Being aware of Depression and Suicide during the holiday season

During the upcoming holiday time, we not only experience the joy of the season with our residents, but unfortunately it is also a time many of our residents experience depression and may even verbalize a desire to end their life. Suicide among elderly adults is a growing and serious concern. The highest rate of suicide in the U.S. is among older white men. Firearms were the most common means followed by hanging, strangulation or suffocation, poisoning and jumping from a high place. A general understanding of suicide in late life is often oversimplified to a single cause; the reality is a complex, interdependent network of numerous diverse circumstances including co-morbid medical conditions. This makes suicide risk identification difficult.

Depression is the single most significant risk factor for suicide in the elderly population. Tragically, many of those people who go on to die by suicide have reached out for help—20 percent see a doctor the day they die, 40 percent the week they die and 70 percent in the month they die1. Yet depression is frequently missed. Elderly persons are more likely to seek treatment for other physical ailments than they are to seek treatment for depression. Depression in elderly people often goes untreated because many people think that depression is a normal part of aging and a natural reaction to chronic illness, loss and social transition.

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Family members, care staff and other professions need to be alert to any change in behavior among older adults. Some specific warning signs include:

  • Loss of interest in things or activities that are usually found enjoyable
  • Less interest in social interaction, self-care and grooming
  • Less compliance with medical regimes (such as refusing medications or treatments)
  • Recent or expected significant personal loss (such as the death of a spouse or other)
  • Feelings of hopelessness and/or worthlessness
  • Changes in sleep patterns including inability to sleep or sleeping excessively
  • Decreased energy, appetite and/or concentration
  • Putting affairs in order, giving things away or making changes in wills
  • Verbal clues, such as “I won’t be needing any more appointments,” This is the last time you will see me,” or other direct expressions of suicidal intent.

Do not depend on verbal clues before reporting a concern because the elderly are less likely to volunteer that they are experiencing suicidal ideation, and men in particular often do not express their feelings. It is important that care and other staff members are attentive to behavior or mood changes that occur with residents. Changes should be reported to the appropriate supervisor. Any direct statement verbalized by a resident threatening to hurt or kill himself, talking about death or suicide, or other direct statements should be taken seriously and immediately reported. Help should be provided as soon as possible. It is not the role of staff to determine if a threat is “low or high,” so an appropriate behavioral health professional should be consulted. If immediate danger of suicide may be imminent, EMS 911 or local behavioral health team should be called.

 

1 National Alliance of Mental Illness.

Helpful links for additional resources include:

http://www.nami.org/

http://www.suicidology.org/

http://www.sprc.org/sites/default/files/migrate/library/OABH_IssueBrief4PreventingSuicide.pdf

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