Senior Suicide: Causes And Prevention Strategies

Despite warnings from his ‘card room’ friends, Isaac, a retired PWD chief engineer with significant ancestral wealth, paid no heed. A naturally reclusive individual, he played cards in the club but became venturesome after retirement, deciding to construct a hotel on his property against the advice of his friends. Ignoring cautionary advice, including that from his family, Isaac borrowed substantial sums from the bank for the hotel project.

Now, you might be wondering why we’re sharing Isaac’s story and its connection to ‘Late Life Suicide.’ As you read through Isaac’s life chronicle, the connection becomes apparent. Due to space constraints and the hotel’s central location, Isaac had to modify the original plan, inadvertently violating building regulations. Relying on his stature as a retired chief engineer, he believed he could overcome these ‘violations.’ However, this strategy failed, and upon completion, he couldn’t secure the necessary permissions, including power and water supply. The hotel project became a ‘non-starter,’ accumulating liabilities that Isaac struggled to manage. In the end, burdened by financial difficulties, he resorted to reckless borrowing from various sources. In summary, his life ended in chaos, leading to the tragic choice of suicide.

In an ideal situation, he could’ve lived a king size life with his hefty pension and other rental incomes. Starting a new business or venturing into uncharted areas after retirement is a risky thing. Once in a lifetime a Col. Sanders happens.

We make the case that late-life suicide is a cause for enormous concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large.A complex web of conditions contributes to late-life suicide, including physical illness and functional decline, personality traits and coping styles, social disconnection and like the case in Issac’s life, ‘messing up’.

But the vast majority of older people who kill themselves also have a diagnosable mental illness, primarily depression, Dr. Rameela Shekar, psychologist says.

"It helps to be around other people”.

Rameela also says that majority older people, feels stigmatised — she says people avoid talking to elders and don't want to engage. Growing older can be "very hard," she says. "People don't talk to you."
Dr. Rameela believes that seniors can improve their mental health through human contact, medical and psychiatric help, exercise, physical well-being, regular visits to primary care providers and nutrition. "Oftentimes it is commonplace to think as normal for older people to feel bad, or to go through loss, or to have lots of death and grief (peers), and to just not recover from their depression, and in reality it's very recoverable and it's something we should be targeting," Rameela says.

There are many factors that might contribute to an elderly individual deciding to commit suicide. One of the primary factors is loneliness and over a period of time this will develop to depression. Unfortunately, Rameela says, seniors are often left behind in ‘modern’ India. The ‘modern’ trend is the nuclear family where parents are no longer welcome and adult children migrate to far away place. The elderly person is likely to have experienced a multitude of losses at this phase of life: family, spouse, friends, as well as outliving their own children.

Again, at some point, we mean 80’s and 90’s, there is no one left who knew them from the past. Many of the friends they use to talk to or get together with, if still alive, may have their own problems with transportation, health, vision, hearing, or memory. They become more dependent and have to rely on others to take them places they want to go. A lack of transportation, as well as possible problems with physical mobility also serve to limit the elderly’s access to others.

Recently, we received a shocking news of a known person committing suicide. He was into his early seventies and ever since he lost his wife couple years back, he was living a desolate life. Only daughter was living away in another state with her family and is doing well. As far as we know, ever since after retiring from Aramco, Jon was in the pink of health. Loneliness and depression are the only two factors we attribute to him resorting to this extreme step. Spouse loss must have exacerbated the depression.

Some older adults are fortunate to have family members that they live with or are close by to keep them from being too lonely. While this is beneficial, there is still the loneliness of not having people their own age with whom to talk. In Jon’s case, though his siblings were living closely but unfortunately not in good terms.

Majority of older adults lack purpose in their lives and that becomes a contributing factor to their depression. For some who have always been self-sufficient, relying on others can lead to feelings of powerlessness, helplessness, or hopelessness. Sometimes the elderly may display signs of depression such as not eating or drinking, isolating themselves, crying, expressing feelings of being worthless.

78 year old ex-seaman, Michel was a divorcee and used to live a desolate wayward life. Recently he was diagnosed with prostrate cancer and has undergone treatment and sort of recuperating. Though he alienated his wife, children and siblings, few of his school mates pitched in when they heard about his health setback. Words that shows dejection in Michel is the cascading effect of many untoward incidents in his life and his own making.

Why to live? Bemoans Mike.

Mike, as his friends call, feel his life is on a downhill course. His attitude and actions suggest for passive acts of suicide, such as the voluntary stopping of eating and drinking and refusing medication. This kind of self inflicted deaths are unlikely to be formally categorised as potential suicide deaths and are, therefore, less likely to be recorded. Few people consider such acts as a rational decision, or interpreted as a ‘legitimate exit’, when people experience dramatic changes in health and social status.

Few older adults intentionally engage in indirect life threatening behaviour, which will eventually lead to their death. Examples include refusing medication, food, or liquid; refusing or ignoring medical advice; not attending to their hygiene; and living in unsafe/unsanitary conditions.

