Suicide Risk in Older Adults
A Growing Challenge for Law Enforcement
By Tony Salvatore
The “graying of America” has arrived, and concern is rising regarding the societal impact of a predominantly older population. Deserving even more attention are the effects the increasing numbers of senior citizens will have on suicide rates. Elders have a higher rate than many younger age groups and account for more suicides than their proportion of the U.S. population would indicate.1 Police and other first responders must understand the nature of this risk among the aging public.
Baby boomers (born 1946 through 1964) are driving a major demographic shift in the United States. There are a large number of them, and they are living longer. In the 2010 U.S. Census, baby boomers numbered approximately 79 million and comprised 27 percent of the population.2 In late 2011 this group began turning age 65, and 10,000 more will do the same every day until the end of 2030.3 The oldest boomers are in their 60s, and the youngest are middle-aged.
From 1999 to 2010 the number of suicides in the United States among individuals aged 50 to 59 doubled, and the rate increased almost 50 percent.4 During this period, men accounted for the largest number of incidents in this age group; however, there was a significant increase among women aged 55 to 59.5 Individuals aged 45 to 49 had the highest occurrence of suicide over this time, and this likely will continue as people in this age bracket become older.6
Some studies attribute the upsurge of suicide in middle-aged adults to the economic recession, prescription drug overdoses, and residual risks from high incident rates among baby boomers in their younger years.7 The latter, known as the “cohort effect,” occurs when a particular generation has a suicide rate it carries through life.8 As early as 1994 researchers noted that one out of every three victims was a baby boomer.9 Individuals in this age group also engaged in nonfatal suicidal behaviors.10 Previous suicidal ideations heighten both near-term danger of completing suicide and lifetime risks.11
The population of middle-aged adults carries other serious risk factors. Most prevalent among these is race.12 The U.S. Census found that the largest group, with over 83 percent of suicide victims, was Caucasian.13 The rate increased from 1999 to 2005 primarily because more whites aged 40 to 64 completed suicides.14
Social isolation, pain, physical illness, and functional impairment are critical risk factors for suicide in older adults.15 These problems may relate to a loss or lack of social connections, reduced resistance to potentially lethal self-harm, a personal belief of being a burden to others, or feeling one’s life is worthless.
Mr. Salvatore coordinates suicide prevention and postvention at Montgomery County Emergency Service in Norristown, Pennsylvania.
Many middle-aged Americans are entering their twilight years with no close interpersonal relationships. Divorce rates doubled among adults aged 50 and above between 1990 and 2009 and tripled among women in this age group.16 In 2009 one of four divorces involved someone 50 or older.17 One-third of baby boomers are divorced, separated, or never married.18 Living alone and having no strong social network are major suicide risk factors in elderly individuals.19 This is particularly true in older men and those who are bereaved.
Another risk factor for aging adults is substance abuse.20 Many baby boomers actively experimented with substances at some time in their lives.21 Such unsafe behavior lowers resistance to self-harm. For many boomers this activity carried over into their older years.22 Individuals aged 45 to 64 made up over one-fourth of all emergency department visits in the United States for drug-related suicide attempts in 2011.23
Alcohol use and abuse correlates with suicide in older adults.24 Problem drinking increases risk by interacting with other factors, such as depressive symptoms, medical illness, disability, a negative self-perception of health status, and limited social ties.25 It is estimated that countless baby boomers used alcohol in greater quantity and frequency than earlier generations, and this use likely will continue.26
Adults 45 to 64 years of age are more likely than other age groups to report physical suffering lasting over 24 hours.27 This is a potential sign of chronic pain, which may persist for weeks, months, or even years. Recurring pain is a precipitant for completed suicide attempts because an individual used to hurting less likely will fear the pain associated with an injurious suicide attempt.28
One study in 2013 found that people aged 49 to 67 were more likely than their parents at the same age to suffer from obesity, diabetes, and high blood pressure.29 Chronic musculoskeletal problems top the list of health complaints for this age group, which also reports that these conditions impinge on daily living activities. Increased disability in later years raises the risk for suicide.30
Depression is a significant contributor to suicide risk in aging adults.31 Baby boomers manifest depressive disorders at higher rates than previous groups did at the same age.32 This correlates with the prevalence of chronic pain and disability and combines with such conditions to amplify the risk.
Older persons differ by gender on the methods employed in suicide attempts. Almost 80 percent of men aged 60 and over used firearms compared with less than 40 percent of women.33 Poison was the means chosen by over 40 percent of women, but less than 8 percent of men.34 Almost 13 percent of female victims and 10 percent of male victims used hanging, strangulation, and suffocation.35 Falls, drowning, cutting, piercing, and use of motor vehicles each accounted for less than 2 percent of suicides in elderly people.36
Senior citizens more likely will die in suicide attempts because of their choice of lethal means.37 Compromised health also lowers the chance of survival. Older adults typically do not report suicidal ideation prior to an attempt, nor do they seek mental health assistance.38 There is not much warning of imminent danger with older people.
