Senior suicides up last five years, but help is available

August 25, 2023

Green Valley News: The number of people aged 60 and older who committed suicide in Pima County increased 11 percent from 2018-2022, with that age group accounting for 33% of all suicides.

The number of senior suicides in 2023 through mid-July accounted for 43 percent of all suicide deaths in the county, according to statistics from the Office of the Medical Examiner.

In 2018, 79 seniors committed suicide compared to 88 in 2022. By mid-July this year, 118 suicides had been reported in Pima County and of those, 51 were age 60 or older.

“While not as high as in younger adults, this is too many suicides in older adults, and speaks to the need for focused suicide prevention efforts specifically for those 60 and older,” said Dr. Jordan F. Karp, professor and chair of the University of Arizona’s Department of Psychiatry.

Karp and Pallavi Joshi, a doctor of osteopathic medicine and a clinical assistant professor of psychiatry at the UA College of Medicine in Phoenix, agree the key to combating suicides is to recognize the signs of depression and to get treatment as early as possible.

The red flags for depression include low moods, irritability and becoming withdrawn or anxious. They can be caused by any number of things including the loss of a loved one, major medical conditions or chronic pain, Karp said. Moving is also a “major life stressor.”

Karp said depression, diabetes and dementia are toxic for the brain and metabolic and cardiovascular health. Together they hasten mortality. However, unless someone has suffered a severe cognitive decline, it’s never too late to increase one’s social connections and take steps to improve their brain health, he said.

“(I recommend) identifying and pursuing meaningful activities. So many people are lost not just in old age, but just in general and I think that this not feeling connected either to something meaningful, to a higher cause, or to some way that they are making the world a better place contributes to a sense of uselessness, and it really interferes with a sense of future,” Karp said. “Part of my routine work when I’m seeing patients in clinic, even very old patients, is to talk about what are their aspirations or goals for the next year or the next couple of years. They can be pretty modest, like managing my diabetes better or talking on the phone once a week or once every other week to my grandchild. Even those little things can add a sense of meaning and accomplishment to one’s day.”

“To help seniors avoid isolation and increase their odds of “aging in place,” Karp said he recommends they sign up for Meals on Wheels or for services provided by Pima County on Aging or some other social work connection.

It’s important to note the signs of depression in seniors are often different than those in younger people, Joshi said.

Different symptoms

“Oftentimes depression doesn’t manifest as what we think of classic signs of depression like crying, tearful or even saying they’re sad. A lot of times, especially in older folks, depression manifests with more neurovegetative symptoms, loss of appetite, sleeping more, cognitive changes, which we sometimes refer to as pseudodementia,” Joshi said. “Older folks may not even recognize those as signs of depression themselves, and so they may not even be sharing with their family, friends or doctors that they may be depressed.”

Joshi also said unwanted loss of employment and mobility issues can lead to depression, but she said people need to pay close attention to the medications they’re taking. For example, corticosteroids can cause endogenous depression, or depression without stress or trauma.

“The earlier the recognition is, the better the prognosis is, so educating both older folks and their family members of two things is key. The first is that depression and cognitive changes are not a normal part of aging. They are abnormal and they do need to be treated. And number two, that there are treatments which will make the situation better, particularly depression which is entirely treatable. Educating them on those two can remove a lot of the stigma and fear,” Joshi said.

Seniors also need to watch out for actions often taken by people preparing to commit suicide. They include overspending, giving away valuables all of a sudden or spending money on things that could be considered last wishes, Joshi said.

She would like to see more discussions taking place about depression in assisted living and 55+ communities.

“What we learned during the COVID pandemic is that even though our older population suffered tremendously physically, they actually had more resilience, more emotional resilience than their younger cohorts and risks of anxiety, depression and suicide are proportionately higher in the younger cohort than in the older cohort. So our older folks who have experienced a lot of adversity, they’ve developed a lot of wisdom and resilience so they are resilient enough to accept and learn about these diagnoses and situations,” Joshi said.

Once they recognize they are depressed and are treated for it, the better the chance they’ll become more involved, Joshi said. They may take the opportunity to take exercise classes and meet new people, for example.

Even people newly diagnosed with dementia or are in the early stages can and should seek treatment and remain active, she said. Dementia can take five to 15 years to progress.

