Dr Patricia Casey: The elderly are at risk of suicide, too
In focusing on young people who take their own lives, we're overlooking the issue among the over-6os
IN IRELAND the focus of discussion about suicide has been on young people, especially men under the age of 30.
This is partly because the actual numbers are high relative to most other age groups and their rates are higher in comparison to most European countries.
Another factor is that these people are young and their potential contribution to society is lost forever.
But in our understandable drive to end these tragic deaths, we have sidelined a group who also carry a risk of suicide that is nearly as high.
Those over the age of 60 are also at high risk of dying by suicide and this is seldom, if ever, discussed in the public arena.
The risk in older people is recognised internationally yet prevention seems to be an afterthought.
Perhaps this is because the subtext is that the lives of older people matter less than those who still have life ahead of them.
In 2012, for example, the rate of suicide in men aged 60-64 was 29.9/100,000 (higher than in any age group under 30) and in the 65-69 age group it was 21/100,000. The equivalent female rate was 3.6/100,000 and 4/100,000 respectively.
Devaluing of the worth of the elderly may be contributing to their high suicide rate. A culture that extols the virtues of youth, beauty and physical prowess may not be a "country for old men".
Because many of the risk factors for suicide differ between younger and older people, they deserve to be examined closely so that preventive strategies can be put in place.
Retirement is a milestone, compulsory for most, which often brings a sense of uselessness and lack of purpose. When nothing replaces the structure that work provided, long days may translate into gloom and despondency.
When conflict occurs as couples struggle to be together without any relief, mental illness may ensue. Depression, especially, plays a much greater role in suicide in older people, yet for reasons of mobility, pride and isolation it is often undetected and untreated.
Depression is common in all age groups but increases in severity with increasing age. It is often "masked" in older people, whose emotional language may not be as well-developed as in younger people and who may present as being stoically lonely rather than despairingly depressed.
If accompanied by guilt, a sense of being a burden and hopelessness, we should be alert to the risk.
Self-harm is viewed as a behaviour of younger people, especially teenagers or those in their early 20s.
When it occurs in an older person it is ominous and may be an indicator of impending suicide. Psychiatrically, it is taken very seriously.
The role of physical illness and especially painful conditions has been identified as also contributing to suicide, especially when these symptoms accompany depression.
Even those expressing the wish to die when they have terminal illness have been shown to do so in the context of depressive illness. So not only is pain relief essential but so, also, is treatment of the associated depression.
A little-recognised factor may be the later emergence of the "empty nest syndrome" that is now becoming apparent.
People marry later and have children later in life, and they are continuing to live with their parents for longer and thus leave home later than previously.
For an older person such an upheaval, perhaps happening at the same time as retirement, may induce an overwhelming belief that they are no longer needed by family or society and ultimately lead to feelings of hopelessness.
Among younger people, it has always been recognised that those who were organised and focused and set high standards for themselves and others, were protected from suicide because of their desire to always do the right thing.
Yet these attributes can be a burden when flexibility and adjustment to new situations are required, as inevitably happens with the emotional, physical and social demands of ageing.
A significant contributor to suicide in older people is loneliness. For those who have no family, this is especially problematic and even many of those with adult children feel they have been abandoned.
Loneliness is often compounded by reduced mobility and difficulties simply getting out to social events or to visit friends.
There are protective factors and these, not surprisingly, include having social contacts, having religious beliefs and practices and receiving treatment when depression occurs.
At a public health level there are changes that can be made to prevent suicide in this group, such as promoting the active involvement of the elderly in civic society, establishing befriending organisations and promoting help-seeking behaviour.
But first let's not airbrush it off our radar simply because we are saturated with the trendiness of youth culture.
Let's acknowledge the tragedy of suicide in the elderly also and ask ourselves if we have ignored it for too long.