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Senior Care: Elderly Suicide

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Sad older gentleman

Loneliness & depression can bring on other challenges

The Elderly and Suicide

So we’ve all heard of depression. We even seem to be aware of what causes it & how to overcome it, but do we really?

So what’s the big deal with depression?   The deal is…

In 2011 statistical report stated that someone over the age of 65 commits suicide every 90 minutes (16 deaths per day). In 2013 it was reported that this statistic had doubled. Elders, account for one-fifth of all suicides, but it only represents 12% of the population. White males over the age of 85 are at the highest risk and completion of suicide attempts, almost six times the national average. The suicide rate among elders is two to three times higher than in younger age groups. Elder suicide may be under-reported by as much as 40% or more. Omitted are “silent suicides”, i.e., completions from medical noncompliance and overdoses, self-starvation or dehydration, and “accidents.” The elderly have a high suicide rate because they use firearms, hanging, and drowning. The ratio of suicide attempts to completions is 4:1 compared to 16:1 among younger adults. “Double suicides” involving spouses or partners occur most frequently among the aged. Elder attempters have less chance of discovery because of greater social isolation and less chance of survival because of greater physical frailty and the use of highly lethal means.

What are the causes?

Elder suicide is associated with depression and factors causing depression, e.g., chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Depression is tied to low serotonin levels. Serotonin, is a neurotransmitter in our brains that regulates and limits self-destructive behaviour.  As we age our Serotonin levels decrease placing us at greater risk. Depression remains under diagnosed and undertreated among the elderly population.

What are some of the key risk factors of elder suicide?

  • Loss of spouse.
  • A late onset depressive disorder.
  • A debilitating and/or terminal illness.
  • Severe chronic/intractable pain.
  • Decreasing independence and self-sufficiency.
  • Decreased socialization and social supports.
  • Risk often accumulates among the elderly. An individual may be white, male, and an alcohol user and then become a widower or depressed.

What are some of the myths of elder suicide?

  • It is the outcome of a rational decision and justified.
  • Elder victims are usually seriously or terminally ill.
  • Only very severely depressed elders are at risk of suicide.
  • Suicidal elders never give any indication of their intent.
  • The suicide of an older person is different from that of a younger individual.

What are the warning signs?

The following may indicate serious risk:

  • Loss of interest in things or activities that are usually found enjoyable
  • Cutting back social interaction, self-care, and grooming.
  • Breaking medical regimens (e.g., going off diets, prescriptions)
  • Experiencing or expecting a significant personal loss (e.g., spouse)
  • Feeling hopeless and/or worthless (“Who needs me?”).
  • Putting affairs in order, giving things away, or making changes in wills.
  • Stock-pilling medication or obtaining other lethal means

Other clues are a preoccupation with death or a lack of concern about personal safety. “Good-byes” such as “This is the last time that you’ll see me” or “I won’t be needing anymore appointments” should raise concern. The most significant indicator is an expression of suicidal intent.

Why aren’t community agencies or providers doing more service involvement with older men?

Community agencies basically serve elderly women who have a suicide rate well under the national mean for all ages. Community agencies may be little concerned because elder suicide is uncommon in their caseloads.

Agency philosophy:

The prevailing value in most services for the aged is to optimize self-sufficiency in terms of individual capability and safety. A commitment to autonomy may cause community agencies to let the client or patient control decisions on referrals to other resources, alerting relatives, or involving available services.

Agency Misconceptions:

  • Community agencies and providers may accept some of the myths about suicide such as:
  • If someone’s determined to commit suicide, no one can stop him or her.
  • Those who complete suicide do not seek help before their attempt.
  • Those who kill themselves must be crazy.
  • Asking someone about suicide can lead to suicide.
  • Pain goes along with aging so nothing can be done.
  • It makes sense for an old person to want to end their suffering.
  • Old people are used to death and loss and don’t feel them like younger folks.
  • Those who talk about suicide rarely actually do it.
  • How many health or human service professionals, other staff, and volunteers believe these statements to be true?

Lack of risk assessment:

A lack of attention to elder suicide and a concentration on client or patient self-determination and self-sufficiency may limit community agencies’ response. Most community agencies do not recognize the problem and consequently do little or no screening for it among their clientele.

What can community agencies do?

Individual prevention must focus on what drives suicide. “Doing something” basically comes down to caring. Community level prevention of late life suicides will require “creative partnerships of primary care providers. This means that senior centers, home care providers, hospices, adult day care, home-delivered meals programs, para-transit, and other organizations serving the elderly are going to have to team up with community mental health centers. This must start soon as the high-risk segment of the aged population is growing rapidly and the oldest baby boomers are within a few years of turning 65. The boomers will arrive in their “golden years” having manifested higher suicide rates on the way than prior generations.

