October 15, 2019

“If you want to show me that you really love me, don’t say that you would die for me, instead stay alive for me” – Unknown

People who are depressed or suicidal, usually feel burdened and want to end life. In the above quote deep sentiments are expressed by people from close relationships reminding the person depressed that we would much want you to stay alive than die. If you really want to sacrifice your life for someone else, do it by living and contributing to make their life better rather than eliminating your existence.

Government of India classifies a death as suicide if it is an unnatural death, the intent to die originated within the person and there is a reason for the person to end his or her life. The reason may have been specified in a suicide note or unspecified.

Suicide has a long lasting effect on the people, who are left behind by the person who has committed the act. It is a tragedy that affects families, communities and the whole of countries. With the foremost necessity to prevent suicide, World Mental Health Day is celebrated every year on October 10. This year focuses on the theme ‘Suicide Prevention’.

Elderly people are an integral part of Indian families. In India, people above the age of 60 years are considered elderly. As the population of elderly is increasing so is the mental illness in them, resulting in poor adjustment and dissatisfaction with life leading to suicide. Adults aged 65 and above, particularly men, have the highest suicide rate than any other group. Suicidal behavior in elderly adults (65 years old and above) is a major public health issue in many countries. Rakhi Dandona, a researcher at the Public Health Foundation of India, and her colleagues estimated suicide rates for both sexes in each state of India from 1990 to 2016 based on multiple sources and found that the highest age-specific rates of suicide for men were among elderly men aged 75 years or above, while among women it was for young women
aged 15-29.

Warning signs of suicide among elderly:

• Loss of interest in things which they were usually enjoying
• Withdrawing from social contact
• Feeling worthless/hopeless
• Misuse and abuse of medication
• Suicidal statements like “I wish I was dead”, “I like to kill myself”, “This is the last time you will see me”
• Change in normal routine – eating and sleep patterns
• Making preparations such as visiting family and friends, preparing the will, writing death note

‘High risk individuals’ among aged who are prone to suicide are elderly with unrelieved pain, grief, physical disability, addiction with psychiatric illness also signifies a risk, late life mood disorders like depression usually overlooked in elderly, persons losing their status, expressing their loss of confidence, facing certain economic loss such as crop failure.

Causes of suicide among elderly:

• Psychiatric and neurocognitive disorders
• Social exclusion
• Retirement
• Bereavement
• Cognitive impairment
• Decision making and cognitive inhibition
• Physical illnesses
• Physical and psychological pain
• Becoming a widow/widower
• Fear of becoming a burden
• Social disconnection
• Inability to function in daily life.
• Life crisis- Financial loss, death of loved one, major illness.

All of these can lead to depression and suicidal thoughts, if not detected and addressed.

Measure to prevent suicide among elderly:

Family/friends support:

Family members and friends can usually understand the problems and provide favorable emotional climate. Family members/friends can establish close relation with a person by caring, listening, respecting feelings and understanding emotions. Whenever such maladjustment and abnormality occurs, family must get alert and should try their best to solve their problem. If such symptoms are sever in nature then victim should be referred for professional help.

Geriatric hospitals in every district:

This is of utmost importance. Every district should have geriatric services like geriatric hospitals, clinics, helplines and professional help. Active emotional support for his or her feelings should be the main focus. Volunteer citizen groups offering confidential referral services should be selected and trained.

Enrolling in U3A (University of third age):

Also known as Life Long Learning, occurs when an adult (especially a senior citizen) opts to learn something new through informal methods. The teaching methodology may take the form of e-learning, distance education, correspondence course or any other course accessible in the continuing education mode. Few topics of interest senior citizens have are astrology, religion, history, languages (like Sanskrit), computer skills, conflict management, retirement planning, investment tips, tax computation, will-writing and relationship management. There are many who wish to learn painting, sketching, singing, dancing and solving puzzles.

Distraction tactics:

The goal of using a distraction is to survive the period of distress by doing things that take one's mind off it. Distraction tactics may range anything from a quiet task like reading a favorite book to an active task like going for a run. Distraction does not act to lessen the emotional pain, but it can take the mind off it long enough for it to recede, which may prevent a suicide attempt that is made to escape seemingly unendurable pain.

Healthy practices and Social networking:

Holistic approach involving yoga studios, aerobics centers, game rooms, meditation, cafeterias, and other areas at senior centers where socialization and exercise take place are great for not just improving mental well-being, but also for educating residents about services and resources available to them.

Elderly day care centers:

Adult day care centers can be initiated in every town, especially for those elderly parents whose care givers are working outside and are unable to stay home to care of them. These days care centers help elderly relax, chat and spend time with fellow senior citizens without interruptions from anyone. The place can be good for spending time rather than being alone at home. Combining day care for children and elderly people can benefit all generations as there will be exchange of years of experience with newer ideas – ‘intergenerational solidarity’.

Lack of awareness of suicide and the stigma with depression prevents many societies to openly discuss it. Mental health professionals should educate the elderly and their care givers by integrating the services in a natural way i.e. we must go where they are, rather than waiting for seniors to come to us. We must involve ourselves with the community, hold informal gatherings and lectures, without elders feeling that they are being targeted. Building a relationship makes seniors connected and establish trust as a friend and easier to render services.

Finally to conclude, many view youth suicide as a greater tragedy than late life suicide. This acts as a barrier in reaching the elderly, understand them and treat their conditions. Many of the elderly health care needs are not met which act as a significant barrier to treatment. Older adult’s intentions are harder to gauge, they tend to talk about suicide less, display less equivocal warning signs, so let us gauge that elderly suicide needs equal attention as the other age groups and thus keep up the theme of this year’s ‘International Day of Older Persons, October 10 ‘The Journey to Age Equality’.