Suicide in Later-Life: Critical Review of Risk Factors - Case Study Example

Name: Course: Date: Title: Suicide in later life: Critical review of risk factors and effective prevention programs. Introduction Suicidal ideation can either be active thoughts of taking own life, or passive which means a feeling that it is not worth living, feeling hopeless, or even wishing for death. Older adults are more likely to express or describe having suicidal ideation as compared to younger adults (Vanderhorst, & McLaren, 2005). Late-life suicide has proved to be a persistent threat and a reality. According to Australian Bureau of Statistics (2000), suicide among older adults is a significant issue of mental health where there is a 50% greater chance for people aged 65 years and above to commit suicide than the population as a whole. According to Cattell (2000), in nearly all industrialised countries, there have been high rates of suicide especially for the people above 75 years. In many of the countries, the rates of suicide usually rise with age. This means that although the older adults usually represent a smaller percentage of the total population, suicide deaths above 65 years accounts for a bigger proportion as compared to the rest of population. Therefore, we must be ready to intervene in order to control these rates. Prevention programs have been implemented at individual, group, or population levels focusing on different stages in regard to targeted population. For instance, The Institute of Medicine (Mrazek&Haggerty, 1994) distinguished between indicated, selective and universal prevention. The design of effective programs for prevention of suicide is based on definition as well as quantification of risk factors in target population of older adults. This study is divided into two sections. First, it explores the risk factors that may influence the older adults to become suicidal. Second, based on the rising rates of suicide deaths, it reviews the effectiveness of programs for preventing suicide. Risk factors Risk factors that may influence older adults to become suicidal can be broadly classified into three areas. These are social variables, psychiatric and physical illnesses. Some of the social risk factors include social isolation or living alone, and marital status or bereavement. Conwell et al (2000) argue that lack of social support, social isolation, and loneliness are related to suicide risk and successful suicide. For an old adult, family discord other than financial problems can be predictive of a suicide. For instance, an older adult who may feel that a decision was made within a family without consultation or agreement may feel abandoned and becomes an older adult at risk. According to Cattell and Jolley (1995), 50% of elderly victims of suicide lived alone while only 20% older people living within the community were victims of suicide. Suicide in older adults is correlated highly with living alone as compared to other social variables. Thus, social isolation and loneliness are crucial contributors to suicide in older adults. In regard to marital status, Cattel (2000) argued that the risk of suicide for older adults is elevated during the first few years of widowhood. For instance, he found out that there were significant associations between suicide in the first four years of loss of a spouse and a history of substance abuse, early life loss, psychiatric treatment or separation. More importantly, he found out that bereavement increases the risk of committing suicide a condition that results to an increase in visits to physician. Thus, with regard to marital status, single, widowed or divorced, there is more risk of committing suicide especially to older adults. However, it is also important to understand the warning signs of suicide risks which are classified as behavioural, verbal, contextual, and symptom clusters. For instance, verbalisation may include expressions of despair, and wanting to end it all. Behavioural clues may include hoarding medication, diminished well-being, giving away possession and money among others. In addition, a person who was talkative at one time changes to be self-isolating or quiet is a sign that needs attention. As Vanderhorst and McLaren (2005) state, higher levels of depression and suicidal ideation are associated with fewer social support resources and enhancing social support resources will lead to reduction in suicidal ideation and depression. Risk factors associated with psychiatric illnesses include depression, vulnerability to personality traits, and previous suicidal attempt or self-harm. Vanderhorst and McLaren (2005) argue that depression is the key antecedent for ideation of suicide and suicide completion in regard to older adults. This means that it is very crucial to understand the predictors of suicidal ideation and depression in older adults as it leads to improved understanding of the risk of suicide in this age group. From the work done by Waern, Rubenowitz, and Wilhelmson (2003), it was found that major depression is nearly a half of the suicide victims aged between 65 and 74 years while their older counterparts constituted 42%. This constitutes depression as a very strong risk factor of suicide in older adults. More importantly, Holkup, Hsiao-Chen and Titler (2003) found that it is better to identify the symptoms related to the risk of suicide because many older adults never seek mental or psychological health services because they feel that it is a sign of stigma or weakness. As a result, depression is usually masked by somatisation which involves excessive expression of physical complaints. Others psychiatric illnesses that may present risk factors of becoming suicidal include vulnerability to personality traits, and previous suicidal attempt or self-harm. Self-harm is an important risk factor for suicide and this usually increases with age. In their research which focused on older adults aged 60 years and over, Murphy et al (2012), found out that for adults presented with self-harm, a significant percentage of them repeated self-harm within a year. In this case, the independent risk factors for repetition were age between 60 and 74, previous psychiatric treatment, and previous self-harm. They also observed that the risk of suicide was 67 times that of older adults in regard to general population. Men were even more affected as those aged 75 and above had the highest risk of the rates of suicide. Thus, it can be argued that in older adults, self-harm closely resembles suicide. Risk factors related to physical illnesses include pain due to terminal or medical illnesses, and disability or functional impairment. Harris and Barraclough (1994) argue that high levels of medical illnesses such as toxic effect of chronic substance abuse and terminal