by Marcie Cooper, MSW, LCSW, C-ASWCM, SeniorBridge Professional Development Specialist

A Preventable Tragedy Every 90 minutes, someone aged 65 or older in the United States commits suicide. What makes this statement even more tragic is the fact that suicide is largely recognizable and preventable.

Surprisingly, most elderly people who commit suicide have seen a primary care provider within the past month. Too often, however, their depression was unrecognized or untreated.

There is little evidence to suggest that physical illness without depression is a risk factor for suicide. The self-destructive acts of the elderly are most often the result of multiple factors (biological, medical, social and psychological) that are present simultaneously and interact to create the ultimate feelings of hopelessness and unbearable psychological pain.

The strong evidence of undetected and untreated depression in older adults who commit suicide underscores the importance of careful interviews when older people present for geriatric assessment. And it brings to light the often overlooked need for consultation with mental health professionals such as psychotherapists.

For many older adults, after an initial assessment by a care manager, an evaluation by a licensed psychotherapist provides an opportunity for early detection and treatment of psychiatric disorders. A psychotherapist can assess individual risk as well as the need for medication or certain psychiatric and/or psychotherapy treatments. A psychotherapist can also determine if close supervision or a protective environment is needed.

Since the mental health care system for older people is often the primary care physician, physicians must be educated in recognizing and treating depression as well as referring elderly patients to appropriate mental health professionals. Watching for the warning signs of depression, offering help, expressing deep concern and, when legally and ethically appropriate, breaking confidentiality, are critical steps in helping to reduce the incidence of suicide among the elderly.

Warning Signs

• Expression of suicidal intent
• Loss of interest in things or activities that were formerly enjoyable
• Cutting back on social interaction, self-care and grooming
• Breaking medical regimens (diet and/or medication)
• The loss or expected loss of a loved one
• Feelings of hopelessness or worthlessness
• Putting affairs in order, giving things away or making changes in wills
• Stockpiling medication
• Changes in sleep or eating habits
• Verbal clues, such as “I’m tired of living” or “I won’t be around much longer”
• Making funeral arrangements