Characteristics of suicidal behavior in the elderly

Suicide is a tragedy at any age. That a person takes his own life is a misfortune for everyone close to him, who wonders why he did it and how it could happen.

Despite the fact that there is increasing awareness of this social problem, few are those who realize realize that elderly people also commit suicide, and there is still no focus on it.

Suicidal behavior in the elderly It is, sadly, a reality and quite common. Next we are going to delve into the subject, seeing what are the main factors that influence in his commission and some signs that an older person might be planning to attempt suicide soon.

• Related article: "Suicidal thoughts: causes, symptoms and therapy"

Suicidal behavior in the elderly

Suicidal behavior in the elderly is a scourge that has gone unnoticed for a long time, despite the fact that acquired proportions to speak openly of a new epidemic and, as such, it is necessary to control and to prevent. In fact, all studies on suicide show that older people have the highest rate of suicide and the lowest rate of attempts.

In the particular case of Spain, the elderly only make 1 out of every 20 minor attempts, compared to 1 out of every 7 serious ones and 1 out of every 3-4 completed suicides. This can be interpreted as older people having stronger intentions to die, using more lethal means.

Not only is the high rate of completed suicides in the elderly worrisome, but also how they do it. Many of them resort to what has been called “silent suicide” or “slip syndrome”, which could be interpreted as passively letting themselves die. The person refuses food and medical care, abandoning himself to the point of death. The fact that it is slower does not mean that it is less lethal than active suicide, since the intention to die is the same and is equally worrying.

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Risk factors for suicidal behavior in old age

There are a number of risk factors that increase the chance that an older person will attempt suicide. These conditions, both personal and circumstantial, if seen in time, can help us prevent an older person from taking their own life. It should also be said that suicide is difficult to predict on many occasions, but keeping these factors in mind can contribute to avoiding it in old age.

Among the factors that increase the risk of suicidal behavior in the elderly, we find the following as the main ones:

1. Advanced age

In industrialized countries, the suicide rate increases with age. This is especially noticeable in people over 65 years of age, coinciding with the retirement age in many countries.. It is from this age that the suicide rate rises markedly.

• Related article: "Types of aging (primary, secondary and tertiary)"

2. Male gender

About 80% of suicides in the elderly are carried out by men. On average, for every woman who kills her, three to four men do. However, women are the ones with a higher risk of suicide attempts. The most used explanation for this is that retirement and the physical deterioration typical of old age are experienced in a much more negative and disturbing way in men than in women.

3. Family members who committed suicide

family history of suicide, whether in the immediate family or in the extended family, increases the risk of committing it. This can be explained because, on the one hand, a psychological disorder may have been inherited that increases the risk of suicide (eg. g., depression, schizophrenia...) and, on the other, that certain models have been learned in the family that conceive suicide as the only alternative to the worst crises (p. g., chronic unemployment, terminal illness, indebtedness…).

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4. Death of a loved one

The death of a loved one increases the risk of suicide, with widowhood being the most common case in the elderly. The circumstances of the death of the loved one and the type of relationship that was had with him condition how the mourning will take place. DIf this duel becomes complicated, there is a probability that it will turn into a major depression and, consequently, increase the risk of suicide.

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5. Live or feel alone

There have been studies that have pointed out that about half of the elderly who committed suicide lived alone. Some have argued that the variable that best correlates with suicidal behavior is living alone, without However, there are also many older people who live alone and do not end their lives nor do they seem to have the intention of do it. This could be explained because, although they live alone, they may have an intense social network and not feel alone or helpless.

The lack of friends, the little relationship with relatives and other variables associated with having a lonely life has been linked to suicidal behavior. People over 65, especially widows, are the demographic group most at risk of social disengagement, something that, combined with the lack of economic and social resources or the suffering of a chronic disease, increases the risk of committing suicide.

• Related article: "Unwanted loneliness: what it is and how we can combat it"

6. suicide threats

Expressed wishes to harm oneself and threats are among the most important indicators of suicide risk. To this day, the erroneous belief continues to exist, committed by many relatives, friends and even professionals, that if a person talks about suicide or says that he is going to commit suicide, he will never will perform. The reality is just the opposite: most of the people who end their lives have communicated, in one way or another, that they wanted to die to their family and friends.

