CHAPTER 18

LECTURE EXTENSION

More on Elder Suicide

Approximately 43,000 (20 percent) of the 216,631 suicides that occurred in the United States from 1990 through 1996 involved adults 65 years or older. The annual number of suicides among adults in this age group decreased 8.4 percent, from 6,394 in 1990 to 5,855 in 1996. Men accounted for 82 percent of these suicides.

For the period 1990 through 1996, the rate of suicide among adults aged 65 to 74 years was greater than the rate for those aged 75 to 84 years; however, the rate remained unchanged between the 75- to 84-year-old group and the 85-year and older age group. Suicide rates among men in the 85 years and older group were higher (65 per 100,000 persons) than rates among those aged 65 to 74 years and 75 to 84 years. Among women, suicide rates were lowest among those 85 years and older, but the difference in rates between age groups was not significant. Men had a higher overall suicide rate (38 per 100,000 persons) than women (5.7 per 100,000 persons).

Suicide rates among adults 65 years and older also varied by race and ethnicity. Rates increased steadily for persons of Hispanic ethnicity for each 10-year age interval; however, the difference between the 75- to 84-year-old group and the 85-year and older group was not significant. For black persons not of Hispanic ethnicity, the rate was similar in each 10-year age group. For white persons not of Hispanic ethnicity, the rate for those aged 65 to 74 years was lower than rates for the other age groups.

Some risk factors and protective factors for suicide are similar for older and younger adults; however, the importance of these factors might differ by age group (for example, the intensity of depressive symptoms, use of highly lethal methods, and social isolation). Participation in religious services has been identified as a protective factor against suicidal behavior. Religious participation and its associated belief system might exert a differing influence among older and younger adults. In addition, older adults make fewer attempts per completed suicide, are more often male, have more often visited a health care provider shortly before their death, and have more physical illnesses and affective disorders than younger persons.

The declining suicide rate among adults 65 years and older could be related to changes in the effect or type of risk factors traditionally occurring among older adults (for example, depression, social isolation, and chronic illness). Perhaps the importance of these factors has changed, or the prevalence of protective factors has increased.

Because older adults have the highest suicide rates, prevention research should focus on factors associated with suicide among older adults. For example, prevention strategies could be tailored to specific age, sex, and ethnic groups. The role of protective factors in preventing suicide among older adults should also be more closely explored and integrated into prevention strategies. Recent cohort studies indicate that suicide rates are higher among younger adults today than they were when their grandparents were young adults. As these younger adults age, their suicide rates might increase above current rates among older adults. However, in some birth cohorts, suicide rates might be higher because of the relative size of the group (that is, larger cohorts might face increased stressors because of greater competition for resources and a disparity between their expectations and the means to satisfy those expectations).

These findings underscore the need for suicide prevention activities directed at older adults. Strategies for reducing suicide among older adults include training primary-care providers to better recognize suicidal risk factors, including depressive disorders, and to make appropriate referrals. These strategies have been effective in reducing suicide risk among older adults. Community-based interventions to identify and treat persons at risk also have been shown to be effective. Other prevention strategies include senior peer-counseling programs; suicide prevention efforts that target persons at high risk; improvements in mental health services through suicide prevention centers; and programs that increase awareness of risk factors and protective factors among persons who have frequent contact with older adults.

Centers for Disease Control and Prevention. (1999). Surveillance for injuries and violence among older adults. Morbidity and Mortality Weekly Reports Surveillance Summaries, 48, 27-50.

LEARNING ACTIVITY

Visiting a Homeless Shelter or Soup Kitchen

Adults aged 50 and over make up about 20 percent of the American homeless population. As post-war baby boomers reach age 50, the number of older adults who are homeless is likely to increase dramatically (Cohen et al., 1997). Students can construct a personal meaning of homelessness among older adults by assisting at a homeless shelter or at a "soup kitchen." Many campuses have community service offices or volunteer organizations that can help instructors make initial contacts with shelters and soup kitchens.

Serving a meal to older adults who are homeless or assisting staff with duties at a homeless shelter can provide a naturalistic opportunity for students to observe and interact with older adults who are homeless. Students will gain greater insight if they make more than one visit to the shelter or soup kitchen. Discuss the students' observations and interactions in class.

Cohen, C. I., Ramirez, M., Terese, J., Gallagher, M., & Sokolovsky, J. (1997). Predictors of Becoming Redomiciled Among Older Homeless Women. The Gerontologist, 37, 67-74.