Steven W. Nicholas Ed.D

Elder suicide

Signs, symptoms, treatment

WHAT ABOUT YOU?

Note your personal beliefs about suicide. How are your beliefs potential counter-

transference dilemmas?

Hiding in plain sight

• Elderly are at significant risk of suicide • Compare to teens and young people

– Who is at greater risk?

• Golden years surely are summations of goodness! – What assumptions are made about elders?

– Maturity, wisdom, achievement, abundance of

relationships, etc.

Completion vs. Attempts

• Senior completion rates are higher than all other age groups. Why?

– Injuries, overdose on meds, accidents – Youth heal more quickly – Youth are perceived differently

• 75 y/o woman: bp meds, crash on I-15 – Accident or suicide attempt?

Total population

Differences by age

11,000+ • 14.9 completed suicides out of every 100,000

65+ y/o (2014 CDC data). • 12 out of every 100,000 of general population _______________________________________

Boomers and aging population 75.4 million = 11,000+ suicides a year

Causes-Depression • Most prevalent attribute to elder suicide

– Under diagnosed – Under treated

• Depression begets more depression • More depression begets Anxiety, BPD, OCD,

etc. etc. etc. – Without treatment, symptoms worsen........

• “Life seems like a failed journey.” • A splendid woman with under treated mental health • She had one 50 minute session once a week.

Causes-AOD use disorders • Substance abuse becomes common as coping

skills are seemingly necessary.

– Chemical depressants might exacerbate clinical depression. What are folks using?

– Stimulants might temporarily hide depression. • What are folks using?

• A (substance)+ B (biology) + C (environment) = Addiction

•Normalization •Generational patterns: happy hour •Years of tolerance •Mum is the word

Causes-Social Isolation •Loneliness: unfulfilling relationships

•Loss of spouse •Loss of peer networks •Loss of employment •Loss of historic abilities

•No golf •No gardening

•Loss of family system •Cats in the cradle

Causes-Demographics

• Men • Caucasian

51 out of 100,000 white males over age 65 commit suicide.

– Stereotypical roles: What are they?

Double suicide/homicide

• Some committed couples age together, stay together, die together.

• Cessation of meaning • Absence of identity • Isolation

Causes-Disabilities and Chronic Pain

• Pain and mood are connected – Not many are in high spirits during chemotherapy. – Loss of physical abilities can translate to loss of

identity. • “Want to play catch, pop?”

• Pain can equate to hopelessness • Physical inability can equate to worthlessness

Causes-Poverty

•Isolation •Low income •Poor access to healthcare •Non-compliance with meds •Unsafe environments

Institute on Aging

Me

End of Life? – Intentionality

• What is the intention? –To die? To live? To what? To not

what? – Presence and absence

• What do they have in abundance? • Flip the coin….what is absent?

When you are worried…..

• Do NOT stay silent! – Doing nothing is not polite; silence is dangerous.

• Express concerns: you are taking the person

seriously.

• Voice the changes that you have seen. Be inquisitive…..Show that you care!

What to do and when?

• DO NOT leave the suicidal person alone. • Believe them until you have more information. • Ask the person to remove the lethal object from

the vicinity. Keep talking to them. 1. Have a loved one or friend take them to the ER.

(This is Reno’s option) Have the person wait. 2. Dial 911 3. Take them in your car to be admitted. Please don’t. ;)

How should I act?

• Like someone who cares? Be yourself. Calm. • Like the person matters. • Listen. Let them vent. • Be sympathetic and non-judgmental. • Offer hope. Help is available. • Ask: “Are you having thoughts of suicide?”

– You are not putting thoughts in their head. You are taking them seriously.

Questions you can ask (intentionality) • When did you begin feeling like this?

• Did something happen that made you

start feeling this way?

• How can I best support you right now?

What you can say that helps • You are not alone in this. I’m here for you. • You may not believe it now, but the way you’re

feeling can change. • I may not be able to understand exactly how

you feel, but I care about you and want to help.

• When you want to give up, perhaps you can hold off for just one more day, hour, minute—whatever you can manage.

What are we to do?

Focus our efforts!

•Connect •Provide healthcare-advocate

•Counseling •Coordinate services-advocate

•Create new meaning

Connection

• Complicated families mandate creative connections – Shortened, consistent interactions. – Create positive feedback loops: New normal – Shared experiences from afar: books, letters, calls – Break bread together when/if possible – “Never underestimate ‘the thought that counts.’”

• Flowers to a woman in a senior care facility

Adequate healthcare

• Not all medical care is equal! $$ talks. – Access and compliance with affordable healthcare

dramatically impacts the health and wellness of our senior citizens.

– This is our problem to solve! – Contemplate the fact that each of us will mature

in age.

Counseling services

• Connect with a mental health professional who can empathize, accurately diagnose, compassionately treat.

• Talk therapy or med management? – Research supports the combination: BOTH/AND – Senior populations might especially benefit from

the BOTH/AND model.

• Who is right for the job?

Strategies for professionals

• Routine check-ups for physical and mental health.

• Depression screenings at every encounter! – ZERO Suicide initiative: effective identification,

treatment, and referral model.

• What is “Normal aging?” • How “should” a senior feel?

What is beautiful? • Perhaps one who has lived a long life thinks

that the best times are in the past. – What were those glorious times like? Story time. – Does that person still reside within?

• “Back in my time……” Get them talking. – Watch them light up again-----apply that light to

the present and then to the future. – What is the 2017 version of that vibrance?

The little things

• Make a quick telephone call to check in. • Send a loving note (handwritten ones are kept

longer). • Share a delicious meal. • Walk the dog together. • Create new memories. • Add to the story!!

Pay it forward

• Our seniors are vaults of wisdom. – How do we tap into that vault? Where are they?

• What services can seniors provide? Think systemically.

Meaningful services

• Faith based organizations: meaning through theology.

• Senior centers/organizations (birds of a feather) – VA, Elks, Soroptimist, etc.

• Exercise classes – Yoga, pool, Tai Chi, weights, running, walking, etc.

Resources for suicidal seniors

• The comfort and acceptance of a counseling session is a front line for prevention. – Clinicians: please have triage services available

with someone appropriate: you or your colleagues

• Veterans Crisis Hotline: 1-800-273-8255 • Center for Elderly Suicide Prevention:

– Friendship line: 1-800-971-0016

What a wonderful world

Please notice what is around you