7. History of previous suicide attempts

Previous suicide attempts increase the risk of committing it in old age. About a third of the people who ended their lives had previously attempted suicide. In many cases, these attempts are a way to get help and be taken into account rather than an actual attempt to end their life. However, if there have been, a lot of attention should be paid because it can be the prelude to what they will finally end up doing.

8. Chronic pain, chronic and/or terminal illness

A risk factor for suicide is suffer from a chronic disease, especially if it involves some type of disability or incapacity for the elderly. More than half of those over 65 who commit suicide have some type of chronic and disabling disease.

• Related article: "Chronic pain: what it is and how it is treated from Psychology"

9. Alcoholism and other addictions

In the general population, alcohol abuse disorder is among the most important suicide risk factors. Even without dependence, alcohol consumption increases the risk of committing suicide. The statistics vary a bit in this aspect, seeing that between 20 and 70% of people who have committed suicide have alcohol in their blood.

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Indicators of suspected imminent suicide

Although for many, suicide in the elderly may seem like an impulsive act, the truth is that it is usually planned in advance. Despite this, it is difficult to find out the exact moment in which an elderly person is going to try to take their own life. Many relatives of people who have ended their own lives often comment that he or she did not behave differently the day she did, nor did it seem like he was in a different mood than usual.

What makes an older person decide to end his life can be seen as something insignificant from the outside, but that the person attributed with great importance: a disapproving comment, not being able to do a task well, reproaching him for being retired, not being able to take care of the grandchildren, needing a high chair wheels…

However, we can highlight some indicators prior to suicidal behavior that can warn us that the elderly person is thinking of taking his own life. The most notable are the following.

1. Interest in death or suicide

Before the act, the person may express a special interest in death or suicide itself. What he is doing is probably looking for information on the most effective method to end his life.

2. talk about suicide

Bringing up the topic of suicide should be seen as a worrying indicator. Constantly talking about wanting to die or wanting to end your life are indications of a possible attempt. Expressions such as "I can't take it anymore", "I won't last like this for a long time", "there is no solution for me anymore, I'm too old"... These and other expressions of concern should be seen as signs that he could try to end his life and you should be especially careful..

3. strange goodbyes

Another obvious manifestation of a probable suicide attempt is saying goodbye to family and friends for no apparent reason. Goodbyes can be verbal and seem to be saying it as if you are going on a trip soon.

Expressions such as "I imagine that I will never see you again", "take care of my things", "I love you very much and I will miss you" in an older person should activate the alarms. They can also call old acquaintances with whom they have had no relationship for years or write farewell letters, notes, e-mails...

4. Will drafting

In an attempt to put everything in order before leaving, elderly people who could commit suicide shortly they can write the will or review it. They can also handle other financial matters and posthumous wills.

5. strange behavior

Among suspicious or unusual behaviors we can mention:

• Accumulation of drugs that you do not need.
• Get documented to know lethal doses of drugs without a prescription.
• Reduced contact with people who care for you.
• Try to stay alone, to practice your suicide plan and see if you have time.
• Visit the doctor without an appointment.
• Carrying out an unjustified trip to the pharmacy.
• Going out alone with no apparent explanation.

6. Apparent improvement or spontaneous recovery

Many people who end up committing suicide seemed calm, happy or even euphoric in the days before their death. It is common for relatives to comment that his suicide surprised them because, in the days before it, they saw the older man as happier.

The explanation for this is that, after spending a long time with the uncertainty of whether or not to end his life, at the moment when who decides that he is going to do it and specifies a day, as he sees that the end of his suffering is near, he lives it with a little happiness.

Suicide in the elderly and psychopathologies

The presence of psychopathology is in itself a powerful factor in the risk of committing suicide, at any age. Several mental disorders have been identified as responsible for suicidal behavior in the elderly. Among them, the following are worth noting.

1. Depression

Depression is the mental disorder most strongly linked to suicide, especially in the elderly. Between 60 and 90% of the elderly who attempt suicide manifest depressive symptoms and depression is considered the first cause of risk. Patients with depression are 4 times more likely to commit suicide than those with other mental disorders.

Depressive symptoms in the elderly are characterized because they are not of great intensity, which makes it more difficult to detect them. In addition, in many cases the depressive episode that leads to suicide may be the first that the individual has presented and does not usually present with psychotic symptoms. This makes it difficult to make an early diagnosis to prevent attempted suicide.