If you think… This cannot be happening here in Canada, Think again!

Canada’s elderly are at high risk of suicide experts say, and Canadian men aged 85 to 89 have the highest rate of suicide. THE CANADIAN PRESS: Dr. Marnin Heisel says public awareness about suicide lets people know their physical and mental health problems can be treated effectively. Studies show that Canada’s elderly are at a much higher risk of suicide than adolescents, and there is growing concern among mental health experts that psychological care may be out of reach for most seniors. Dr. Marnin Heisel, a clinical psychologist and professor at the University of Western Ontario, says lack of public awareness of the issue is a key problem that affects not only the elderly but also their families and the public in general.

“One of the challenges that people face is thinking ‘I’m unique in this, I’m alone, there’s something wrong with me, no one can understand it,’ and then they tend to back away from family, other supports, including professional supports” Heisel said in an interview.

Public awareness lets the people struggling with these issues know that they are not alone and their physical and mental health problems can be treated effectively, he said. It may also cue their relatives into the fact that their older family members who are struggling with depression might be contemplating suicide, he said. “They might, as a result, begin asking their family (member) ‘How are you doing? Are you struggling with some of these things?’ or even asking them if they’ve thought of suicide.” A 2009 report by Statistic Canada states that men aged 85 to 89 have the highest rate of suicide among any age group in Canada, at a rate of about 31 per 100,000, and usually do so through more violent means. A report by the chief public health officer released the following year also showed that men over the age of 85 have on average higher suicide rates than all other age groups. For most Canadians, psychological services — which can easily run $100 or $200 an hour — are not covered by provincial and territorial health-care plans, but psychiatric services and medications generally are. Psychological care is covered only if it’s hospital-based. “But many if not most hospitals, at least in Ontario, typically don’t have very much in the way of psychological services and typically not for older adults,” said Heisel. “One thing we do know is that unless somebody has extremely good third-party health coverage, or they are a child in the school system, or a veteran, or if they have access to psychological services as a result of a motor vehicle collision — most Canadians can’t access psychological services unless they pay out-of-pocket. Heisel says research has shown that 75 per cent of older adults who die by suicide had seen a primary-care physician or provider within a month prior to ending their lives. “That suggests that primary care is a key place where we should be assessing for screening for suicide risk factors and then try to implement aggressive, meaning very focused, interventions,” Heisel said. “And we really don’t see that happening, literature supports that treatments works extremely well; it just requires funding to do that.” There’s also concern that many elderly suicides go undetected due to the way they are reported by coroners across Canada. “I can envision a circumstance, for example, where an elderly male is found (deceased) in a bed alone … maybe with no history of depression or suicidal thinking that he had expressed to anybody, and the coroner could determine that the death was due to natural causes and not even order an autopsy because of the age group,” said Dr. William Lucas, Ontario deputy chief coroner for inquest. “And if the person had used a relatively subtle means like an overdose of medications … that wasn’t obvious … we wouldn’t know,” he said. Heisel says research shows that when the means of death are more ambiguous, then suicide is more likely not to be detected. He goes on to say, “It’s somewhat frustrating because we really don’t know the full scope of the issue”. The frustration stems from the fact that many suicide prevention strategies are largely aimed at youth. That’s why he says he decided to speak publicly about the issue. Victims of depression say that family is what helps them the most in combating episodes of depression, in addition to staying physically active, mentally stimulated, including social companionship in their daily lives with interaction in the community. “Those are the good things in life when periods of depression start to creep in”.  Incorporate them to combat depression and from recurring episodes. One patient says… “Well if the glass is half empty, it must be half full … I try to forget about the half-empty side but what a wonderful half full my life is.” The following posted articles also speak to this issue in the same relative terms… it a bigger problem that we think and about to get bigger. Be sure to also read the posted comments from readers, as it further illustrates the issue in the elderly communities. Suicide rates climb among elderly in Canada. Elderly suicide rates hitting new highs as traditional social networks break down. Over the past years our aging population has skyrocketed. This growth is only expected to increase exponentially over the next 15-20 years. The issues we are currently facing and learning about are just the beginning of the cycle. Growing challenges relating to care of our elderly will continue to provoke our ideals of what is acceptable in our society. Anything that we have an answer for (treatment) is therefore a preventable measure… like the treatment for depression and respectively reduce depression related suicides.

The following graphs illustrate the population growth for the following demographics.

graph1depressionsuicide graph2depressionsuicide

For a more detailed population projection statistical review visit the Canadian Statistics web page.