illnesses influence or lead to suicide. I most cases the older adults may prefer to pre-empt the inevitable outcome and the frightening course through suicide. In addition, disability associated with medical illnesses may easily lead to social withdrawal and hence influencing suicide. Conwell et al (2000) found out that suicide is associated with functional impairment where results showed significant relationship between suicide and functional limitations. Prevention programs In order to ensure better prevention of suicide in older adults which is evidenced by high rates, intervention is sorely required. Various interventions have been put in place to prevent suicide in various levels and include selective interventions, and combination of indicated, selective and universal intervention. Use of selective interventions has shown reduction in suicidal rates and such programs include the telephone counselling outreach programs which has been successful for older women. De Leo, DelloBuono, and Dwyer (2002), evaluated a telephone service which comprised of a twice-weekly telephone support check as well as a 24-Hour emergency service. Their results showed that there was a significant reduction in the rates of suicide. This was more effective in the psychosocial functioning of the elderly through reductions in the scores of depression, requests for GP to visit homes, and hospital admissions. Programs on telephone counselling are very crucial based on the capability to enhance social support through a regular and entrusting relationship. Heisel et al. (2009) acknowledged use of telecommunication strategies especially to those who find it inconvenient or intimidating to visit medical centres which presents warning signs of various risk factors such as depression. They add that the key components of telecommunications should be to expand education and support, as well as detecting and treating mental illnesses. Indicative prevention program has also led to reduction of the rates of suicides in a unique way as it is focused on strengthening protective factors with an aim of improving the resilience to suicide in older adults (Lapierre et al, 2011). This program focused on cognitive behavioural approach and it was applied to small groups of retirees who had challenges in adapting to retirement. The results showed significant reduction in levels of psychological stress and depression where the participants showed a significant improvement in goal realisation, hope, flexibility, serenity and attitude towards retirement. Combination of indicated, selective and universal program has proved to be efficient in reducing the rates of suicide. Oyama et al (2006) evaluated a community based approach program in Japan which targeted the entire population at indicative, selective and universal levels in an area with elevated rates of suicide. The programs involved mental health workshops provided by public health nurses to the elderly with an aim of understating depression and the risk of suicide. Among the activities was annual depression screening, following of results by general practitioner or psychiatrist, as well as follow up meetings with mental health nurse. Their results were efficient in reduction of rates of suicide especially on interventions focused on group activities and depression screening for females. It was also suggested that programs focused on educational activities for men with more emphasis that suicide is avoidable may reduce the risk in males. Conclusion The increasing rates of suicide in older adults are an issue that calls for more attention. More importantly, identification of risk factors that influence suicide in older adults as well as signs for these factors are essential in developing solutions to this problem. It is evident that through evaluation of programs for prevention of suicide in older adults, there is a reduction in levels of suicidal ideation as well as the rates of suicide. However, based on high rates of suicide, it is also clear that prevention of suicide in older adults is still a challenging task. This calls for more effort in making the programs efficient. More integrative strategies are required with a great need to educate the society and health professionals on late life suicide to increase participation. In addition, early detection and treatment of high-risk elderly adults are also crucial in prevention of suicide in older adults. References Australian Bureau of Statistics (2000). Australian social trends: Health-mortality and morbidity, (no. 3309.0). Canberra, Australia. Cattell, G., & Jolley, D.J. (1995). One hundred cases of suicide in elderly people. British Journal of Psychiatry, 166, 451–457. Cattell, H. (2000). Suicide in the elderly. Advances in Psychiatric Treatment, 6, 102–108 Conwell, Y., Lyness, J.M., Duberstein, P.R. (2000). Completed suicide among older patients in primary care practices: a controlled study. Journal of American Geriatrics, 48, 23–29 De Leo, D., Dello Buono, M., & Dwyer, J. (2002). Suicide among the elderly: The long-term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226–229. Harris, E.C., B.M., & Barraclough. (1994). Suicide as an outcome for medical disorders. Medicine, 73, 281–296. Heisel, M., Duberstein, P., Talbot, N., King, D., & Tu, X. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings. Professional Psychology: Research and Practice, 40, 156–164. Holkup P.A., Hsiao-Chen J, & Titler, M.G. (2003). Evidence-based protocol. Elderly suicide-secondary prevention. Journal of Gerontology Nursing, 6-17. Lapierre, S., Erlangsen, A., Waern, M., De Leo, D., Oyama, H., Scocco, P., & Quinnett, P. (2011). A systematic review of elderly suicide prevention programs. Crisis, 32(2), 88- 98. Mitty, E., & Flores, S. (2008). Suicide in Late Life. Geriatric Nursing, 29(3), 160-165 Murphy, E., Kapur, N., Webb, R., Purandare, N., Hawton, K., Bergen, H., ..., & Cooper, J.  (2012). Risk factors for repetition and suicide following self-harm in older adults: Multicentre cohort study. The British Journal of Psychiatry, 200, 399-404 Oyama, H., Ono, Y., Watanabe, N., Tanaka, E., Kudoh, S., Sakashita, T., . . ., & Yoshimura, K. (2006). Local community intervention through depression screening and group activity for elderly suicide prevention. Psychiatry and Clinical Neurosciences, 60, 110–114. Vanderhorst, R. K., & Mclaren, S. (2005). Social relationships as predictors of depression and suicidal ideation in older adults. Aging & Mental Health, 9(6): 517–525 Vanderhorst, R. K., & McLaren, S. (2005). Social relationships as predictors of depression and suicidal ideation in older adults. Aging and Mental Health, 9(6), 517-525. Waern, M., Rubenowitz, E., & Wilhelmson, K. (2003). Predictors of Suicide in the Old Elderly. Gerontology, 49, 328–334 Read More

