1. Suicide Prevention for Older Adults: Depression is NOT Normal Aging Alan Holmlund Director MDPH Suicide Prevention Program 18 APR 07

2. Learning Objectives 1. Increase knowledge of the scope of suicide in MA (and US) 2. Gain an understanding of suicidal behavior in older adults 3. Learn about effective strategies to prevent suicide

3. Examining Our Own Attitudes What associations do we have to the word “suicide”? What associations do we have to the word “suicide”? What do we “know” about suicide? What do we “know” about suicide? What do we “know” about people who are suicidal? What do we “know” about people who are suicidal?

4. Suicide in the US 32,439 completed suicides in 2004 32,439 completed suicides in 2004 11 th leading cause of death 11 th leading cause of death Rates highest in intermountain states Rates highest in intermountain states Males complete 4 times the rate of females Males complete 4 times the rate of females Females attempt at 3 times the rate of males Females attempt at 3 times the rate of males Elder rates 50% higher than national avg Elder rates 50% higher than national avg

5. Elder Suicide Fact Sheet Disproportionate number of suicides Disproportionate number of suicides Highest rate of any age group Highest rate of any age group 85% of elder suicides are male 85% of elder suicides are male Low attempt to completion ratio Low attempt to completion ratio After age 60 rate declines for women After age 60 rate declines for women Firearms most common means Firearms most common means 66%-90% have diagnosable mental illness 66%-90% have diagnosable mental illness 2-4% completed suicides are terminally ill 2-4% completed suicides are terminally ill

6. Suicide in Massachusetts Suicide 2.5 times rate of homicide Suicide 2.5 times rate of homicide 25 attempts for every completion 25 attempts for every completion Hanging most frequent method Hanging most frequent method Men of middle age – highest number Men of middle age – highest number Men 80+ years more than twice state rate Men 80+ years more than twice state rate Mental health and substance abuse in 69% of completions Mental health and substance abuse in 69% of completions 35,700 adults attempted in past year 35,700 adults attempted in past year 17,580 high school students attempted 17,580 high school students attempted

7. Elder Risk Factors Male, white and old old Male, white and old old Depression Depression Access to firearms Access to firearms Substance abuse Substance abuse Social isolation Social isolation Physical illness or fear of prolonged illness Physical illness or fear of prolonged illness Major changes in social roles Major changes in social roles Missed opportunities in clinical settings Missed opportunities in clinical settings

8. Warning Signs: Depression Physical Aches, pains, or other physical complaints Aches, pains, or other physical complaints Marked changes in appetite Marked changes in appetite Change in sleep patterns Change in sleep patterns Fatigue FatigueEmotional Pervasive sadness Pervasive sadness Apathy Apathy Decreased pleasure Decreased pleasure Crying for no apparent reason Crying for no apparent reason Indifference to others Indifference to others Changes in Thoughts and Feelings Feelings of hopelessness and helplessness Feelings of hopelessness and helplessness Feelings of worthlessness Feelings of worthlessness Impaired concentration Impaired concentration Problems with memory Problems with memory Indecisiveness Indecisiveness Recurrent thoughts of death and suicide Recurrent thoughts of death and suicide Changes in Behavior Loss of interest in previously enjoyed activities Loss of interest in previously enjoyed activities Neglect of personal appearance Neglect of personal appearance Withdrawal from people Withdrawal from people Increased use of alcohol Increased use of alcohol Increased agitation Increased agitation Talking about the "end" Talking about the "end" Adapted from Schmall V, Lawson L, Stiehl R. Depression in Later Life: Recognition and Treatment. Pacific Northwest Extension publication. Corvallis, Ore, 1993

9. Is Depression Different in the Elderly ? Similar prevalence Similar prevalence Higher co-morbid physical illness Higher co-morbid physical illness More refractory to treatment More refractory to treatment Higher relapse and recurrence Higher relapse and recurrence Under diagnosed Under diagnosed Under treated Under treated

10. Warning Signs of Suicide Direct or indirect communication Direct or indirect communication Giving away possessions Giving away possessions Getting affairs in order Getting affairs in order Saying good bye Saying good bye Sudden interest or disinterest in religion Sudden interest or disinterest in religion A plan A plan

11. What You Can DO For at risk individuals Ask the Question Ask the Question Listen actively Listen actively Persuade them to seek help Persuade them to seek help Involve others Involve others Accompany them to help Accompany them to help Make a Referral Make a Referral

12. What You Can DO For your constituents Sponsor a suicide prevention awareness training Sponsor a suicide prevention awareness training Further educate yourself – websites, statewide conference Further educate yourself – websites, statewide conference Join the MA Coalition for Suicide Prevention Join the MA Coalition for Suicide Prevention Apply for suicide prevention funding (FY08) Apply for suicide prevention funding (FY08) Promote depression screening by doctors, nurses, elder caregivers Promote depression screening by doctors, nurses, elder caregivers Know community referral sources Know community referral sources

13. Prevention Strategies Primary care health professional screening training and materials Primary care health professional screening training and materials Gatekeeper training Gatekeeper training Psychiatric consultation for primary care MD’s Psychiatric consultation for primary care MD’s Means restriction Means restriction Guideline based depression care Guideline based depression care

14. MDPH Suicide Prevention Program 7 community-based service contracts 7 community-based service contracts School of Social Work Planning Grants School of Social Work Planning Grants QPR Certification Training QPR Certification Training Statewide Suicide Prevention Conference Statewide Suicide Prevention Conference Assessing and Managing Suicide Risk Training - Mental Health and Substance Abuse professionals Assessing and Managing Suicide Risk Training - Mental Health and Substance Abuse professionals Strategic Planning Strategic Planning Data collection and analysis support Data collection and analysis support Program evaluation Program evaluation FY08 FY08

15. Summary Elderly suicide is not part of the natural course of aging Elderly suicide is very often the result of untreated depression Elderly depression needs to be recognized and treated All patients expressing a wish to die should be carefully screened for depression and cognitive impairment Elderly Suicide is Preventable