Suicide Rates Are High

August 7, 2013, 5:00 am 

Suicide Rates Are High Among the Elderly

By PAULA SPAN

Greacian Goeke and her father, Joseph Goeke, at their New Jersey home in an undated family photo.

In hindsight, Greacian Goeke can see that there were warnings.
Her father, Joseph, had never fully recovered from surgery to repair a heart valve and feared he would soon need a wheelchair, as his own father had. He had developed cataracts and had to stop driving. Along with his increasing physical disability, he had a history of depression that included hospitalizations and electroconvulsive therapy. For years, he had struggled with alcohol abuse.
Yet Ms. Goeke, who was starting graduate school across the country in California in 1986, was only vaguely conscious of those problems. “The culture in our home was not to talk about things in an up-front, personal way,” she told me. “I didn’t put it together.”
So it came as an utter shock when her mother called from New Jersey to say that her father had killed himself, using an old shotgun intended to keep groundhogs from destroying his garden. Just 69, he had still been working part-time as an opinion research executive.
“I can’t imagine wanting to do that,” his daughter remembers shouting into the phone. “How could you hate life that much?”
For most people, psychological well-being increases later in life, following a well-known U-shaped curve: people report less satisfaction in midlife and more at either end of the age spectrum. Paradoxically, though, suicide rates also rise sharply. Older white men, like Joseph Goeke, are particularly at risk.

Among Americans of all ages, 12.4 per 100,000 take their own lives each year, according to 2010 statistics from the Centers for Disease Control and Prevention. But among those over 65, the official number is 14.9, and suicide may be under-reported. Because of the stigma, “coroners will go to great lengths to call it something else,” said Patrick Arbore, founder and director of the Center for Elderly Suicide Prevention in San Francisco. “If it’s an overdose, they can call it an accident.”
Though suicides among older people have declined in recent decades, most likely as a result of improved screening and treatment for depression, they remain disturbingly high among men. Suicides by women decline after age 60, but the rate among men keeps climbing. Elderly white men have the highest rate: 29 per 100,000 over all, and more than 47 per 100,000 among those over age 85.
Why are suicide rates so high among seniors? We know that while older people make fewer suicide attempts than the young, they are far more likely to die from them, in part because they rely primarily on guns. “Younger people have more physical resilience and use less lethal means,” said Dr. Yeates Conwell, a psychiatrist at the University of Rochester Medical Center who has studied late-life suicide.
Moreover, depression is behind a majority of suicide attempts, and “a lot of older people have problems asking for help,” Mr. Arbore said. Depression can involve different symptoms in older patients, and “men are good at masking it, because we’ve been conditioned to believe it’s not O.K. to express emotional pain.”
Beyond mental illness, researchers have identified a cluster of other risk factors in late-life suicide, including physical illness and pain, the inability to function in daily life, fear of becoming a burden and social disconnection. “Things that remove older people from their social groups — bereavement, retirement, isolation — leave them vulnerable,” Dr. Conwell said.
Knowing that some readers here have announced that they want to end their lives if (or before) they are suffering, seeing that as an exercise of personal autonomy rather than mental illness, I asked both experts if they thought suicide could ever be a rational act. If life loses pleasure and meaning, with or without a terminal disease, can suicide be a legitimate response?
Both said, cautiously, that in certain situations, after a great deal of discussion and consideration, it could be — but that’s rarely what occurs.
“The proportion of older people who take their lives without a diagnosable mental illness is very, very small,” Dr. Conwell said. Because elderly suicide is generally a result of multiple factors — physical illness and depression and a recent loss, say — “if you change one of those parameters, it may tip the balance in favor of finding solutions that help you want to live.”
At the Center for Elderly Suicide Prevention, staff and volunteers handle 3,000 calls a month to the “friendship line” (a name deemed more acceptable to seniors than “suicide hotline”). They also place 3,500 outgoing calls to people considered isolated or otherwise at risk.
“We believe connections are what bind us to life,” Mr. Arbore said. “Just having the opportunity to talk might shift their view of the end, temporarily. It might not have to happen today.”
Such opportunities to talk, in ways tailored to older adults, should be more widely available than they are. (One resource is the Veterans Affairs Department’s Veterans Crisis Line.) Instead, the task of trying to recognize elderly depression and encourage treatment falls largely to primary care physicians and, of course, to family members, who should always take suicidal talk seriously. When a depressed and hopeless relative commits suicide, the family must cope not only with grief but often with guilt and unanswered questions.
“I’ve gone through years of being angry — ‘He chickened out, he bailed,’ ” Ms. Goeke said. “I’m someone who needs information to feel better. What did I miss? What was really going on?”
She joined the first eight-week support group for suicide survivors that Mr. Arbore’s center established. “I understand it better now,” she said of her father’s death, “but it makes me both furious and agonized that he was in such despair.” It also makes her determined “to go forward and really, really live.”
Now 60 and teaching music and movement in the Bay Area, Ms. Goeke takes particular pleasure in working with students in their 70s, 80s and 90s. “They tell me they’re happier now,” she said. “It’s exciting to be around older adults who are growing and healing.”