In 2012, 15.9% of the Vermont population was over the age of 65, ranking #4 in the US. By 2032, 23.8% of the Vermont population is predicted to be over the age of 65, ranking #1 in the US. In 2012, 2.3% of the population was aged 85 and over, ranking #10. This age group is estimated to increase to 3.5% of the population in 2032 (rank #3) and to 5.8% of the population in 2050 (rank #2).
DATA An estimated 8,618 older Americans (ages 60+) died from suicide in 2010. Although the rate of suicide for women typically declines in older age, it increases with age among men. Older men die by suicide at a rate that is more than seven times higher than that of older women. The incidence of suicide is particularly high among older, white males (30.3 suicides per 100,000). Notably, the rate of suicide in the oldest group of white males (ages 85+) is over four times higher than the nation’s overall rate of suicide. (Injury Prevention & Control: Data & Statistics (WISQARSTM). Fatal Injury Reports. [Accessed October 25, 2012]. http://www.cdc.gov/injury/wisqars/fatal.htmlhttp://www.cdc.gov/injury/wisqars/fatal.html “Most older adults who complete suicide experience a period of depression prior to their deaths and up to 20% of these older adults were seen by their doctors within 24 hours prior to their suicides.”(L.Furst, Depressed Older Adults) Among older adults who die by suicide, approximately 77% see a primary care provider within their last year of life and 58% do so within their last month of life.
RISK FACTORS FOR OLDER ADULTS Risk factors for onset or exacerbation of depression and suicidality include: BIOLOGIC FACTORS: Comorbid chronic illness, sensory or mobility impairment, cognitive impairment, pain disorders, and presence of vascular lesions in the brain FUNCTIONAL DISABILITY: Loss of ability to maintain activities of daily living (ADL) because of illness, injury, or frailty
RISK FACTORS PSYCHOSOCIAL RISK FACTORS: Sadness and grief associated with loss of spouse, family members, friends; loss of social status accompanying retirement and aging in a culture that does not respect older adults; social isolation related to reduction of physical capacity and mobility SOCIOECONOMIC RISK FACTORS: Lower economic status; economic stress related to lower income; stress of planned and involuntary job loss
IMPLICATIONS The combination of the demographic surge in older population taking place now and for the next 20 years, and the high incidence rate of suicide deaths of older persons, necessitate a specific focus on suicide prevention measures for older persons Primary Care deserves a special focus for training and support to screen for and address depression and suicidality in the older population
WHAT ARE WE DOING NOW? There is no explicit focus on suicide prevention for seniors in the state of Vermont The Elder Care Clinicians are trained to assess for and address depression in seniors
WHAT COULD/SHOULD WE BE DOING? Forge and action partnership between health, mental health and aging services to formulate a suicide prevention plan within the context of the statewide suicide prevention platform Train aging service providers (and laypersons) to identify warning signs and refer to services those older adults who are at-risk for depression or suicide (“gatekeepers,” “mental health first aid”) Introduce depression and suicide screening in the course of non-clinical activity (senior centers, adult day, senior companion)
WHAT COULD/SHOULD WE BE DOING? Provide systematic outreach to assess and support high- risk older adults (e.g. recently widowed, socially-isolated individuals) Screen for suicidality among older adults receiving mental health or substance abuse treatment Implement evidence based practices for treating depression (IDEAS, PEARLS) Implement routine standard screening for depression and suicide in primary care Optimize diagnosis and treatment of late-life depression by using collaborative depression care management interventions in primary care like PROSPECT (Prevention of Suicide in Primary Care Elderly)