This article explores the topic of suicide by older adults and may be distressing to some readers.
” Even the darkest night will end and the sun will rise.” Victor Hugo
Three people I know have chosen to suicide in their later years. I’m not talking about Voluntary Assisted Dying (VAD) where the legal and medical processes are clearly articulated. No, the older adults I’m talking about planned their own deaths and enacted them successfully without telling anyone of their plans.
Having a friend, colleague, acquaintance commit suicide raises a multitude of feelings in addition to the normal grief process associated with death. Why didn’t they talk to me or seek help? It’s such a selfish act, what about those they leave behind? What about those people that have to find them dead? What could I have done to prevent this? Why were they so desperate? Why did they die in a hotel far away from family? They’ve gone, but we have to carry the pain: what a terrible way to die. Why didn’t his/ her family know about their plans? Isn’t suicide illegal? Did they die as criminals? Where was his/her partner? Why didn’t they know of their plans to suicide?
These are among the comments made in the aftermath of the tragic deaths by suicide of those I knew.
As a society we are only just starting to talk about death at all. In Western Anglo cultures death is handled by professionals; the funeral home, priests and ministers and celebrants. People ” pass away” rather than die. We give to charity instead of sending flowers. Tea and sandwiches follow the funeral. But things are changing. We now talk of ” celebration of life ” rather than a funeral. We have biodegradable baskets or cardboard coffins instead of oak with brass handles. We meet in pubs and gardens, sing and look at audio visual shows of the dead person’s life……. and yet when it comes to death by suicide we freeze, whisper and adopt a different type of judgmental grief.
” To anyone out there who’s hurting- it’s not a sign of weakness to ask for help. It’s a sign of strength.” Barak Obama
Before we look at some of the issues raised, what is the extent of death by suicide in older people? We hear about young men being the most vulnerable group, but what about older people?
Trends in suicide rates for older adults
Here are some interesting statistics
- For the over 60’s suicide occurs at a rate of 11.8 deaths per 100,000 people (average annual rates)
- Men 85 and over have the highest suicide rate across all age groups at the rate of 31.2 deaths per 100,000 people
- In comparison women aged 85 plus suicide at a rate of 7.8 deaths per 100,000 people
- Recent ABS data showed an 18% spike in age specific suicide rate for men in the 60-64 age group
- There are also distinct trends for older Australians using the Aged Care system. Those using Home Care Packages have an average annual suicide rate of 21.5 per 100,000. Those in Residential Care are less likely to suicide, the rate being 13.0 per 100,000.
What are the risk factors for people taking their own lives?
- Chronic pain and disability
- Social isolation especially after the loss of a partner
- Major life transitions such as forced retirement, ceasing driving, loss of mobility, leaving one’s home for residential care
Clearly there is a significant risk for men to die by suicide in their older age and women much less so.
Let’s look at some of the responses to death by suicide
Legal Issues
In Victoria suicide and attempted suicide are not criminal offences under state law. Section 6A of the Crimes Act 1958 (Vic) officially decriminalized the act of a person taking or attempting to take their own life.
However it remains a serious crime for anyone to incite, assist, aid anyone outside of the Voluntary Assisted Dying (VAD) framework. That’s tragically, why so many people die alone, telling no one of their plans and dying in interstate, anonymous hotels. This is a devastating way for people to end their lives. They die protecting friends and family from possible criminal consequences.
The Brain in Suicidal Ideation
It’s natural to be angry, distressed and judgmental when someone we know dies by suicide. It’s a terrible experience.
Neurologists are now learning a lot more about how the brain works when suicidal ideation is happening. We know that someone thinking about death by suicide has very different brain functioning to ours. In a suicidal person the brain is under severe stress where its normal capacity to regulate pain and decisions is temporarily impaired. Suicide is not just an emotional choice nor a rational choice.
” Key changes include an underactive prefrontal cortex (making problem-solving and emotional regulation harder), a hyperactive amygdala (amplifying emotional pain) and chemical imbalances, specifically low serotonin and increased brain inflation.” Sadek, J. Front Psychiatry May 2024
In other words someone in pain, depressed and with suicidal ideation is not capable of making the same logical decisions as those left behind. Suicide appears to the mentally ill as a solution to resolve pain and free the family and friends from witnessing the incessant, dark pain of their life. It’s a distortion in thinking that needs clinical intervention, but often its too late.
“Sometimes even to live is an act of courage.” Seneca
The cruel fact is that until death with dignity and VAD is made more accessible for older adults, men in particular will be at greater risk of dying by suicide. Families and friends who have lost someone to suicide need our compassion, understanding and freedom from judgment. Those who have died deserve the same respect, dignity and compassion. Death by suicide is a tragic loss. Blame and judgment have no place in this dark time.