“In the mild stage, sure there may be some impairment, maybe they can’t drive as much as they used to, but they may still be able to do a ton of other things,” Joshi said. “In the beginning stages, they may be able to cook with their loved ones, have conversations, watch movies, read books, all of that still may be preserved. I have a patient who has mild dementia and she’s highly educated and she writes newsletters in the community to educate other people about Alzheimer’s disease. She found a way to give meaning to her life, not just despite, but through the diagnosis itself.”

Although Joshi recommends concerned loved ones have those conversations about depression, she understands it’s difficult. In those instances, she recommends they ask an ally to have that conversation.

“They might receive that sort of feedback much more easily from a trusted friend than from a child that they may perceive as perhaps being overly cautious,” Joshi said.

Getting help

Solari Crisis and Human Services is the agency responsible for answering the statewide crisis line, 1-844-534-HOPE, and the national suicide and crisis line, 988.

Solari’s Director of Contact Center Operations and Clinical Services, Eric Lee, said they typically receive just over 8,700 crisis calls a month from Southern Arizonans and 20% of them are related to suicide or self-harm. The rest of the callers are suffering a crisis due to substance abuse issues or a mental health disorder.

Not only are the number of suicidal callers increasing, but the severity of the crises seems to have increased, Lee said.

“They’re more distraught, maybe they’re further along in the process where it’s not just thoughts anymore, but they have a plan for how they’re going to do it. They’ve gone about procuring those methods and sometimes they’re actively in the process of carrying out those methods,” Lee said.

COVID-19 was a challenge for most people, but now there are new stressors, Lee said, including the increased cost of food, housing and gas.

The specially trained call takers conduct a safety assessment that determines the best way to respond to the situation, which could include referrals to psychiatric hospitals, behavioral health agencies for ongoing counseling and detox services, he said.

While it may sound like a cliche, sometimes just listening, being supportive and non-judgmental helps to de-escalate the situation, Lee said.

When it’s not, Solari has the mobile crisis response teams available throughout Arizona.

“They are an option for us so we can send somebody out to their their home to have a face-to-face conversation and intervention,” he said.

Solari’s mobile crisis teams are dispatched throughout Southern Arizona roughly 1,400 times a month, Lee said.

Dispelling myths

There are a few common myths when it comes to suicide, Lee said. The first is that there’s nothing anyone can say or do to keep someone from carrying it out and the second is that they’ll find some other way to commit suicide if you take away their preferred method.

“That really key suicidal crisis tends to last a pretty short period of time and if we can intervene, provide support, provide resources and options and help instill some hope in that person we can usually curb those suicidal thoughts or intentions,” Lee said.

As for the methods, Lee said, “By removing the means, by making them more difficult to obtain, we know that that leads to more safe outcomes, you know, where people look to other options, such as getting help as opposed to looking to other options to harm or kill themselves.”

The third myth pertains to bringing up the topic of suicide with a depressed person, Lee said.

“The two biggest pieces of advice that I have… Don’t be afraid to ask them if they are having suicidal thoughts. There is a myth that still perpetuates today that asking a suicidal person if they are suicidal will increase the chances of them killing themselves. We know that the reverse is actually true. Asking them if they are suicidal helps them identify that you’re observing, that you care and that there’s no shame in feeling that way,” Lee said. “It can also bring about a sense of relief because now the secret and the strong feelings that they’ve been hiding can be spoken about. The other piece of advice I give is that if you have concerns about a person and they’re not able to tell you directly, just listen to your gut and call for help.”

Lisa Reams, vice president of programs and services at Pima Council on Aging, and Elizabeth Reeves, community services system program director, said their staff is trained to listen to their clients and callers for signs of isolation, loneliness, depression, stress, anxiety and feelings of being disconnected.

“Anything that we can do as an organization to help our staff be able to hear that and connect people with appropriate resources and talent, whether that’s acute behavioral health providers, whether that’s their primary care physician for a larger health, health screening or health assessment, or whether that’s linking them with other opportunities to engage with other people to potentially feel less isolation and feel a bit more engaged can potentially help,” Reams said.

No matter your age, Reeves said she encourages people to take action now to reduce their risk of depression.

“I think building up a network, finding things that you enjoy doing, that are outside of your house and getting connected with other people is a really good inoculation,” she said.

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