Senior Suicide Rate Alarms Doctors

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Dr. Allan Anderson remembers with frustration how the retired professional who was losing his eyesight calmly explained he would kill himself once he became blind.

He didn't wait that long.

Senior citizens commit suicide at higher rates than any other age group, and with graying Baby Boomers - already more prone to suicide than other generations - entering the riskiest years, psychiatrists fear that could soon worsen.

Now researchers are uncovering factors - such as lack of social support, poor sleep patterns, and memory or other brain problems that sometimes hit seniors - that could help primary care physicians spot elderly patients at risk of suicide and intervene.

It's hard: Many of today's seniors are the generation of the stiff upper lip when it comes to mental health. Ask how they're feeling and you may hear a litany about aching joints, but they're far less likely than younger people to admit to depression, said Anderson, a geriatric psychiatrist in Cambridge, Md.

That leaves doctors and loved ones to notice subtle clues like a senior not discussing a much-beloved hobby anymore - or to struggle to help the elderly surmount a daunting physical loss, like Anderson's patient who had no family to lean on when his vision faded.

Most are not terminally ill, and thus these are largely preventable deaths, insists Dr. Yeates Conwell, a University of Rochester specialist in elderly suicide.

"We tend to seek the simple solution: Mr. Smith killed himself because his wife died or Mrs. Jones killed herself because she was diagnosed with cancer," but that's seldom the real reason, he said. "We have to go beyond simple explanations and start looking ... at the tapestry of older people's lives."

Americans 65 and older account for about 13 percent of the population but almost a fifth of all suicides. The national rate is 11 suicides for every 100,000 people, about the same for teens. But the risk steadily rises with age - and most at risk are older white men: 33 of every 100,000 of them commit suicide every year, translating to 4,655 suicides in 1998 alone.

Contrast that with older black women: In 1998, fewer than 20 killed themselves, yielding a suicide rate too small to reliably compute, University of Pennsylvania researchers report in this month's American Journal of Geriatric Psychiatry.

What explains those dramatic differences - and could psychiatrists harness whatever protected the black women into some sort of therapy for other seniors at risk?

Scientists don't yet know for sure. But new research reported in the geriatric psychiatry journal shows while depression is a clear risk at any age, there are some special senior warning signs. No specific illness was associated with suicide, but perceived poor health is - as is poor sleep quality and having fewer friends or relatives to confide in.

Memory or other brain problems may play a role, too.

In contrast, strong ties to social and religious support networks may be the key protection for older black women.

Whatever the cause, senior suicide attempts are strikingly lethal. Four elders attempt suicide for each who succeeds. That compares with 200 attempts per completed suicide among young adults, who may have planned the attempt less carefully or may have more family or friends around to find and revive them.

Worsening the problem is the myth that it's normal to feel sad or depressed when you get old. Too often, Conwell laments, even doctors believe that myth and don't diagnose treatable depressive illnesses.

"Your doctor can only treat you if you say how you're really feeling," advises the National Institute of Mental Health, which urges seniors to seek help for symptoms including:

  • Feeling nervous, "empty," worthless, tired, restless or irritable.
  • Not enjoying things like they used to, or feeling no one loves them or that life isn't worth living.
  • Eating or sleeping more or less than normal.
  • Having persistent headaches, stomach aches or chronic pain.

    Most seniors who commit suicide had seen a primary care physician in the previous month, and psychiatrists urge those doctors to look for clues. Ask "What thoughts have you had about suicide?" instead of the easier-to-evade "Are you depressed?" advises Anderson - and consult a mental health specialist immediately about any patient deemed at risk.

    By Lauren Neergaard