to not have a confidante, were more likely to live alone and were less likely to have a hobby or be active in an organization or community activities. According to the NIH, “The influence of a social connectedness on risk for death is comparable to or greater than that associated with well-established risk factors such as smoking, obesity, and physical inactivity.”
Other risk factors for suicide, according to the NIH and Mental Health America include:
- Financial problems
- Employment changes
- Rupture of relationships with family members and other sources of support
- Feelings of loss of independence or sense of purpose
- Impulsivity due to cognitive impairment
- Recent death of a loved one
- Alcohol or medication misuse
- Prior suicide attempts
Identifying Suicidality and Preventing Suicide in Older Adults
Since depression is a major risk factor for suicide, it is important to be able to recognize how symptoms of depression manifest in older adults. According to Beyond Blue, some of these symptoms include:
- General slowing down or restlessness
- Neglect of responsibilities and self-care
- Withdrawing from family and friends
- Decline in day-to-day ability to function
- Confusion, worry or agitation
- Inability to find pleasure in any activity
- Behaving out of character
- Denial of depressive feelings as a defense mechanism
- Feeling tired all the time
- Loss of appetite
- A significant weight change
According to the NIH people are spiritual or religious are more protected from suicide than people who aren’t, as these people may find support in a religious community or in their religion or spirituality as a whole. Someone struggling with depression should be urged to seek comfort in spirituality and/or religion, especially if that is already something familiar to them. Religious institutions should also bring light to this issue in order to destigmatize it and its treatment.
One precaution older people can take is asking their doctors whether their medication may cause depression, and be mindful of this possibility and how their feelings may or may not change with use. As older people are unlikely to bring up depression or mental health issues at their doctor, social service providers such as nurses, visiting aides or social workers who may interact with older adults should be trained to identify at-risk people and refer them to an agency to help (NIH).
Identifying at-risk older people can be difficult, but it is certainly not impossible if one watches for the signs. There is help available for both those at-risk older adults and those trying to keep their older friends and family members safe.
According to Mental Health America, if anyone you know has a suicide plan with intent to act, you should not leave them alone. Stay with that person until emergency services have intervened.
If you or someone you know is having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.