Suicide among the elderly population is a significant and concerning problem worldwide. According to the World Health Organization (WHO), around 800,000 suicides are recorded worldwide each year, and at least 20% of them are estimated to be committed by people over 60 years old.
In the United States, older adults make up approximately 22% of the total population, but represent 20% of all suicides. Regarding the suicide rate among the elderly population, according to the Centers for Disease Control and Prevention (CDC), in 2019, the suicide rate for men between 65 and 74 years old was 24.7 per 100,000 inhabitants, and for women it was 5.6 per 100,000 inhabitants. In addition, older adults accounted for 20% of all suicides in the United States in 2019.
These statistics are alarming and highlight the need to effectively and urgently address the problem of suicide in the elderly population. Early detection and intervention are fundamental to preventing future suicides and promoting mental health and well-being in the elderly population.
Risk Factors
The risk factors that contribute to suicide in the elderly population are multiple and interrelated. Below are some of the most common risk factors, known as the 5 Ds:
1. Depression: It is a mood disorder that can significantly increase the risk of suicide. Older adults may experience depression due to the loss of loved ones, loss of autonomy, and other stressful situations.
2. Disease: Chronic illnesses and physical limitations that come with age can increase the risk of suicide in older adults. Older people who have chronic pain, cardiovascular diseases, diabetes, neurological disorders, and other health problems may also be at higher risk of suicide.
3. Access to lethal means: The availability of lethal means, such as firearms, can increase the risk of suicide in older adults. Older adults may also have access to prescription medications, which can be dangerous if taken in large quantities.
4. Disability and dependence: Older individuals experiencing disabilities and dependence may feel a greater burden of care and stress, which can increase the risk of suicide. They may also feel a loss of independence and autonomy.
5. Social disconnection: Social disconnection can increase the risk of suicide in older adults. As we age, we may lose friends and family, leading to loneliness and isolation. Lack of social support and the feeling of isolation can increase the risk of suicide.
Many elderly individuals with chronic illnesses opt for accelerated decisions such as physician-assisted suicide (PAS).
Physician-Assisted Suicide (PAS)
Physician-assisted suicide (PAS) is a procedure in which a doctor provides a patient with a terminal or incurable illness a lethal prescription of medication so that the patient may end their life voluntarily. The doctor does not directly administer the medication but instead provides the prescription and advises the patient on its use. PAS is a highly controversial and legally complex issue in many countries, and various ethical, legal, and medical aspects are discussed regarding this procedure.
Dr. Jack Kevorkian (1928-2011) was an American pathologist and euthanasia activist who became known as "Dr. Death" for his role in helping terminally ill patients end their lives. Kevorkian believed that assisted suicide was a compassionate option for people suffering from incurable and painful illnesses and became a controversial figure in the 1990s for his advocacy and participation in assisted suicides.
Kevorkian assisted in the deaths of more than 130 people between 1990 and 1998, often using his "Mercitron" machine, which allowed patients to self-administer a lethal injection. He was arrested and convicted of second-degree murder in 1999 for his role in the death of a man with Lou Gehrig's disease and served eight years in prison before being released in 2007.
Medical stance
Below are some points to consider:
- Legality
In many countries, euthanasia is illegal and considered a punishable act. However, in some places, it has been legalized under certain circumstances, such as in countries like the Netherlands, Belgium, Luxembourg, Colombia, Canada, and some U.S. states.
- Ethics
From an ethical standpoint, some doctors consider euthanasia to go against the principle of non-maleficence, i.e., not causing harm to the patient. On the other hand, others argue that it is a way to relieve the patient's suffering and is, therefore, ethically justifiable in certain circumstances.
- Deontological codes
The deontological codes of physicians establish the obligation to alleviate the patient's suffering, even in situations of terminal illness. However, these codes also establish the prohibition of intentionally causing death.
- Opinions of medical organizations
Medical organizations, such as the World Medical Association, have very clear positions regarding euthanasia. In general, these organizations oppose the legalization of euthanasia and advocate for palliative care as a more suitable alternative to alleviate the patient's suffering.
Religious Stance
The religious stance is another important point to consider when addressing the topic of euthanasia in patients with terminal illnesses. Some religions view euthanasia as a sin and a violation of the sacred value of human life. While other religions have a more flexible stance focused on compassion and relief of suffering.
It is important to note that the religious stance does not always determine the patients' decision, as each person has their own beliefs and personal values. However, it is a relevant aspect to consider and can influence the decision of some patients and families.
Alternatives
It is very important to mention the alternatives. Palliative care focuses on alleviating pain and other physical symptoms, as well as providing emotional and spiritual support to patients and their families. They are often described as a more compassionate alternative since they allow the patient to have a natural and painless death while ensuring that their needs and desires are met.
Furthermore, it is important to note that palliative care is not only intended for patients in a terminal situation but can be used at any stage of a severe or chronic illness. Palliative care focuses on improving the quality of life of the patient and their family and may include medical treatments, home care, and emotional and spiritual support.
It is also important to highlight that end-of-life care is not limited to palliative care. Patients and their families may need additional support in areas such as medical decision-making, advance care planning, and conflict resolution within the family. Health professionals and social workers can provide resources and support to help patients and their families face these challenges.
Difficulties in detecting suicide risk in the elderly population
Detecting suicide risk in the elderly population can be a challenge due to various factors, some of which include:
Lack of training for healthcare providers: Healthcare providers may have little training in detecting and managing suicide risk in the elderly population. Additionally, they often focus on treating chronic medical conditions, and suicide risk may go unnoticed.
Difficulty detecting warning signs in the elderly: Warning signs of suicide risk in the elderly may be different from those in young adults. For example, the elderly may have physical symptoms such as chronic pain, fatigue, loss of appetite, and sleep disorders, which may be indicative of depression or suicidal thoughts. Additionally, the elderly may be less willing to talk about their feelings or seek help for emotional or mental health problems.
Stigma associated with suicide and mental health: Stigma associated with suicide and mental health may make the elderly less likely to seek help or talk about their feelings. Additionally, healthcare providers may be less likely to ask about suicide risk in the elderly due to lack of training and associated stigma.
It is important for healthcare providers and caregivers to be trained in detecting suicide risk in the elderly population. This may involve education on warning signs, suicide risk assessment, and appropriate management of at-risk patients. It is also crucial to reduce the stigma associated with suicide and mental health so that the elderly feel more comfortable talking about their problems and seeking help if needed.
We Need to Talk
It is essential to understand the importance of talking about suicide in the elderly population. We must eradicate the stigma and shame associated with this topic and promote open and honest dialogue about the issue. Public awareness about suicide is crucial for identifying at-risk elderly individuals and preventing future tragedies.
It is important to emphasize that seeking help is not a sign of weakness, but a show of strength and courage. We must ensure that the elderly feel comfortable seeking help and have access to necessary resources, including mental health services and support groups.
Furthermore, we must promote social connectivity and community participation for older adults, which can help reduce the risk of suicide. This can include creating support groups for older people and promoting volunteer programs and recreational activities that encourage socialization.
Ultimately, we must work together to create a safe and supportive environment for older people who may be at risk of suicide. This can include implementing safety measures to reduce access to lethal means, as well as promoting a culture of care and support for older adults. Only through collaborative efforts and collective commitment can we prevent suicide in the elderly population.
References:
www.biography.com/political-figure/jack-kevorkian