Suicide Prevention for Geriatrics
What do I need to know about suicide prevention for geriatrics? It is common for an elderly person to talk about death and dying, especially if he has a worsening medical condition. This makes it difficult to recognize when an elderly person is planning suicide instead of just thinking or talking about it. Learn to recognize warning signs that the person may be considering suicide. Locate resources to help prevent the person from attempting to take his life.
What should I do if I think the person is considering suicide?
- Call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Contact the person's therapist. His caregiver can give you a list of therapists if he does not have one.
- Keep medicines, weapons, and alcohol out of the person's reach. Do not leave the person alone. Stay with him if he says he wants to commit suicide or you think he may try it. Make sure you do not put yourself at risk if he has a weapon.
- Do not be afraid to ask if he is thinking of ending his life. Ask if he has a plan for hurting or killing himself. Ask what he would use to kill himself and if he has it.
What warning signs should I watch for?
Changes in how he talks about death: The person may suddenly talk about death or suicide when he never did before. He may talk about death and dying more than usual, or suddenly stop talking about it altogether. He may tell you he sees no reason to live or that he is in constant pain. He may say he knows he will die soon, so he should end his life to prevent pain and suffering. He may say his family will have an easier time when they no longer have to care for him.
Suicide plans: The person may say he wants to hurt or kill himself. He may try to get items he could use to kill himself, such as a gun or extra prescription medicine.
Changes in appearance or routines: The person may gain or lose weight, or he may have less energy than usual. He may have trouble sleeping or spend a lot of time sleeping. He may eat more than usual, or stop eating or drinking. The person may withdraw from others or stop doing things he enjoys.
Mood swings: The person may seem hopeless, anxious, or angry and then suddenly become happy or peaceful.
Drug or alcohol use: The person may have new or increased drug or alcohol abuse. He may stop taking prescription medicine or take too much. He may secretly collect medicine instead of taking it so he has enough to use for an overdose.
What increases the person's risk for suicide?
Mental illness: Depression is the main reason people attempt suicide. The death of an important person, or the anniversary of a death, can cause intense grief and depression. Mental illness, such as schizophrenia, bipolar disorder, or posttraumatic stress disorder (PTSD), can also increase the risk of suicide.
Physical illness: Chronic pain can be overwhelming. A serious illness, such as heart disease, cancer, or AIDS, may make the person feel hopeless. He may feel helpless if he has to depend on others to survive or function. He may think he is a burden to his family and friends.
Financial stress: The person may not have enough money for bills if he is retired.
Suicide history: His risk is higher if he has attempted suicide before. He is also at risk if someone close to him attempted or committed suicide.
Abuse: Physical or sexual abuse in the past or present can increase the person's risk. He may be in a relationship that is not healthy or is abusive. He may have a history of violence or aggression toward others. Frustration, anger, or feelings of revenge can lead to thoughts of suicide.
Loss or loneliness: Moving out of his home can cause distress to an elderly person. He may have lived in his home for many years or have a lot of happy memories in his home. Stress can come from divorce or loss of a spouse, or loss of a friendship. The person may live alone, or have few friends. He may not live close to family members or have good relationships with them.
How will caregivers help the person?
Assess his risk: Caregivers will examine the person and screen him for depression. They will ask questions about his suicide thoughts and plans. They will ask how often he thinks about suicide and if he has tried it before. They will ask if he has begun to hurt himself, such as with cutting or reckless driving. They may ask if he has access to weapons or drugs.
Create a safety plan: Caregivers may ask the person to make a safety plan. This will include a list of people or groups for him to contact if he has suicidal feelings again. He may be asked to make a verbal agreement or sign a contract that he will not try to harm himself. His belt or shoelaces may be removed so he cannot harm himself.
Recommend care: Caregivers may refer the person to a psychiatrist. The person may choose to be admitted to a psychiatric care unit. His caregiver may admit him if he feels the person is not safe on his own or with others.
What treatment may the person need?
Medicines: Medicine can help the person feel well enough to continue with all of the treatment he needs.
Antidepressants: These help reduce and control symptoms of depression. The person will need to take this medicine as directed. A sudden stop can be harmful, so he must not stop taking the medicine unless directed. It may take 4 to 6 weeks for the medicine to help him feel better.
Mood stabilizers: These help prevent mood swings.
Antipsychotics: These help decrease symptoms of severe agitation and anger.
Life review therapy: This therapy focuses on both the successes and failures of the person's life. He can express his feelings and find peace with anything he feels is not resolved.
Cognitive bibliotherapy: This therapy uses written materials or computer programs to help the person change thoughts that make him feel depressed.
Problem solving: This therapy helps the person find the best way to solve problems. It may also help reduce his desire to commit suicide when he is faced with hard times.
How can I help the person?
Drug or alcohol treatment: Encourage him to seek help for drug or alcohol abuse. Drugs and alcohol can make suicidal feelings worse and make the person more likely to act on them.
Social connection: Help him connect with others. Encourage him to become involved in his community. Some examples are tutoring a young student, volunteering at a local organization, or joining a group exercise program.
New experiences: Encourage him to try new things. Elderly people who are open to new experiences handle stress and change better than those who are not.
Offer support: Call, visit, or send postcards to him often. Check on him after the loss of a pet, longtime friend, or child. Holidays, birthdays, and anniversaries can be difficult for a person after a loss. The loss of a spouse can be especially painful and lonely.
Adaptive equipment: Help the person get equipment that will increase his comfort and mobility. Examples are hearing aids, glasses, large print books, and walkers. The person may need help setting up a computer or creating an e-mail account to help him remain connected to others.
Where can I find more information?
- National Suicide Prevention Lifeline
New York , NY 10004
Phone: 1- 800 - 273-TALK (8255)
Web Address: http://www.suicidepreventionlifeline.org
- Suicide Awareness Voices of Education
8120 Penn Ave. S., Ste. 470
Bloomington , Minnesota 55431
Phone: 1- 952 - 946-7998
Web Address: http://www.save.org
When should I contact the person's caregiver? Contact the person's caregiver if:
- The person has intense feelings of sadness, anger, revenge, or despair, or he cannot make decisions easily.
- The person tells you he has more thoughts of suicide when he is alone.
- The person withdraws from others.
- The person stops eating, or begins to smoke or drink heavily.
- The person feels he is a burden because of a disability or disease.
- The person has trouble dealing with stress, such as a breakup or a job loss.
- You have questions or concerns about the person's condition or care.
When should I seek immediate care? Seek care immediately or call 911 if:
- The person has done something on purpose to hurt himself or tries to commit suicide.
- The person tells you he made a plan to commit suicide.
- The person acts out in anger, is reckless, or is abusing alcohol or drugs.
- The person has serious thoughts of suicide, even after treatment.
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.
© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
References and sources