One such case which comes to our mind is Nayanappa. He was a retired bank employee and due to differences of opinion with his second wife, he started developing a rebellious attitude. Because he got married second time after his wife’s death, his son got estranged. Nayanappa’s nemesis started with the uncontrolled diabetes and the toll was his right leg. Nayanappa’s death is not ‘Suicide’ in the perfect sense but all the ingredients of slow self inflicted death. These deaths are not labeled as suicide even when the older adult’s intent is to die.

You’ve completed the things you supposed to do. (I have fought the good fight, I have finished the race,….Bible) You see life’s satisfactions getting smaller and the burdens getting larger – that’s true for a lot of elders as the bodies start breaking down.

At this phase, “it might be rational to end your life”, Dr. Rameela continues. “Unfortunately, in the present world, if you don’t take control of life’s end, it’s likely to go in ways that are inimical to your wishes. But many people never cultivate any liking (hobbies)” “Spending few hours with someone who understands, who communicates caring, who is listening, is itself a reason for living,” Dr. Rameela says.

Vasumati’s always had a pet dog and the current one is a six year old female dachshund, Jenifer. First thing she insist on when children suggested her to move to a retirement home is to get permission to keep her dog. When the management refuses the request, she flatly rejects the suggestion. 81 one year old Vasu Ajji cannot stay away for a minute from her dog. Her son and daughter live in the US but she never felt loneliness with her pet dog. Crippled with arthritis Vasu, ajji overcomes pain while Jenifer is around. Though she’s unable to walk the dog, she made arrangements for a dog handler to walk Jenifer and a mobile spa arranged every month. Like Dr. Rameela suggested, in Vasu ajji’s case it is ‘human-dog’ conversion which keeps Ajii forget her pain and keep her away from sliding to depression. Here we are listing the risk factors and the suggestions of prevention Risk Factors

• Previous suicide attempt If someone has attempted a suicide bid earlier and failed, then such people must be kept under watch.
• Co-morbid physical health conditions As the age progresses, deficits in the faculties and physical health deterioration are expected. When you cross 80’s and 90’s a slowdown is anticipated. One should not keep bothering about it and try to tweak your activities which suits you.
• Depression and other mental health problems Seeing a doctor and getting treated is important in clinical depression and also mental health problems. Psychotic disorders are a risk factor as the one who got afflicted may injure themselves. The caregivers (family) of such people must be very alert and careful.
• Social isolation Again Social isolation can lead to loneliness and may develop to depression.
• Disability and pain Try coping with disability and use gadgets to overcome such deficits. Only way to minimise pain is to use drugs. In both cases a doctor’s advice is necessary.
• Substance abuse problems (including abuse of prescription medications) Many elders seem to get addicted to alcohol and smoking. Root cause to turn to such abuse is because of the boredom. Minimise the alcohol intake if not able to stop.
• Stressful life events and loss One major Life event which impact the elderly person is spouse loss. Same with the sibling loss. In few others it can be the death of a pet. To alleviate this trauma you need to practice diversion.
• Finding it difficult to adjust to change For many elders coping with change is a challenge. Especially, a change of place or residence. Adaptation to a new environment is a challenge and it can be exasperating but this change may be inevitable. Preventive Factors
• Assessment and care for physical and mental health conditions Regular health checkups and appropriate medications are a must in old age. Again maintaining nutrition and hydration is another crucial thing.
• Social connectedness There are very many avenues for being socially active. Getting involved with the local community for various volunteering opportunities. Involving with the religious activities. Local clubs offer also offer many activities.
• Skills in coping and adapting to change In old age, be prepared for more adjustments otherwise you get disheartened. Things may not happen the way you want it to happen because you are dependent on many people.
• A sense of purpose and meaning In old age, many elders don’t know what to do and this result in boredom. At the same time few others are too busy with ‘something or other’, which excites them and enhance a sense of purpose.
• Participation in community activities Antidote for social isolation is nothing but engagement with community. You can choose from a multitude of activities and various forums to get participated.

We feel the discussion of ‘late-life suicide’ is not complete without mentioning the concept of ‘Rational Suicide’- the idea that suicide can be a well-reasoned decision, not a result of emotional or psychological problems. Few elders whom we interacted has been vocal about the desire to end their life rather than experience a slow decline due to dementia or diseases which diminishes the quality of life.

The authors abhor the very idea of “Rational Suicide”: it runs counter to many societal norms, religious and moral convictions and as social gerontologists who preserve old age are of the view that every life is worth saving. Limited research on elderly suicide leads to the oversight of warning signs by loved ones and caretakers. As social gerontology practitioners, we emphasise the importance of recognising certain behaviours as red flags. These include stockpiling medication, hastily revising a will, escalating use of alcohol or drugs, changes in sleep patterns, expressions of hopelessness, and social withdrawal.

Suicide is a tragedy at any age, impacting the individual, their family, friends, and the broader community. If you become aware that someone is experiencing passive or active suicidal thoughts, or has articulated a plan with the intention to act, swift intervention is crucial. Seek help from a mental health professional promptly. A timely and appropriate intervention can make a significant difference and save a life.