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A TGB READER'S STORY: The First of May

High Rates of Suicide Among Elders

In the past couple of months or so there has been an uptick in the number of media stories about old people taking their lives and, according to those articles, there is an alarming increase in the suicide rate among the U.S. older population.

”In a nation where suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults...are often overlooked.”

A six-month investigation by Kaiser Health News and PBS NewsHour finds that older Americans are quietly killing themselves, frequently in nursing homes, assisted living centers and adult care homes.

”Poor documentation makes it difficult to tell exactly how often such deaths occur,” reports the KNH/PBS study. “But a KHN analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care.

“Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows.”

According to federal statistics, 16,500 suicides were reported among people 55 and older in 2017 – 364 of them among people living in or moving to long-term care settings – or among caregivers.

Dr. Yeates Conwell is director of the Office for Aging Research and Health Services at the University of Rochester. He says the main risk factors for senior suicide are what are called “the four D’s”: depression, debility, access to deadly means and disconnectedness.

“'Pretty much all of the factors that we associate with completed suicide risk are going to be concentrated in long-term care,'” said Conwell.

Veterans are among the highest risk for suicide in recent years:

”The VA National Suicide Data Report for 2005 to 2016, which came out in September 2018, highlights an alarming rise in suicides among veterans age 18 to 34 — 45 per 100,000 veterans.

“Younger veterans have the highest rate of suicide among veterans, but those 55 and older still represent the largest number of suicides.”

Most seniors who choose to end their lives don’t talk about it in advance, and they often die on the first attempt, he said.

(The suicides referred to in the KHN/PBS article - and others I consulted - are not about people like me who have chosen, when the time comes, medically-assisted suicide. That's a different kind of end-of-life choice with different issues.)

The KNH/PBS research relates the story of Paul Andrews whose father died by his own hand. Andrews says he was “shocked, devastated and even angry about his dad’s death. Now, he just misses him.”

”'I always feel like he was gone too soon, even though I don’t think he felt like that at all,' he said.

“Andrews has come to believe that elderly people should be able to decide when they’re ready to die.

“'I think it’s a human right,' he said. 'If you go out when you’re still functioning and still have the ability to choose, that may be the best way to do it and not leave it to other people to decide.'”

Conwell see it differently. He finds the idea of

”...rational suicide by older Americans 'really troublesome.' 'We have this ageist society, and it’s awfully easy to hand over the message that they’re all doing us a favor,' he said.”

Here is a 10-minute video of this research from PBS NewsHour including some additional information.



Comments

Ronni, I think if an elder wants to end their life that is their own business. Sometimes it is the rational way out of an intolerable situation which in all likelihood will only get worse. It really bothers me that my own decision would be overridden by someone else’s moral/ethical/religious standpoint. As for the grief suffered by those left behind, they should consider it a release from suffering by the one they say they love.

The only amazing part about this is that people find it ... amazing.

I was ready yesterday. I made the mistake of telling my husband.
He was very upset. And I am still alive.
It was a dilemma...I may live another 6 months...and I will need to make the decision again.

I have always felt that one has the absolute right to stop living when (and pretty much, how) they wish. One of my brothers chose to end his life at age 70. I miss him; but, it was his choice.

Like Paula, I don't understand peoples' amazement!

I think it is a marvelous idea when the time is right but I would just need to know if it would impact any potential afterlife negatively. I would not want to screw that up for short-term gain.

I too think a person has a right to end their life.

I agree with Paula...and have been wondering how to talk to my son about this, although not at this stage now. Just sucking air is no reason to continue on, without connection, contribution, love, being heard and being able to be there for others and in nature, why? I've heard there are other options being considered, kibbutz type settings that are villages and foster normalcy, connection, continued contribution...a great idea. Look at these facilities...barren, little nature, cement, and the food....nutrition mostly carbs shown here and certainly what I saw my Mom have at her facility for 4 years. Nutrition is tied to depression, as well.

The people that don't want anyone to end their own life are the ones who are distraught about it. They are upset about someone else finding their life not worth living. Surely we should be entitled to go when we want to, not stay around for others to feel fine about us living on beyond when our life is worth living. I think much of their distress is due to feeling guilty - that they didn't give us what we needed - usually their time and attention.

But most elders want and need not only the time and attention of others, especially loved family members, but also their health, mobility, independence and freedom. When it is no longer possible to have those, life may not be worth living. Who are we to decide for someone else? All that said, people can change their mind, especially if life improves.

Suicide is kind of a hot-button issue for me. Fifty years ago I was a cog in the process of moving wounded Marines back to "the World" for rehab, and I occasionally wondered what they thought about it (because I tried not to think about it a lot). I know of at least one and have heard of several others who later ended their lives.
I think it's natural that our loved ones don't want to lose us, but that loss is inevitable. Organized religion teaches that to take one's own life is a sin although apparently inflicting the conditions that lead us to consider it is not.
My mother's last words to me were in the ICU when she took my hand and said: "Let me go."
Needless suffering is a tragedy.

Amen to most of the comments here. I find it odd that family members left behind think about how they are feeling and not about what quality of life their elder family member had and how it was their right to not continue in this life. I have a large, loving family and can’t imagine that I would ever lose my connection with them. But at some point I know I will be in enough pain and/or have lost enough abilities that I will not want to continue. MY decision! I’m 68 now and have made sure for several years that my children and older grandchildren are well aware of my feelings on this matter. In the next few years I’ll be considering how the end of my life might look if I reach that point. While I’m sure my family may prefer that I hang on as long as I can, I know that they’ll support me in what I want. I’m hoping that by starting the conversation early they will be at peace with it when it happens.

Thanks for sharing Judy Davis’s interview. I have volunteered for 4 years with a program that tries to prevent child shootings and firearm suicides. My father, after talking to my mom, stopped taking his meds after a stroke and died within a week. I never considered that suicide.

Some additional facts to consider:
many survivors of suicide do not attempt again; 75% of men over 65 who die by suicide use a firearm; the lethality rate of firearms used for suicide is 90-95%. I was surprised to hear the doctor comment that suicide rates in LTC facilities are similar to those elsewhere among elders. I would be interested in seeing data on this. It seems like means would be severely limited in a LTC facility.

My mom committed suicide at age 73. (2008) She was always a tough old broad and it was a shock to all of us. She had been grieving my dad, who died just one year prior.

I agree that no one should have the power to determine the time of death for another. As the aches and pains become more frequent and longer lasting and as the dependency on others for my care becomes larger I have considered suicide as an option. If my legs were to go I don't think that there would be any other option.

My biggest concern is how to do it without causing pain to those who love me. I have told my daughter that she must be happy for me when I die because I am free of pain. However, I am reluctant to broach the subject of suicide.

I am not planning on committing suicide at this time, but in the future, it may be a viable choice. And if that time comes I want to be able to do it with as little mess as possible. There should be a primer on how to do this.

I do not find it strange that those in Assisted Living facilities have a high rate of suicides. They have been displaced from the large home they love to live among strangers who may or may not be compatible. Their own friends are either dead or too busy to visit and the activities provided may be boring or too challenging. Only the perpetually cheerful and optimistic could find this drastic change to be the way they choose to spend their end days.

So what is the purpose in forcing elderly people to stay alive once they are no longer able to live a life of meaning? And they want to die.
So the kids don't feel guilty?
Because our society views death as some sort of abhorrent aberration?
Because some god says?

"Death with Dignity" is now legal in Colorado, as it should be nationwide. And I'll certainly choose it over chronic pain, confusion, disability, the loss of all I hold dear, and/or "life" in a warehouse. If people want to get alarmed about suicide rates they should look to our teenagers.

My mother was always adamant that she did not want to end her days in a nursing home, but then she fell. Although she was not injured, her doctor wanted her to be monitored, and my sister talked her into a nursing home with the promise it would be temporary . What my mother didn't realize is my sister had tricked her into signing herself into the facility permanently.

Mom was dead three days after she learned what my sister had done to her.

Family members should realize the choices they make for their elderly relatives might work well for them, but not for the person in question. Most people would not enjoy living in the controlled environment of nursing homes, and the assisted living facilities in my area are even worse.

I relate to every comment here (so far), except concern for an afterlife.
I’m absolutely for us having the final say in our own death. Come hell or high water, I won’t go into a nursing home to rot and eventually die a prolonged death.

I understand family being upset, but it’s really a selfish point of view. Consider the person ready to go and support them and their rights as human beings.

My only concern is how and how to be sure it will work.

Even living in a right to die state is problematic, as you have to be terminal. Some people are just tired, have had a good life and are ready to go.

The loss of a significant "other" is often a trigger. Yet, it is often true there is nobody left
to hear the story of a fulfilled life. Social isolation is devastating, hence solitary confinement. We are preparing the best we can for the inevitable. We have a few years together then the unknown. All states should be like Oregon in allowing voluntary demise.
To end life by a 4 story fall is a terrible finis to an accomplished life. The terror and pain in
the last few moments, but he knew it was time. It's like a much younger friend of mine once said: "Only here can we afford to store people in a closet". He had worked in a long term care facility. Suicide by elders is reality, more so in the future. If only we could all just slip into
that final deep sleep.

One more point...
I also think the fact that a person will deplete most if not all of their life savings they either intended for their children and grandchildren. In my case, being childless, charities that I want to have the advantages of doing more for the public or environment, at large, is my concern.
Our money,no matter what we have, should go to help our families or other organizations to help and not to profit a nursing home.
This is a factor too in desiring suicide, I think.

Ah yes, "how and how to be sure it will work"! A really bad situation could be made much worse by a failed attempt. I'm in total accord that elders should be able to elect the time and means of their own demise. I cannot imagine why anyone would be surprised that elders are ending their lives in "facilities". When you've lost your health, independence, mobility, freedom, home and human dignity--also most likely your spouse and most of your friends--the question becomes, "Why not?" Add chronic, undertreated pain and physical debility to the mix and. . .

There must be a better way!

Definitely count me among those who believe an adult, not suffering from suicidal ideation with which even they disagree, has the right to decide when life is over. My grandmother, having outlived her husband, most of her kids and friends, blind, deaf and with severe arthritis of the spine, attempted suicide from hoarded medication, in a facility. They found her, "saved" her and kept her under restraint, both physical and chemical, for almost ten years. To me that is obscene torture. I will make sure I will not be saved if I need to decide! Perhaps, in addition to talking about death, we need a more frank and open discussion of self-induced passing.

We, older survivors of all life's experiences, all need to be able to choose if and when we feel the time has come to end our own lives. And guns and jumping out of windows should not have to be the method.

I totally don't agree with those who say anyone who shares thoughts about suicide are depressed and need to be treated and watched. So---If the suicide person can't talk about it with your family and it comes as a surprise -- you should feel guilty and ask yourself and wonder why they didn't confide in you.

Mostly, I think, families just feels guilty, and /or selfishly concerned about how they react to the death and go on a mission --- making it a cause to stop all people from choosing to die.

Making it more difficult for those who will want or need a way in the future to die without a fuss.

This topic is important. Old people need to be able to decide for themselves whether or not they wish to continue to live. In Holland many years ago, after a certain age, your doctor was happy to give you a little posset that would kill you. Surprisingly few people used it.

Why is it that people are so interested in controlling other peoples' lives and deaths? Very strange.

I'm in fairly good health and not contemplating suicide, but wish my state made assisted suicide a legal option.

I think of being dead as Endless Peaceful Sleep. I don't fear being dead but I do fear dying a slow painful death. There is great pressure on doctors to prevent them from oversubscribing powerful pain killers.

Doctors say, "Don't worry about it, we will give all the drugs you need." I DON'T TRUST THEM! When push comes to shove they will turn their backs on the end-of-life patient. After all, their career is more important than the miserable old bastard who will be dead within a few weeks. No matter that he is writhing in pain, just ignore him!

I am so in agreement with all the above! The woman in the video is young. She has no idea of what life must have been like for her father. And of course, she misses him, but he was 89. He wasn't going to live forever!

Prolonging a life for years of misery and imprisonment, not to mention the using up of resources, especially in the case where younger families have to shoulder the expense, is just immoral. I suppose it is, in the end, just another way old people's concerns are not taken seriously.

I am so glad to see that almost all the comments here support Aid-in-Dying for people who have simply had enough. Those who are not allowed this option are dementia sufferers, because, it is said, they are not competent to make their own choice. Instead, they are forced to live on for years either at home with 24 hour supervision and assistance for all "Activities of Daily Living," including bathing, dressing, 'toileting' etc or in so-called "Memory Care" -- about $10,000/month and rising quickly in major urban centers. Their families have to be practically bankrupt ($3,000 in 'savings' allowed!) before government paid care in often inferior Medicaid facilities.

The law has to be changed to permit Aid-in-Dying for Alzheimer's and other dementia patients, by a prior legally recognized request made BEFORE a dementia diagnosis. All anyone has to do is to Google the "seven stages of ALZ" to know that you definitely do not want to get to seven, and six includes double incontinence, not recognizing family and in many cases, paranoia and physical violence against caregivers.

My husband, stage 5, asked me last week: "Is my wife dead?" And to our adopted son: "Who are you? and who are your parents?" But we are only five years into the diagnosis, and are told to expect at least another five, if not more. People can live for years in stage seven, totally dependent on others for being cleaned and turned.

The greatest current enemy of the right to die is Neil Gorsuch, Trump's Supreme Court pick who wrote a book outlining his anti-choice views. The individual states will have to defend what they have, so I realize the dementia issue will not go anywhere for another generation. But it needs to be recognized as a major problem. Thank you for listening.

10 years ago my father died as a result of deciding not to eat. Supposedly he also didn't drink anything, but he lived for over 30 days after his decision to fast, so he must have had some liquids at some point. The local hospice supported him, providing liquid morphine to put under his tongue and support to my mother and his brother who were with him. I didn't know anything about his decision, because of being estranged from my family for many years, but I was not surprised when I heard about his death. He had been diagnosed with a weird auto-immune disease some years before and had gradually lost the use of his legs, and then began to lose the use of his arms. He had always said he would choose suicide if or when he began to be unable to care for himself. I think he made the right decision, albeit a slower one than I would make.

I agree with so much that has been said! Who wouldn't want the choice to opt out of increasing pain, debility, loss of loved ones, and, god forbid, dementia? How dare anyone else say that an old person shouldn't have the right to make that choice? Just because they are afraid of death they shouldn't have the right to impose their fear on anyone else. Life is too full of unavoidable suffering to not try to avoid what you can.

I watched my husband, terrified of death, slowly dwindle to a weak, incontinent, confused wreck of a man. He supposedly was in palliative care but as far as I could see that care did nothing to help his suffering lest they be seen to hasten his death. My last memory of him at home was him standing in the shower, shitting uncontrollably, while I rinsed him off until I was able to get a diaper on him. Then I had to clean the shit off the bath mat and floor so he could walk to put his clothes on before I took him back to the nursing home. No thank you!

And we have pretty good health insurance! I shudder to think of those poor souls who don't.

One of the themes I see in everyone's remarks is that they don't trust others to take care of them lovingly, kindly, or respectfully. And that distrust is absolutely on target, in my opinion. Family don't want you to die because they will miss you, doctors want to try the latest thing on you or just want to forget about you because your ailments are boring and will never improve. Some people actually believe that suffering refines your "soul" or that life is worth anything, any torment. Well, let them try it themselves and not try to control other people.

Final Exit is an organization that talks frankly about suicide and I recommend that everyone check them out. Now that the medical community is having a fit about prescribing opioids it will be harder to stockpile pills for yourself. Supposedly you can go to Mexico and get barbiturates, but with Trump aggravating the Mexicans and the border, that seems very problematic. Anyway, let me leave you with one of the most important realizations of my life: IF YOU DON'T TAKE CARE OF YOURSELF, DON'T EXPECT ANYONE ELSE TO DO IT!

In a society that doesn't value, often doesn't even SEE old people, why don't they want them to kill themselves? Because then death intrudes, briefly, on the insane pursuit of youth and fitness and sexiness. Then we all see that we are fleeting, powerless, mortal.

What sensible readers you have, Ronni. I'm afraid it will be a long time before the country as a whole agrees though.

Excellent topic, Ronni.

What Darlene said times 100000.

Most of us are on the same page.

On that note..

I just started volunteering at a hospital- reading and friendly visits to veterans.

I expect to hear some heartbreaking stories.

Will do my best to elicit smiles.


Thank you, Mary Symmes, that is exactly right....take good care of yourself because nobody else is going to do it for you.....I hope that I can continue to walk daily at least 30 minutes and go to yoga as that keeps me from getting depressed. I still have someone to love, ( my spouse, my cats, my children, my grandchildren), something to look forward to and a garden and cats, and spouse to take care of....

My first reaction on reading this was that elders should get help for their depression but after reading everyone's comments I agree that at some point when one is impaired to the point of not being able to exercise, or have anything to look forward to, no one to love and nothing to do, let that person exit this world in their own way so as to avoid suffering any longer.

I agree 100% with all the sentiments expressed by the readers of this site. Are you, Ronnie,
considering suicide? I support whatever decision you make. Realize also that there is a suicide hotline phone number. Call them first.

While I never really contemplated ending my life, I certainly came close. Sick, alone and in great pain in a hospital bed listening to doctors who had no idea how to cure me, it would not have taken too much more to push me over the edge just to have it end.

We have legally assisted death legislation in Canada, but you must be terminal, and mentally capable of consent, which means many people are forced to choose to die while they still have a good quality of life, and long before they are ready, for fear of losing the ability to consent. This is totally insane.
My brother "checked out" at the age of 67 simply by discontinuing his medications. He called to say goodbye and tell me what he was doing. He died three days later. I knew how much he was suffering and understood completely. When I get to that point (we have the same inherited degenerative neuromuscular disease, but it progresses faster in men.) I will do the same. I have a DNR and No chest compressions order in place and on my fridge.
I've had this conversation with my sons over the years. They both have inherited the damn stuff from me. They understand. They watch me struggle now, to walk, to breathe at times, to deal with the constant pain and muscle weakness. It's a slow downhill journey. My Dad lived to 82 with it, maybe I will too, but he made his decision when to go as well.
I miss my brother and Dad like crazy, and grieve their deaths, but I respect their decisions. It was their lives after all.
As they say in the Italian operas, "Coraggio!" If life is to mean anything at all we have to live, and die, with courage.

Thank you for sharing! This is all very important stuff, of course.

I am glad we live in a state where Death with Dignity is acceptable. And I resent being talked down to, by anyone, as though we no longer have a brain because our limbs don't work!

Unfortunately, for some, it is a case if not having enough money to end our days in a retirement facility. I want to make sure I don't run out of money before I run out of me!

Yes, thank you Mary Symmes for an eloquent statement of what it can be like at the end.
The Alzheimer's literature provides chirpy, upbeat advice to the effect that "some people have a negative reaction to cleaning up bodily wastes," a reaction they are basically scolded for and urged to get over. I find double incontinence (which we have not yet reached) to be a kind of deal breaker, but the Memory Care option is so expensive that I know I will be dealing with it in the coming year or two. By stage 7, which can last for years, they are bedridden, don't recognize people, have to be spoon fed pureed food, diapered and changed often, and turned to avoid bed sores. Is that a life? It consumes whatever a family has managed to save for the other spouse's retirement and for some legacy to children. And there is NO POINT to these long end stage bedridden lives, except that people are afraid of a 'slippery slope' and start citing Nazi death camps which is a great way to shut down a conversation.

I want to add my thanks to Mary Symmes for her starkly honest and graphic depiction of what it means to be old and helpless. None of us should have to go through that, either as patients or caregivers.

If life is precious, then it should be treated like that. Laws should be made that allow us to take complete control of how we end our lives. And I don’t mean so-called death with dignity laws, which only add layers of bureaucratic bullshit to something which should be a simple decision made solely by the person whose death it is. We need to demand of our legislators some compassion and respect for our ability to make our own decisions about when and how we will die.

Even though, at 84, I am in complete control of my faculties, I am physically feeble and would be frustrated and exhausted about going through a complicated process of obtaining permission to die from doctors and witnesses and psychiatrists, none of whom knows me well enough to make such a decision. And, moreover, how does this absurd “six months to live” caveat come into the equation? Why don’t I get to decide the when and the how of it instead of asking a doctor who wouldn’t recognize me on the street t0 let me know how it should happen.

I'm a long time fan of Alex's Gabnet and am delighted whenever you come on as his spotlight guest. I always enjoy your segment the most!
I'm a Nurse who has worked in LongTerm care for 20 years. i don't see the elder suicide statistics reflected in any of the facilities I've worked in. Our residents are closely monitored for safety. Any high rise facilities have safety windows that only open a few inches. I think the PBS Report may be talking about assisted living complexes where residents have more opportunities to harm themselves. I hope families don't conclude that LTC aka Nursing Homes are unsafe places for their elders to live. This is just not the case!

Thanks for your intelligent musings!

Thank you Emma Jay and others who recognize that the medical prolongation of life, which works wonders in some situations, even if perhaps for a limited time, should not be applied to the kind of terrible extended lives that many people are forced into, especially those with various forms of dementia. I love my husband and always will, but when he asks me so earnestly and repeatedly, "is my wife dead?" along with " I need to call my mother" (dead for years), and wonders to our adopted son "who are you and who are your parents".... I can deal with this, it's only been five years so far, I want to keep him at home for as long as possible (he is still stage 5), but there will come a point, beginning with wandering (already had to have special locks on doors), double incontinence (stage 6) where the question is: can you physically get this person out of bed, hopefully to the bathroom a few times a day, or at any point in a week or so into a shower by your smaller self? I will let you all look up stage 7, bedridden, cleaned for bodily wastes and turned for bedsores, hand fed pureed food, which is considered "life." If the person is not violent or dangerous to themselves or others, there will be no governmental support until you are close to bankrupt (some veterans may do better). If you are not poor enough for Medicaid, but not rich enough for years of $10,000 per month or more, you are looking at spending any retirement funds for however long, leaving nothing for your adopted high school only son, not to mention yourself.

Yourself? You are that person's caretaker, punto finito as we say in Italian (how to translate -- maybe 'end of story'? ) Who do you think you are, anyway? this was something my Mother liked to ask on any pretext. I always assumed the answer was 'no one, I don't think I'm anyone, I'm sorry to exist, despite being eldest daughter, the kapo who is responsible for herding your other six children. Apologies for this personal digression -- Don't worry, I've had years of therapy about all that, but the past never prepared me for what I'm dealing with now, except to realize that I am once again in charge, although now with no over burdened mother who should have realized that I was not really up to dealing with her multiple offspring -- they arrived every 18 months, which is called natural fertility.

My central thought about dementia is to hoard the pills you would be jailed for giving to an ALZ spouse -- you don't want do this to your children. I will do anything, while competent, not to have our son live through this a second time. I'm sorry if I have posted this rant before, and I hope none of you end up out on this limb. But the fact is that one in ten persons in the USA will start in on or have some form of dementia, especially Alzheimer's by the age of 65. No one other than myself has, in my time on this site, mentioned this outcome.
Of course there are other sites. But the idea that you and yours are all somehow immune to this form of protracted and ultimately pathetic death, turned and cleaned for years no matter what you wanted -- that is a wishful illusion for one out of ten persons over 65.
Nothing to be done legally with the current Supreme Court, so make your own plans if and when you are diagnosed -- do not wait until you forget, as you will if you wait.

If you type into Google: "gillian bennett dead at noon", you will find one Canadian woman's articulate, honest story of her decision to end her own life, before encroaching dementia removed her ability to do so.

This took place before Canada's Medical Assistance in Dying legislation was passed. But as others have already pointed out, nothing has changed for those suffering from dementia.

A dementia diagnosis automatically excludes you from medical aid in dying, a fact which infuriates me beyond words.

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