Elder suicide Signs, symptoms, treatment Steven W. Nicholas Ed.D - - PowerPoint PPT Presentation

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

• ur 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