In regard to marital status, Cattel (2000) argued that the risk of suicide for older adults is elevated during the first few years of widowhood. For instance, he found out that there were significant associations between suicide in the first four years of loss of a spouse and a history of substance abuse, early life loss, psychiatric treatment or separation. More importantly, he found out that bereavement increases the risk of committing suicide a condition that results to an increase in visits to physician.

Thus, with regard to marital status, single, widowed or divorced, there is more risk of committing suicide especially to older adults. However, it is also important to understand the warning signs of suicide risks which are classified as behavioural, verbal, contextual, and symptom clusters. For instance, verbalisation may include expressions of despair, and wanting to end it all. Behavioural clues may include hoarding medication, diminished well-being, giving away possession and money among others.

In addition, a person who was talkative at one time changes to be self-isolating or quiet is a sign that needs attention. As Vanderhorst and McLaren (2005) state, higher levels of depression and suicidal ideation are associated with fewer social support resources and enhancing social support resources will lead to reduction in suicidal ideation and depression. Risk factors associated with psychiatric illnesses include depression, vulnerability to personality traits, and previous suicidal attempt or self-harm.

Vanderhorst and McLaren (2005) argue that depression is the key antecedent for ideation of suicide and suicide completion in regard to older adults. This means that it is very crucial to understand the predictors of suicidal ideation and depression in older adults as it leads to improved understanding of the risk of suicide in this age group. From the work done by Waern, Rubenowitz, and Wilhelmson (2003), it was found that major depression is nearly a half of the suicide victims aged between 65 and 74 years while their older counterparts constituted 42%.

This constitutes depression as a very strong risk factor of suicide in older adults. More importantly, Holkup, Hsiao-Chen and Titler (2003) found that it is better to identify the symptoms related to the risk of suicide because many older adults never seek mental or psychological health services because they feel that it is a sign of stigma or weakness. As a result, depression is usually masked by somatisation which involves excessive expression of physical complaints. Others psychiatric illnesses that may present risk factors of becoming suicidal include vulnerability to personality traits, and previous suicidal attempt or self-harm.

Self-harm is an important risk factor for suicide and this usually increases with age. In their research which focused on older adults aged 60 years and over, Murphy et al (2012), found out that for adults presented with self-harm, a significant percentage of them repeated self-harm within a year. In this case, the independent risk factors for repetition were age between 60 and 74, previous psychiatric treatment, and previous self-harm. They also observed that the risk of suicide was 67 times that of older adults in regard to general population.

Men were even more affected as those aged 75 and above had the highest risk of the rates of suicide. Thus, it can be argued that in older adults, self-harm closely resembles suicide. Risk factors related to physical illnesses include pain due to terminal or medical illnesses, and disability or functional impairment. Harris and Barraclough (1994) argue that high levels of medical illnesses such as toxic effect of chronic substance abuse and terminal illnesses influence or lead to suicide. I most cases the older adults may prefer to pre-empt the inevitable outcome and the frightening course through suicide.

In addition, disability associated with medical illnesses may easily lead to social withdrawal and hence influencing suicide.

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