Ageing and suicide

In life we ​​continually face changes, but none are as important as those that will make life different.

The first is that of the initiation rites towards adulthood, that is, adolescence and youth. This stage involves great individual and social changes: the transformation of the body, the identification of belonging to the group of equals, which is of utmost importance to feel accepted, and obviously, the beginning of the path to the future based on the first decision-making of one's own. they can mark you deeply. And of course, living the first emotional bonds, the most intense, love.

The other important stage is at the end of the vital continuum, where again there will be a confrontation with great individual and social changes: the transformation of the body with the irreparable aging process and with it, the appearance of more or less important diseases, most already chronic. The great social change that retirement entails, with the sometimes inevitable feeling of "ceasing to feel useful."

The effort to adapt to a new way of living, assuming new roles that do not always fit with imagined expectations, is also an important process. Decision-making may be expected, even respected, or on the contrary, they will be disregarded and questioned. All this in an environment where communication and social relationships have undergone an unprecedented change in recent times, generating almost a gap between generations, also experiencing painful losses in the immediate environment, with loneliness as the only companion in many cases.

32% of deaths by suicide are in those older than 65

Today it is questioned whether "the duration of a life can be redistributed by giving more time to each vital stage" (Antonio Abellán) when speaking of a life expectancy that in a short time can reach 100 years, according to some experts.

In the population pyramid, according to 2019 data, people in the age range of 65-99 years represent 20.10% of the total population. Chronic and age-related diseases might be expected to be the leading cause of death.

However, the statistics tell us about another reality. Suicide deaths from the age of 65 add up to 1,129, representing 32% of the total observed in 2018 (3,539 deaths)

Suicide is the leading cause of death in the 15-35 age group, but it is also the leading cause of death for the age group over 79. The suicide death of an older person is less shocking to people than the loss of someone younger, particularly adolescents and young adults. For this reason, suicide in the elderly population is a phenomenon that is often ignored or neglected, and attracts less attention than suicide in the younger population (Parra-Uribe, Blasco-Fontecilla & García-Parés, 2017 ).

In a 5-year follow-up study in our environment (Crestani, Masotti, Corradi, Schirripa & Cecchi, 2019) it was observed that young age, under 20 years of age, together with the presence of personality disorders and alcohol consumption were the risk factors for making a suicide attempt again. However, alcohol consumption and advanced age were factors in death by suicide.

In the two stages of major life changes there is a risk of experiencing emotional pain that can become too unbearable.

Geriatric specialists warn about the issue of suicide in older people and point out that depressive disorders may be present in around 15-25% of cases (Forlani, Morri and Ferrari, 2014), which implies a very high prevalence .

Conejero et al. (2019,) detail a review of risk factors. In mentally impaired conditions, depressive disorders can often be underdiagnosed, as comorbid anxiety disorders with depression have been observed in one in six people who died by suicide.

45% (in studies reported in Europe, Australia and the USA) had contacted their primary doctor in the month prior to death by suicide and only 20% had received assistance from mental health professionals. The personal impact of receiving a dementia diagnosis is associated with a moderate risk of suicide, including, in our experience, those who may be clinically suspected of suffering from it.

In an extensive retrospective series on 538 cases older than 60 years who died by suicide, it was observed that the male sex is correlated with a higher risk of suicide, with a male-female ratio of almost 3 to 1, with the highest risk of suicide being in the age between 70 and 79 years. Pathological factors were revealed in 427 cases (physical state for 194 cases, mental state for 233 cases) and mental illness was significantly related to suicide risk (Parra-Uribe, Blasco-Fontecilla & Garcia-Parés, 2017).

Primary care; key to prevention

The social environment acquires great relevance for the elderly person who may meet some risk patterns: specific sociodemographic (social isolation, marital status (widower), grieving) or clinical (dementia, cognitive impairment and physical illness). For this reason, primary care assistance teams should be equipped to alert and have resources for prevention, since it is a population that consults regularly with this professional for their physical problems. The treatment and therapeutic approach of anxiety and depression should be optimized in this population where the pharmacological and therapeutic response is not always as expected, due to interactions with other treatments or doses and / or treatments may not be adequate. Geriatrics together with psychogerontology are vitally necessary specialties to comprehensively address physical and emotional problems at this stage of life, especially grief, understood as frequent losses of any kind that must be faced. And promote social interaction programs in the community, especially among peers, and promote alerts that can help early prevention (Conejero, Olié, Courtet & Calati, 2018).

Warning signs that should not be normalized in old age:

• Constantly sad or anxious mood.
• Feeling "empty" much of the time.
• Loss of interest or pleasure in hobbies and activities.
• Pessimism or lack of hope.
• Feelings of guilt, lack of self-esteem and helplessness.
• Fatigue or having less energy, feeling that you move or speak more slowly.
• Difficulty concentrating, remembering details, or making decisions.
• Trouble sleeping, including waking up too early or sleeping too much.
• Changes in appetite or weight, without trying.
• Thoughts about death or suicide or suicide attempts.
• Feeling restless or irritable
• Physical aches and pains, such as headaches, cramps, or digestive disorders with no apparent physical cause and that are not relieved even with treatment.

Our help can be useful:

• Offering support, showing understanding, being patient and encouraging.
• Helping you remember your appointments and organize your “pill box” if possible, since sometimes older people with depression cannot think clearly.
• Try to make sure they know how to go to medical consultations and if they can be accompanied.
• Talk to them and listen to them carefully.
• Do not ignore comments about suicide and inform your loved one's therapist or doctor about these comments.
• Invite them for a walk or stroll and involve them in activities.
• Remind them that with time and treatment, the depression will go away.

We do not have to turn our backs on the problem of suicide in older people. The opportunity to help someone who is suffering must be a moral obligation regardless of age. Death by suicide violates "the golden rule" that Edwin Shneidman transmits to us when he refers to a good death: "that our death, as far as possible, causes the least amount of pain to those who survive us" (Shneidman, 1972).

Living this experience is too tragic and traumatic for the whole family and friends, but in particular for those young people close to them, who will rarely be the priority object of receiving help for this ordeal, with the possible uncertain consequences for their future.