It is within us to create an environment whereby our elders are cared for in a manner that protects them physically & holistically, paving the way for the future. Our campaign and advocacy to enriching the lives of our elderly should be one of our primary goals… “We ourselves are becoming to ones who will require care in the near future and our actions today will dictate the outcome for ourselves tomorrow”.

Senior Care: What Is Dementia?

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Dementia articleWhat is Dementia?

Dementia, is a broad term that refers to a deterioration in brain functioning. It can include thought processes, judgment, reasoning, memory, communication and behaviour.

What’s the Difference Between Alzheimer’s and Dementia?

Dementia is a broad category, while Alzheimer’s disease is a specific type, and the most common cause, of dementia. Other kinds of dementia include Huntington’s disease, frontotemporal degeneration, vascular disease, Creutzfeldt-Jakob disease, and Parkinson’s dementia.

 What Are the Symptoms of Dementia?

Dementia symptoms can included, but not limited to the following:

Cognitive changes

  • Memory loss
  • Difficulty communicating or finding words
  • Difficulty with complex tasks
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Problems with disorientation, such as getting lost

Psychological changes

  • Personality changes
  • Inability to reason
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

What Causes Dementia?

Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain. Dementia may affect people differently, depending on the area of the brain affected.

Dementias can be classified in a variety of ways and are often grouped by what they have in common, such as what part of the brain is affected, or whether they worsen over time (progressive dementias).

Some dementias, such as those caused by a reaction to medications or an infection, are reversible with treatment.

The risk of developing dementia increases as people age, but it is not a normal consequence of aging.

Prevalence of Dementia

As of 2010, more than 35.6 million people worldwide are living with dementia, or more than the total population of Canada. The global prevalence of dementia stands to double every 20 years, to 65.7 million in 2030, and 115.4 million in 2050.

Approximately half of people over the age of 85 develop Alzheimer’s disease, the most common cause of dementia. Currently, 5.4 million Americans suffer from Alzheimer’s or another dementia.

In 2011, the first wave of the baby boomers turned 65. Between 2 per cent and 10 per cent of all cases of dementia start before the age of 65 an the risk for dementia doubles every five years after age 65.

Diagnosis of Dementia

Doctors employ a number of strategies to diagnose dementia. It is important that they rule out any treatable conditions, such as depression, normal pressure hydrocephalus, or vitamin B12 deficiency, which can cause similar symptoms.

Early, accurate diagnosis of dementia is important for patients and their families because it allows early treatment of symptoms. For people with AD or other progressive dementias, early diagnosis may allow them to plan for the future while they can still help to make decisions. These people also may benefit from drug treatment.

Early, accurate diagnosis of dementia is important for patients and their families because it allows early treatment of symptoms, including:

  • Patient history
  • Physical examination
  • Neurological evaluations
  • Cognitive and neuropsychological tests
  • Brain scans
  • Laboratory tests
  • Psychiatric evaluation

If you suspect someone has dementia, arrange for a doctor’s appointment for an evaluation. Sometimes, reversible conditions such as normal pressure hydrocephalus or vitamin B12 deficiency can cause confusion or memory loss. An assessment by a doctor can determine if any of those reversible health concerns exist, as well as outline a plan for treatment.

Treatment of Dementia

While treatments to reverse or halt disease progression are not available for most of the dementias, patients can benefit to some extent from treatment with available medications and other measures, such as cognitive training.

Not withstanding the aforementioned regarding treatment of dementia. Some Medications that are approved specifically to treat Alzheimer’s disease are often prescribed to treat other kinds of dementia as well. While some people report seeing very little benefit, others report that these medications seem to temporarily improve cognitive functioning and slow the progression of dementia. Other ways to respond to changes in cognition and behaviour include non-drug approaches like maintaining a daily routine, changing how caregivers respond to the person with dementia, and paying attention to non-verbal communication from your loved one.

Preventing Dementia

There is no sure-fire way to prevent all types of dementia.

However, research suggests a healthy lifestyle can help lower your risk of developing dementia when you are older. It can also prevent cardiovascular diseases, such as strokes and heart attacks.

To reduce your risk of developing dementia and other serious health conditions, it’s recommended that you: 

  • eat a healthy diet 
  • maintain a healthy weight 
  • exercise regularly 
  • don’t drink too much alcohol 
  • stop smoking (if you smoke) 
  • make sure to keep your blood pressure at a healthy level

 

Please contact us today, to discuss any of the above mentioned challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at homecare@inourcareservices.com

 

Senior Care: Alzheimer’s & Dementia

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Alzheimers

Caring for people with Alzheimer’s and Dementia

While there’s nothing wrong with bingo as an activity, there are many reasons to think creatively when it comes to activities for those with Alzheimer’s disease and other kinds of dementia.

