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The ‘Silent Epidemic’: Why Suicide Is So Prevalent in Older Men, and What Can Be Done About It

Public health practitioners often call suicide in older men “the silent epidemic.” Men take their own lives at nearly four times the rate of women, according to the Centers for Disease Control and Prevention, and men 75 and older have a suicide rate nearly 30 percent higher than any other age group.

Despite the data about the prevalence of suicide in older men, it’s an issue that’s not often talked about when people discuss health and wellness in older adults, leaving many — including some physicians — unprepared to discuss it with men who may be at risk.

 

“It’s easy to overlook suicide among older men,” said Joseph Hullett, M.D., a psychiatrist and executive committee member of the National Action Alliance for Suicide Prevention. “That’s because there are a lot of other causes of death in older age groups.”

The serious health problems that are a common part of the aging process are one of the primary culprits of increased suicide rates in older men. People with two or more chronic illnesses are much more likely to both suffer from depression and die by suicide than those without chronic conditions.ⁱ As people age, their chances of developing a chronic illness increase dramatically. In fact, 86 percent of people over the age of 65 have at least one of six common chronic conditions, and 56 percent have two or more.ii

When the physical and psychological effects of multiple chronic illnesses are combined with other risk factors common in men, the results can literally be deadly.

“Men tend to place a high value on autonomy, which usually decreases as people age,” said Amy Fiske, Ph.D., a clinical psychologist and associate professor at West Virginia University who focuses on suicidal behavior in older people. “Men also have a hard time finding support to deal with a loss of independence because they are typically less likely to seek help.”

All people with Medicare coverage are eligible for an annual depression screening that’s typically conducted as part of an annual wellness visit or physical, but a visit to a physician does not necessarily make a man less likely to die by suicide.

“There are many people who die by suicide right after seeing their doctors,” said Patrick Arbore, Ed.D., founder of the Center for Elderly Suicide Prevention & Grief Related Services, a nonprofit project that provides counseling, referrals, grief support programs and well-being checks for tens of thousands of older and disabled adults. “We need to make sure that physicians are asking the right questions when they see men who are at high risk.”

Those questions include not only direct queries about whether an older male patient is depressed or contemplating suicide, but also whether he’s undergone any major life changes recently. Arbore recommends that physicians ask older male patients about any conditions that can limit a man's autonomy and if they're taking any medications that can affect their mood. “If it’s a matter of life or death, it’s worth taking a few minutes out of an appointment to ask these things,” he said.

Caregivers also have an important role to play in preventing suicide. Older men who have a spouse, adult child, home health aide or close friend who lends a hand on a regular basis have a potentially powerful ally when it comes to reducing their risk of suicide. Regular social interaction and social engagement, what psychologists often call “connectedness,” are powerful and provide a protective force.

According to Arbore, however, having friends and confidants doesn’t necessarily mean someone isn’t socially isolated. “Loneliness can be a problem for anybody, even older men who are married or live with family,” he said.

Hullett of the National Action Alliance for Suicide Prevention advises friends, family and caregivers to learn how to speak to the older men in their lives about how they are feeling and how changes in their health or living circumstances are affecting them. “The most important thing is to take what some people call a ‘man-savvy’ approach,” said Hullett. “Don’t frame the conversation in terms of feelings and depression. Phrase it in terms of simple steps a man can take to enjoy life.”

People who think they may be at risk for depression and suicide or ever have thoughts about harming themselves shouldn’t underestimate the importance of talking to a doctor, caregiver or loved one. Men are often surprised by how much sharing their thoughts can help, according to Fiske.

“Talking about suicide doesn’t increase the chances of actually dying by suicide,” said Fiske. “Actually, people usually feel relieved when they decide to talk about it.”

Perhaps the most important thing for older men as well as their caregivers and loved ones to know is that medical help is available to manage both the chronic health conditions and the corresponding depression that can lead an older man to contemplate suicide. Being honest about concerns regarding your or your loved one’s physical and mental health is the first step in finding treatment and resources that can make a

“The fact is that suicide, especially among the elderly, is related to things that are treatable,” said Hullett. “The feelings a person has are temporary, but suicide is permanent.”

A wide variety of resources are available for those who are worried that they or a loved one might be at risk for suicide.

  • The Institute on Aging’s 24-hour Friendship Line is the only accredited crisis line in the country for adults 60 and older. People who call the line’s toll-free number at 800-971-0016 can speak directly to a counselor and even schedule ongoing outreach calls.
  • Call the National Suicide Prevention Lifeline at 800-273-8255 to reach a trained crisis worker 24 hours a day.
  • The Veterans Crisis Line connects veterans as well as their families and friends with qualified Department of Veterans Affairs responders through a confidential toll-free hotline. Veterans and their loved ones can call 1-800-273-8255 and press 1.
  •  The Suicide Prevention Resource Center maintains a list of suicide prevention resources at http://www.sprc.org/strategic-planning/finding-programs-practices.
  • The American Psychological Association offers a resource guide, which also provides information about risk factors for suicide in older adults: http://www.apa.org/pi/aging/resources/guides/depression.aspx

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Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.

i Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217074

ii https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm