November 23, 2006

Why Do The Elderly Commit Suicide?

A thought provoking article.  I have to admit this never occurred to me, and that's exactly the problem.
 
First, a question, and you must commit to an answer: why do the elderly suicide at higher rates? Write in your answer here: _________________________.  No, don't read on without answering.
 
General theory is that they are hopeless, pessimistic, and their intent to die is high. That's what you wrote, right?  Me, too.
 
But what if they died at higher rates not because they wanted to die, but because they were more susceptible to dying, even by a half-hearted, low-lethality attempt? 
 
Using Sri Lanka's most common poisoning, yellow oleander overdose (= cholinergic toxicity),  94/1900 suicde attempters studied died.  Elderly were 13 times more likely to die than those under 25--  even when the number of seeds was controlled.  And the number of seeds was often low (median was 3).  In other words, the elderly were not dying at higher rates because they ingested more seeds; they were dying because they couldn't survive even a few seeds.
 
Wow.  Ok, my previous bias had been to worry most about the intent in the elderly, not so much the means; once they decided to die, they'd find any way they could.  Whereas in, say, teens, the bias was to worry about the means, because (often) their intent to die was low, but they might take  something that was much more lethal than they thought it would be.  A common question I ask is, "which is more lethal, an OD of Zoloft or Tylenol?"  Because many believe psych meds are lethal, while Tylenol, an OTC, shouldn't be. 
 
But it may be that I was wrong, and that the elderly have vague attempts just as frequently as others, but actually die from them.  Maybe I need to be more careful about prescribing them meds that even in mild overdose could result in their death (Elavil, Tylenol, narcotics, etc)?
 
What's against this is that 60% of people under 65 use a gun to kill themselves, while 73% of those over 65 use a gun-- suggesting that intent is pretty high after all.  But that's not my point here. 
 
What's interesting is why this all never occurred to me.  Where did I get the idea that the elderly were more intent on death than the younger people?  Certainly, the popular psychiatric literature constantly reminds us the elderly have higher risk; but perhaps a culture which places so much value on youth, and which is incessantly and publicly debating doctor assisted suicide (always for the elderly), the right of family to withdraw care, etc-- maybe all those notions recursively reinforce the premise on which they are based: that old people want to die?  Of course a 20 year old doesn't  really want to die because he doesn't "understand" death,  he has his whole life ahead of him, hasn't learned impulse control, etc.  But the old guy "knows" there's nothing to live for...(?)
 
Yet another reason why doctors should not become social policy analysts.  We are too much in the thick of it, and never question our assumptions because we believe them to be axioms.
 
 
 






Comments

First, I have to say: this ... (Below threshold)

March 22, 2007 10:04 PM | Posted by anonymousreader: | Reply

First, I have to say: this blog is fantastic. Second, my grandfather committed suicide, and I became disabled in my early 20's by a debilitating chronic illness. With these two facts, I'd like to posit some theories about what you just wrote. First off, there's an ableist assumption in the notion that people who are old, sick, invalid, etc., would have a greater desire to die, and it's quite honorable of you to question your assumptions. In fact, physical frailty often places a higher value on the minutaie of life that, as youth, we fritter away uncaringly. So it makes people value certain aspects of life. Coupled with that are social horrors that can't be ignored: the disabled and elderly are treated with disrespect, outright neglecct, and often violence. These can make a person suicidal. Do these two forces balance each other out? Who knows. But I think the bias you're talking about exists to protect people from the social horrors that are inflicted upon the elderly and frail who want to live, but cannot muster up the means. Because we don't offer adequate help and care and income to these groups, they may easily swing from those clinging most tightly to daily moments to those buying their ammunition at WalMart.

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Why is it that psychiatry c... (Below threshold)

January 8, 2012 8:19 PM | Posted by aek: | Reply

Why is it that psychiatry conflates assessment with treatment? The sole "treatment" of incarceration in an inhuman and humiliating environment, while intentionally refusing to confront the distressors of the person who is distressed and having that distress manifest in suicidal ideation and/or intent, only exacerbates the distress. The biggest risk factor in suicides is having a previous attempt. As you would say, "duh."

Joiner has begun to identify the upstream correlating distressors - not so sure of causality, but C Fred Alford, has done a bang up job in describing the distressors confronting many whistle-blowers. No one, including Alford (I wrote him and asked), has any idea about how to mitigate these distressors without larger, societal and cultural supports. In other words, alleviating suicidality, in the absence of psychosis, extreme impulsivity or mania, can't be done as far as anyone has been inclined to investigate, by pulling oneself up by one's bootstraps.

Psychiatrists actually instruct patients with suicidality on how to answer the assessment questions so as not to distress the treaters and thus, trigger an incarceration - er - hospitalization. Which leaves patients nowhere. Wonder why treatment f/u rates are so low? Would any sane person subject himself/herself to intrusive, painful assessments which are distressing, knowing that the results will either be a) a denial of the distress and/or b) involuntary incarceration/humiliation/exacerbation of distress? In other words, another form of societally proscribed ostracism, which has been used as a lethal punishment across cultures from recorded history?

Suicide is frequently an act to put a permanent end to terminal unbearable distress.

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Im 18 Y... (Below threshold)

May 10, 2012 1:34 PM | Posted by Keyona LaShay Woody: | Reply

Im 18 Y

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Im 18 Y... (Below threshold)

May 10, 2012 1:34 PM | Posted by Keyona LaShay Woody: | Reply

Im 18 Y

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One element in passive atte... (Below threshold)

April 14, 2015 9:54 AM | Posted by Dope: | Reply

One element in passive attempts is the ability to break character. The capacity for instinct to over-ride emotion and say, "put the gun down". As people get older, they lose their self-control. This is why you have to remind your mother not to say "colored people". Perhaps a 65-year-old is just not as quick to change their mind as a 35-year-old. Or, maybe I shouldn't have said 'perhaps'.

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I just noticed this post's ... (Below threshold)

April 15, 2015 12:34 AM | Posted by johnnycoconut: | Reply

I just noticed this post's URL. Look at it.

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(My last comment wasn't spe... (Below threshold)

April 15, 2015 12:37 AM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

(My last comment wasn't specifically directed to anyone.)

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