One of the keys is that the activity should be meaningful for the person. Often, meaning is tied to past occupation or hobbies, so what’s meaningful for one person might not be so for another. Whether you’re caring for a loved one in your own home or for a patient at a facility, consider the person’s interests, occupation and passions. If you work in a facility and don’t know the person’s history, ask their family members or observe their reaction to different activities. Then, choose a few activities they’ve responded well to and note the areas of interest. Here are a few types of people and corresponding activities to consider.

  • The Homemaker For those individuals who primarily took care of a home, you might offer a cloth to dust dressers or handrails, or to wash the table. They might enjoy folding a basket of washcloths and towels, or the task of setting the table. The object here is not to have the individual do large amounts of work, but rather to give the person something familiar and meaningful to do.
Just a note here. If you’re using this idea in a facility, you may want to ask the physician for an order that allows therapeutic work and receive permission from the family as well.
  • The Fix It Individual Was your loved one the fixer, the handyman, or the go-to guy? Maybe he’d like to sort through and match up nuts and bolts, or tighten screws into pieces of wood. Perhaps he’d like to connect smaller PVC pipes together. There are also activity boards with lots of “to do” things attached that you can purchase.
  • The Mechanic If his passion is cars, maybe he’d enjoy looking at pictures of old cars or tinkering with smaller engine parts. Some towns hold car events where older cars are displayed or driven down a road; if yours does, consider bringing him to that event. He also may be able to help you wash the car.
  • The Pencil Pusher For the person who sat at a desk and worked with papers, pens and pencils, she might love having a pile of papers to file, an adding machine or calculator to use, forms to complete or documents to read. Some people might like carrying a notebook and pen around to write down information.
  • The Musician If music is her thing, offer her opportunities to use this gift. People in the early to mid-stages of Alzheimer’s may be able to sing in a choir or play the piano. I know one woman with dementia who leads a sing-along almost daily because of her musical gifts. She’ll even take requests for which songs to play, and despite her poor memory, plays songs almost faultlessly.
If he enjoys listening to music rather than performing it, make recordings of his favorite songs and play them for him.
  • The Parent / Caregiver Have you ever noticed how people with dementia often brighten up and take note when babies and children are around? A child can often get a response when adults fail. Interactions with children and babies have been a normal part of many people’s lives. Sometimes when a person is living in a facility with other people of similar age or living at home and not getting out often, they no longer interact regularly with kids. Create opportunities for interaction with kids, whether that’s arranging for a visiting time, going on a walk together or bringing by your new baby to a facility near you.
Some older adults, particularly women, may also enjoy holding and caring for a baby doll. Often, the person connects with that baby doll and enjoys the sense of a familiar role in caregiving for the doll
  • The Animal Lover If your family member loves pets, consider having him walk the dog with you or brush the dog’s hair. If he’s not able to do these things, he might enjoy having a bird or two in a cage or a fish aquarium to watch. 
In the middle to late stages of Alzheimer’s, some people are comforted by holding a stuffed kitten or puppy. I’ve often observed them stroking the fur and holding it close.
  • The Gardener Is she an accomplished gardener? Provide her with a place to plant seeds, water them and watch them grow. She might also enjoy flower arranging or harvesting and preparing vegetables.
  • The Puzzler Although people with dementia typically have impaired memories, some of them are still quite capable of doing crossword puzzles, word searches and jumbles. Others might enjoy simple jigsaw puzzles as well. Have some different puzzle opportunities sitting out for your loved one to do.
  • The Engineer If he collected trains growing up, or is simply fascinated by them, consider setting up an electric train so he can help arrange the tracks or simply watch the activity. You can also gather a book collection or movies about trains.
  • The Sports Fan Provide the avid sports lover the chance to mini putt, do Wii bowling, play the beanbag tossing game or watch a little league baseball game. You can also arrange for several people to get together to watch the big game on television and eat some junk food, or, I mean healthy alternatives. Or, perhaps he’d get a kick out of sorting through and organizing baseball cards.
  • The Artist Art provides a creative outlet to make something, so it provides a purpose and a task. Gather some non-toxic clay, watercolor paints, washable markers, colored pens or pencils, and paper. You can use these materials in a directed way i.e. “Here’s some clay for you. Today let’s try to make a flower vase” or a non-directed way “There’s art supplies laid out on the table. Feel free to choose any color of paint to get started.” Clay and paint are great for tactile stimulation and they provide a way to occupy and strengthen the hands as well.
  • The Faithful Don’t neglect this important area. For many people, as they age, the importance of spiritual nurturing increases. Offer them books of faith in keeping with their tradition, times of prayer or meditation, or singing together.

Sources:

Alzheimer’s Society. Keeping active and staying involved. Accessed August 23, 2012.