Elder suicide: Are you aware of it?

If you ever want to bring a discussion of serious health issues to a screeching halt, simply utter two words: elder suicide. I repeatedly experienced this when talking with fellow students and mental-health professionals during my years in graduate school and while working as a counselor on hospital psychiatric units.

Although suicide-prevention programs have proliferated in recent years, almost all attention has been directed at teenagers. This national focus ignores a basic fact: Seniors have the highest suicide rate of all age groups. While people aged 65 and older comprise only 13 percent of the US population, they account for 19 percent of all suicides. The suicide rate in 1999 among 15- to 24-year-olds was 10.3 per 100,000, while among the aged it was 15.9 per 100,000 (almost 50 percent above the national average). This statistic translates into a total 6,000 elder suicides, and most experts believe the actual, unofficial number is considerably higher.

Why has this issue received so little publicity? I believe the answer lies in our youth-obsessed society's fear of aging. This contributes to ageism - a belief that the elderly are inferior, and people to be kept out of sight and mind.

As a result, the struggles of older people are given short shrift in American life.

There is also widespread belief that depression - considered the greatest risk factor for suicide - is a natural part of aging for which there is no remedy.

Certainly there are life circumstances that can hit the elderly especially hard, such as physical illness, loss of family and friends, and the need for care. But depression is not linked to aging itself, and most seriously depressed seniors respond well when their problem is acknowledged and treated.

Yet proper treatment occurs all too rarely. Most general physicians have little if any training in evaluating suicidal risk among the elderly.

This is significant because research indicates more than 70 percent of seniors who kill themselves see a physician within the preceding month, and most give verbal or behavioral clues as to their deadly intentions.

Physicians are not alone in this regard. For example, the vast majority of social workers, who provide half of all mental-health services in this country, have no specific geriatric training. It is predicted there will be an acute shortage of specially trained doctors, social workers, and other health professionals over the coming decades as the elderly grow to represent an unprecedented proportion of the US population.

Although many Americans view suicide as a taboo subject - particularly when not concerning teenagers - it will not magically disappear if ignored.

The number of older Americans is expected to double by 2030 - and unless the issue receives serious attention, suicides can reasonably be expected to increase accordingly. Here are some suggestions for change:

• Increase public-health efforts to raise awareness of elder suicide. This should include discussion of social, economic, health, and psychological risk factors that lead to suicide.

• Increase the number of health and mental-health professionals trained to work with seniors. This may require providing incentives such as scholarships and loan-forgiveness programs for those who choose a geriatric concentration.

• Combat the stigma many seniors associate with receiving mental-health treatment.

• Develop and fund community treatment programs for the elderly. Everyone should be entitled to accessible and affordable mental-health services.

• Most important, the ageism that permeates American culture must end. It is only when everyone is regarded and treated as unique and valuable that suicides will decrease. Regardless of age, people with purposeful lives, good self- esteem, and a supportive environment rarely choose to kill themselves.

Ezra Ochshorn is a social worker employed at the Florida Mental Health Institute in Tampa.

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