Although in general older people present depressive symptoms similar to those of the rest of the adult population, some differences can be highlighted, such as:

• More somatic complaints
• More hypochondriacal symptoms
• Less depressed mood
• hopelessness
• Insomnia and other sleep problems
• Less frequent feelings of guilt
• More memory failures
• More susceptible to criticism

2. Schizophrenia

The schizophrenia It has been directly linked to suicide. This is due to several reasons: it has a poor prognosis, it causes continuous wear and tear on personal, family and social resources, it is chronic and, above all, it is difficult to treat. Between 10 and 15% of people who commit suicide had a diagnosis of schizophrenia.

Traditionally, great importance had been attached to the appearance of auditory hallucinations that ordered the person to commit suicide. However, these cases are relatively rare in people with schizophrenia who end up committing suicide (5%). It is rather negative situations and social isolation that induce suicide in this population.

3. Alcoholism

As we have mentioned before, alcohol abuse is a serious health problem and it is even more so in the elderly population and one of the most important risk factors for suicide. Some statistics point to about 25% of older people who had attempted suicide had consumed alcohol before the attempt.

Added to this, older people who abuse alcohol often have depressive problems. It is precisely this combination of alcohol and depression that is responsible for many suicide attempts.

Medical illnesses and suicidal behavior in the elderly

There is a strong correlation between somatic illnesses and suicide. Having a serious medical illness increases the risk of attempting suicide, either due to the characteristics of the illness itself, the consumption of drugs that it generates a depressive state and, therefore, an increased risk of suicide, such as the appearance of associated depressive disorders, especially if the disease is chronic, painful or terminal.

The diseases that most increase suicidal behavior in the elderly are the following.

1. neurological

Neurological diseases, such as Alzheimer's and Parkinson's dementias, are an important factor associated with suicide in the elderly. Parkinson's is of special mention., since about half of the patients with this condition present depressive symptoms. Added to this, some medications for this neurological disease can facilitate the appearance of depressive symptoms.

2. rheumatic

The main one is rheumatoid arthritis which is characterized by chronic pain, pain which is itself one of the major risk factors for self-injurious behavior. If, in addition to this chronic pain, there is a severe, progressive and deformed disability, it can be produce a change in body image that directly influences self-esteem and greater isolation Social.

3. Oncological

The suicide rate among cancer patients is 20 times higher than the rest of the population. Between 30 and 40% of people with cancer suffer from depressive symptoms. Oral, pharyngeal and lung cancer, genital, digestive and breast neoplasms are the oncological diseases with the highest risk of suicidal behavior in the elderly.

4. Gastrointestinal

peptic ulcer It is one of the gastrointestinal diseases most found in people who have committed suicide. This disorder is related to the prevalence of alcoholism. Also, although to a lesser extent, we have liver cirrhosis and Crohn's disease as diseases related to suicide.

5. cardiovascular

Statistics indicate that about 10 to 15% of suicide cases presented cardiovascular pathologiessuch as myocardial infarction and high blood pressure. An added problem to this type of pathology is that the treatment is carried out with drugs that have symptoms of depression as side effects. If, before presenting cardiovascular disease, the person suffered from depression, the risk of suicide increases.

Prevention of suicidal behavior in the elderly

Many times, suicide in old age is caused by a depressive disorder, a psychiatric condition that can be treated and thus prevent its tragic end. To prevent this problem, it would be advisable for any professional who interacts with elderly people to have the ability to identify symptoms of depression and initiate an entire action protocol to send patients to a psychologist or psychiatrist, who will diagnose the condition and will try.

Detection and suspicion would fall mainly on medical professionals, since it is known that a very high percentage of seniors who end up committing suicide visited their doctor that week or even days before committing the act. However, other people not so involved in the health field, such as home carers, could receive training to make sure they have the necessary tools to suspect that an older person might try to end their life.

It is especially important put the spotlight on the elderly men and women who live alone. They are this population especially sensitive to trying to end their lives, in their despair at feeling isolated from the rest of the world or feeling that they no longer have anything to contribute to their environment. They should not be forced to live in company or end up in a residence, but they should be encouraged to interact with other people in social activities such as dance groups, painting workshops or outdoor sports. A greater contact and approach prevents feelings of loneliness and, consequently, suicide.