Elderly Suicide Is an Actual Problem - Research Paper Example

Elderly suicide is a problem that has not been as extensively studied as other mental health issues have. However, there are a few factors that recur in many studies. The main one is that, no surprise, many of the elderly who commit suicide had been suffering from depression. Another risk factor is the presence of a physical illness. Educational attainment and intelligence also have a correlation between suicide, according to one study. Elderly suicide is an issue that cuts across population, cultural and gender lines. Therefore, the most prudent measure would be to develop an appropriate intervention program that not only screens the elderly population for depression and other suicide risk factors, but educates, informs, supports, and helps the elderly know that their thoughts are not taboo, but need to be talked about. Although elderly suicide has not been extensively studied, Cattell and Jolley (1995) conducted a study on 100 suicide deaths in the city of Manchester on individuals over the age of 65. They found out that marriage was a protective factor for men, as the suicide rates for elderly men were higher in widowed and single men than married men. For females, there was no such protective factor (Cattell & Jolley, 1995, p. 453). 89% of those studied were British nationality, compared to three Polish, two Chinese and two Indian nationals. They found that there was “no significant increase among any of the ethnic minorities...when compared with the ethnic origin of the elderly population” (Cattell & Jolley, 1995, p. 453). 89 of the 100 suicides occurred at home, while two occurred in hospitals and none in psychiatric hospitals. 49% of the individuals were living alone at the time of their suicide, but this is no statistically significant, as 50% of all pensionable aged persons were living alone at this time (Cattell & Jolley, 1995, p. 453). They also found that 44% of the older adults committed suicide by taking a drug overdose, 24% hanged themselves, 12% asphyxiated themselves, 6% drowned themselves, 1% killed themselves with motor vehicle exhaust and 5% used other methods. The men used more violent methods then women, as 41% of the men hanged themselves, compared to only 7% of women. For drug overdoses, it was just the opposite – 67% of women died by drug overdose, compared to just 18% of men (Cattell & Jolley, 1995, p. 453). As a further examination of the characteristics of the elderly who commit suicide, Shab & Chatterjee (2008) conducted a study that investigated the link between educational attainment and elderly suicide. Noting that previous literature on the topic of the relationship between intelligence and suicide rates is inconclusive – there is a relationship between suicide rates and lower levels of intelligence in individual level studies, yet there is no relationship between intelligence and suicide rates in aggregate level studies – their study sought to produce a link, or lack thereof, between educational attainment and suicide rates (Shab & Chatterjee, 2008, pp. 795-796). The hypothesis is that lower intelligence and lower educational attainment might predispose somebody to suicide, due to the reduced ability to compete for jobs, which results in lower income and status; and that attaining less education might be a sign of other problems, such as neurodevelopmental problems, poor problem solving abilities and anti-social behaviour development (Shab & Chatterjee, 2008, p. 796). Another hypothesis is that individuals who are highly intelligent, yet undereducated, might also be predisposed to suicide, due to the fact that their lack of education might result from mental illness, and if there is a mismatch between their level of education and benefits such as jobs, social status, and better housing (Shab & Chatterjee, 2008, p. 796). Their study confirmed these hypotheses. There are a number of theories for why the elderly commit suicide. Waern et al. (2002) and Tadros & Salib (2006) both examined the role that physical illness played in elderly suicide. Waern et al. stated that, as a hypothesis for his study, elderly people who commit suicide late in life mostly suffered from depression, while the role of physical illness was less clear. According to Waern et al., the incident of physical illness was present in anywhere from 35% to 94% of elderly suicides, and that serious physical illness was present, according to one study examined by them, in 56% of all elderly suicides. The control group, by contrast, showed that serious physical illness played a part in just 16% of that populations suicides (Waern, 2002, p. 1). With these bases, Waern et al. examined the association between illness and elderly suicide. Their hypothesis was that those with serious physical illness would be more likely to commit suicide than their control group, which consisted of individuals in the general elderly population who do not have serious physical illnesses (Waern, 2002, p. 1). In their study, the looked at reports of 100 cases of elderly suicide in Scandinavia people aged 65 or more who underwent necropsy at the Gothenberg Institute of Forensic Medicine. They then located and interviewed these individuals next of kin. Their control group consisted of individuals who had the same sex and birth year as each of the 100 participants who were studied. 240 were invited to participate, 155 actually did. These control individuals were then given interviews that covered a range of topics, including “questions about social situation, life events, past and current mental and physical health, and use of alcohol and illegal and prescription drugs” (Waern, 2002, p. 2). They then rated the physical illnesses and disabilities on a scale of 1-4, with level three being constant or severe disability or chronic problems that were uncontrollable and level four being extremely severe disability or illness. They found that the risk factors for suicide included such disabilities and diseases as neurological disorders, impaired vision, stroke, and malignant disease. Serious disability or illness in any organ was another risk factor (Waern, 2002, p. 2). They also found that men were more likely to commit suicide then women if there was a physical or disability present, finding that physical illness was responsible for fourfold increase in the suicide rate. No such correlation was found in women (Waern, 2002, p. 2). They further found a strong correlation between mental illness and suicide, finding that 89% of the people who committed suicide had a serious mental illness, compared to 10% of the control group. Specifically, mood disorders were highly prevalent in those who committed suicide (Waern, 2002, p. 3). Tadros & Salib (2006) also conducted a study regarding physical illness and the risk of suicide. They extracted data from coroners inquest records in Birmingham and Solihull from the dates of January 1995 to December 1999. They found that 27.3% of the suicides had physical morbidity, finding that the prevalence was more for females (34..4%) then males (24.7%). They studied younger people, as well, excluding those under 18, and they found that, of the older individuals who committed suicide, that 59.6% of them had a physical morbidity, compared to 19.3% of younger adults between the ages of 18-24 (Tadros & Salib, 2006, pp. 751-752). The females (31.3%) were more likely than the males (20.9%) to have visited their general practitioner within the last six months of life. Of these, 82.2% of older adults visit to their general practitioner took place within the last month of life, compared to 76.9% of younger adults, and that 92% of older adults and 94% of younger adults general practitioner consultations took place within the last three months of life (Tadros & Salib, 2006, p. 752). They further found that older adults, as a whole, were three times as likely than younger adults to have seen their GP within the last six months of life. The most frequent complaint to the GP was depression for both males and females, followed by pain for both. Older adults also complained of falls, and anxiety and insomnia were more common complaints with older adults than younger adults (Tadros & Salib, 2006, pp. 752-753). They also found that only 4.5% of all the studied suicide victims actually expressed suicidal ideation to the GPs, which led the researchers to state that GPs need to ask their patients if they have suicidal ideation if they present with depression. (Tadros & Salib, 2006, p. 755). Tadros & Salib also state that it is important to identify depression and suicide ideation in older adults, as they do not express themselves, thus making it harder to detect severe depression and suicidal thoughts in this group (Tadros & Salib, 2006, p. 755). Cattell & Jolley also found a high incidence of physical health problems in suicide victims. They found that 65% of their examined victims had physical ailments at the time of death. None of the victims had a terminal malignancy, although one had lung cancer but appeared not to be aware of this fact. 8% had severe cardiovascular disease and 4% were bedbound. 23% had been in the hospital within the preceding 12 months with a physical disorder, and 27% had complained of pain, with 16% complaining of severe pain (Cattell & Jolley, 1995, pp. 453-454). 61% were diagnosed with depression before they died, while one has a diagnosis of paranoid schizophrenia, one had dementia, and three were alcoholics (Cattell & Jolley, 1995, p. 454). 54% were on psychotropic drugs. Also, like Tadros & Salib, they found a high correlation between contact with medical services, with 19% of the victims having seen a GP in the week before they died, 43% within the month before they died, and 58% in the six months before they died (Cattell & Jolley, 1995, p. 454). As for psychiatric services, 14% had contact with psychiatric services in the month before they died, and 20% had contact with psychiatric services in the six months before they died (Cattell & Jolley, 1995, p. 454). Because depression has such a high correlation with suicide, there are a number of programs that can prevent elderly suicide. Oyama et al. (2004) propose an intervention program that includes depression screening at an early stage, one on one education against depression, and an enhancement of suicides taboo (Oyama et al., 2004, p. 251). Similarly, Fujisawa et al. (2005) propose a method of depression screening that would be helpful to identify the elderly who are at risk (Fujisawa et al., 2005, pp. 635-637). Fujisawa et al. (2005) proposed a screening method that consisted of administering two self-report questionnaires that include the self-rating depression scale (SDS) and the hospital anxiety and depression scale (HADS). They found that the HADS failed to discriminate the suicidal group from the non-suicidal group, therefore only the SDS was used. They then took the results from the SDS, and decided which items actually helped differentiate suicidal individuals from non-suicidal individuals and created the Depression and Suicide Screen (DSS). The questions were whether the participants found their life to be full; whether they still enjoyed the activities they used to enjoy; whether they think that it is too much trouble to do the things they used to do; whether they felt that they were useful people who is needed by others; and whether they felt tired for no specific reason (Fujisawa et al., 2005, p. 636). The advantages of this screening method is that it contains only five items, all yes or no questions, therefore it can be administered without assistance or with minimal assistance; and it was acceptable to the elderly community, as the wording is modified and questions about death are omitted, so it is more easily accepted by the general population, therefore reaching even those elderly who might not be aware that they are depressed, as well as reaching the elderly who would be offended by questions regarding their moods and thoughts (Fujisawa et al., 2005, p. 637). Oyama et al. (2004) compared implementation data to pre-implementation data. Their pre-implementation data was established by collecting data regarding suicide notices by age and gender (Oyama et al. 2004, p. 254). The results of their study showed that the implementation of the intervention program resulted in a 73% reduced risk of suicide among males aged 65 and over, and a 76% reduced risk of suicide among females of the same age. In their control areas, there was not a significant change in the suicide rates (Oyama et al. 2004, pp. 257-258). They also found that such intervention as telephone talking, health education, and consulting helped females more than males, while males benefited more from such intervention strategies as depression screening and psychiatric treatment for depression. They further found that the number of elderly with suicidal thoughts and subclinical depression who consult family members, professionals or others is low. Therefore, their proactive method of screening, follow-up, education, advice and taboo enhancement helps the elderly seek help amongst their loved ones and professionals, and give a more supportive atmosphere (Oyama et al., 2004, pp. 261-262). Additionally, this intervention program could also reduce the risk of suicide among the non-depressed elderly who might be maladjusted and suffering from social withdrawal (Oyama et al., 2004, p. 262). Therefore, the two above studies provide a way that social workers can help prevent elderly suicide. The Fujisawa study demonstrates an appropriate screening method that help social workers identify and target the at-risk population, by determining who is depressed. The Oyama study shows how proper intervention can in turn help the population that has been identified by the Fujisawa study. Since the Fujisawa study shows that a simple screening method, one that can be self-administered or administered with minimal supervision, is a good screening method, then social workers do not have to be trained to administer this study. It is therefore a good technique to use for all social workers, even those with minimal psychiatric background. The intervention techniques are also simple, but social workers probably need to properly trained to administer them. Therefore, proper training in this regard will be key. Conclusion Elderly suicide is an issue that has many causes. However, as one major cause that is seen in the vast majority of cases is elderly depression, the screening technique proposed by Fujisawa, combined with the Oyama intervention techniques, should provide a good prevention strategy that can be used by all social workers with a minimal amount of training. Sources Used Cattell, H. & Jolley, D. (1995). One hundred cases of suicide in elderly people. British Journal of Psychiatry, 166, 451-457. Fujisawa, D., Tanaka, E., Sakamoto, S., Neictti, K., Nakagawa, A., & Ono, Y. (2005). The development of a brief screening instrument for depression and suicidal ideation for elderly: the Depression and Suicide Screen. Psychiatry and Clinical Neurosciences, 59, 634-648. Hirofumi, O., Koida, J., Sakashita, T. & Kudo, K. (2004). Community-based prevention for suicide in elderly by depression screening and follow-up. Community Mental Health Journal, 40(3), 249- 263. Rahme, E., Dasgupta, K., Turecki, G., Nedjar, H., & Galbaud du Fort, G. (2008). Risks of suicide and poisoning among elderly patients prescribed selective serotonin reuptake inhibitors: A retrospective cohort study. Journal of Clinical Psychiatry, 69(3), 349-357. Shab, A. & Chatterje, S. (2008). Is there a relationship between elderly suicide rates and educational attainment? A cross-national study. Aging & Mental Health, 12(6), 795-799. Tadros, G. & Salib, E. (2007). Elderly suicide in primary care. International Journal of Geriatric Psychiatry, 22, 750-756. Waern, M., Rubenowitz, E., Runeson, B., Skoog, I., Wilhelmson, K. & Allebeck, P. (2002). Burden of illness and suicide in elderly people: case-control study. British Medical Journal, 324, 1-4. Read More