As We Age

Depression and Suicide Among Older Adults

The elderly are the fastest–growing segment of the population in the United States, and the number of elderly at–risk for depression underscores the importance of understanding the link between mental illness and suicide.

Although they make up only 13 percent of the population of the United States, those 65 and older account for approximately 18 percent of all deaths by suicide (about 6,000 suicides yearly). White men age 85 and older had 59 deaths per 100,000 in 2000, more than five times the national rate for that year (10.6 deaths per 100,000).

Suicide rates among black men reach a peak in young adulthood, decrease through middle age, and peak again late in life. The suicide rates for women rise until middle age, then flatten–out in later years.

Of the nearly 35 million Americans age 65 and older in 2000, about 2 million suffer from a depressive illness, and another 5 million have symptoms that fall just short of the criteria for a depressive disorder.

Mental and neurological illnesses, including depression and Alzheimer's disease, are more common in the elderly than for younger segments of society. A range of factors contributes to depression in the elderly. Many are dealing with physical and/or financial difficulties, and may find traveling difficult. This can lead to their becoming physically isolated from family and friends, which in turn can lead to feelings of despair and depression. This often combines with physical inactivity to bring about a decline in both physical and mental health.

Depression often occurs with other serious illnesses, such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. Because many older adults suffer from a variety of illnesses, they and their family, friends, and even primary care physicians mistakenly believe that depression is a just a normal part of the physical illness. But depression — in and of itself — is a separate and serious illness.

Suicide prevention requires the ability to identify key factors that place our loved ones at increased risk. The overwhelming majority of the elderly dealing with a serious physical illness aren’t suicidal, or course; but factors such as chronic pain, functional impairment, disfigurement, the person’s own perception of their condition or prognosis, and the presence of other stressful conditions and life situations must also be considered. Additionally, bereavement, losses (real or perceived), and personality traits that include hostility, neuroticism, and a low capacity for interpersonal relations, have all been associated with late–life suicide.

But no other factor places an older person at increased risk for suicide as much as psychiatric illness. In fact, various studies in the United States and Europe have shown that up to 91 percent of elderly suicide victims had one or more diagnosable psychiatric disorders, with clinical depression appearing in as many as 87 percent of the cases.

Older people are far less likely to seek treatment for mental health issues than are younger people, even though they are the heaviest users of health care services overall. But even when elderly people visit a primary care physician — where the overwhelming majority of depressive–related illnesses first present themselves — the very real danger exists that depressive symptoms might be overlooked or mistaken for something else. In fact, studies have shown that about 70 percent of elderly suicide victims had seen a primary care physician in the last month of life, and about 40 percent had seen one in the week prior to taking their own life. The need to recognize the signs of depression is clear. To improve the chances of early diagnosis, effective treatment, and prevention, be aware of these signs:

Symptoms of Depression

• Persistent sad, anxious, or empty moods
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies or activities that were once enjoyed
• Decreased energy, fatigue
• Difficulty concentrating, remembering, or making decisions
• Difficulty going to sleep, early-morning awakening, or oversleeping
• Unexplained loss of appetite or change in body weight
• Thoughts of death or suicide, or suicide attempts
• Restlessness or irritability

Anyone suffering from at least five of these symptoms every day for longer than two weeks meets the definition of being depressed.Further assessment, diagnosis, and treatment by a behavioral health professional are the necessary next steps.

If five or more of these symptoms are present every day for at least two weeks, you or your loved one may be suffering from depression. The diagnosis of a behavioral health professional is crucial in the proper treatment of depression, and in minimizing its impact or its chances for return.

Although suicide remains a rare occurrence, when it does happen it devastates a family like few other events. If you believe that one of your elderly loved ones may be suffering from depression, contact your EAP. A clinical professional will listen to your concerns in complete confidentiality, 24–hours a day, 7–days a week. You’ll be given the guidance, resources, and assistance you need to handle your situation in an effective and appropriate way.