July 7, 2014

Catching The Big One


Catching The Big One

by Dan Roberts
Caregivers of older adults have understandable concerns about potential suicide when their loved ones begin talking about death. They may, however, be worrying unnecessarily. During those moments, three questions need to be considered:

1. Is the person depressed?
2. Is the person suicidal?
3. Is the person simply sharing personal thoughts?

Risk factors for significant depressive disorder and suicidal behavior are similar, but the two disorders are not synonymous. Common risk factors for late-life depression include:

• Complex interactions among genetic vulnerabilities
• Cognitive changes
• Loss of interest
• Health changes
• Stressful events
• Insomnia
• Curtailment of daily activities
• Self-critical thinking (1)

Suicide is an outcome of depression displaying these additional risk factors:

• Previous suicide attempt(s)
• History of depression or other mental illness
• Alcohol or drug abuse
• Family history of suicide or violence (2)

All factors should be taken into account, but with the realization that, while tending to talk freely about death, older adults are less likely than younger adults to actually talk about ending their own lives. Instead, they focus more on expecting death and on their wish to go there.(3) Talking about one’s own death is different than wanting to cause it. Understanding this difference can lead to more sensitive communication between the young and the old.

The short narrative, “Catching the Big One”, personifies a large segment of the older adult population. The author hopes it will encourage open conversation among caregivers and the people they serve.

Read/Print it here.
1. Age differences in depression and anxiety symptoms: a structural equation modelling analysis of data from a general population sample. Christensen H, et al (Psychol Med. 1999 Mar; 29(2):325-39.)
2. Centers for Disease Control and Prevention (CDC) fact sheet (Published online at www.cdc.gov/violenceprevention/pdf/suicide_factsheet_2012-a.pdf
3. Suicide in late life. Review and commentary. Blazer DG, Bachar JR, Manton KG (J Am Geriatr Soc. 1986 Jul; 34(7):519-25.)

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