Firearms are common in homicide-suicides among older people, which, though rare, are expected to rise. Specific danger signs include a depressed elderly man with new or worsening health problems who is the main caregiver for a dependent spouse and who has access to a firearm.39 Homicide-suicides are more common in couples in their 80s, generally with the wife murdered by the husband who then completes suicide. Typically, the female victim is in her spouse’s care or under his control in a relationship with a history of domestic violence or marital discord.40
Veterans more likely will own firearms as they age and use one to complete a suicide attempt. Elderly veterans are at high risk for suicide because military training and exposure to trauma lower resistance to lethal self-harm.41 In 2012 the median age of male U.S. veterans was 64, and 36 percent were between ages 45 and 64.42 Veterans entering their later years have a higher rate of suicide than earlier generations of veterans had at the same point in their lives.43
Law Enforcement’s Role
With a potentially suicidal older adult, law enforcement officers and first responders must ensure the safety of all parties, including themselves. Additionally, officers need to determine if the individual is in near-term danger of completing suicide. They can do this by screening for suicide risk factors. Several questions can help identify these factors in older adults.
- Does the individual cite a loss of meaning, usefulness, or purpose in life?
- Does the person exhibit or express poor coping, problem-solving, or help-seeking skills?
- Has the individual reported intimate partner conflict or social isolation?
- Is there a history of suicidal behavior, mental illness, or substance abuse with this person?
- Is this individual dealing with legal or financial problems believed to be insurmountable?
- Does the person exhibit signs of physical illness or disability, or does the first responder believe these are present?
Generally, the more risk factors that exist, the higher the danger for suicide. When risk factors are present, the officer should send the person to the nearest hospital emergency department or crisis center. If the individual is uncooperative, the first responder should initiate the process for securing an involuntary psychiatric evaluation. When in doubt it is advisable to always err on the side of safety and ensure that a psychiatrist or other appropriate health care professional performs a suicide risk assessment as soon as possible. Officers and other first responders should keep certain points in mind when dealing with a suicide call involving an older adult.
- Officers should assume the individual is close to or over the threshold for imminent danger.
- There is a high probability that any suicide plan is based on highly lethal means.
- If dealing with an older man, especially a veteran, firearms may be present.
- There may be little opportunity for negotiation or crisis intervention.
- Because of social isolation, collateral information or contacts may be unavailable.
- Inflexibility and rigid personality styles can contribute to suicide risk in older adults.
- A major transition, such as a housing change, could trigger suicidal ideations in elders.
Police Officer Risk
There are many retired and soon-to-retire police officers among the group of baby boomers. These individuals carry the suicide risk factors (along with their firearms) acquired during their careers into old age. Estimates indicated that 40 retired police officers complete suicide annually, but the actual number likely will be higher and continue to rise.44 Studies have suggested that “absence of friends, loss of status as a law enforcement officer, and a decline of self-definition leave some retiring officers vulnerable to suicide.”45 Efforts to address suicide risk in active police officers must extend to former officers also at risk.
Suicide among baby boomers has increased significantly. In part this has been attributed to the recession and prescription drug overdoses. High divorce rates and alcohol abuse among boomers may add to the increase. Individuals in this group likely will suffer from obesity, diabetes, and high blood pressure. Additionally, seniors often choose more lethal means and do not report suicidal ideations.
Certain traits in older adults constitute high risk factors for suicide. The key characteristics—caucasian, male, living alone, depressed, previous suicidal behavior, serious illness or disability, chronic pain, substance abuse, or military service—are tools law enforcement officers and first responders can use to help determine if a senior adult who is the subject of a mental health call or other contact could be suicidal.
Officers first must ensure that all individuals, including themselves, are safe. Next, they should determine if the person is close to completion of a suicide attempt. They should evaluate the risk factors, and remember that the danger of suicide increases as more of these factors are present. Most important, they should make certain that the individual is properly evaluated and taken to a hospital or crisis center to receive the help needed. All officers and first responders should be aware of the risk factors and potential means a person may use to commit suicide.
Many officers are retired or close to retirement age and may possess some of these characteristics as well. If officers see that they, their fellow officers, or retired cohorts are at risk, they should seek assistance immediately.
Mr. Salvatore may be contacted at email@example.com.
1 Centers for Disease Control and Prevention, “Suicide Among Adults Aged 35-64 Years—United States, 1999-2010,” Morbidity and Mortality Weekly Report 62, no. 17 (May 3, 2013): 321-325, accessed June 4, 2015, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm.
2 United States Census 2010, http://www.census.gov/2010census/.
4 Centers for Disease Control and Prevention, “Suicide Among Adults Aged 35-64 Years.”
7 Julie A. Phillips, Ashley V. Robin, Colleen N. Nugent, and Ellen L. Idler, “Understanding Recent Changes in Suicide Rates Among the Middle-Aged: Period or Cohort Effects?” Public Health Reports 125, no. 5 (September-October 2010): 680-688, accessed June 4, 2015, http://www.publichealthreports.org/issueopen.cfm?articleID=2514.
9 John L. McIntosh, “Generational Analyses of Suicide: Baby Boomers and 13ers,” Suicide and Life-Threatening Behavior 24, no. 4 (Winter 1994): 334-342.
11 Annette L. Beautrais, “A Case Control Study of Suicide and Attempted Suicide in Older Adults,” Suicide and Life-Threatening Behavior 32, no. 1 (Spring 2002): 1-9.
12 Guoqing Hu, Holly C. Wilcox, Lawrence Wissow, and Susan P. Baker, “Mid-Life Suicide: An Increasing Problem in U.S. Whites, 1999-2005,” American Journal of Preventive Medicine 35, no. 6 (December 2008): 589-593.
13 United States Census 2010, http://www.census.gov/2010census/.
14 Hu, Wilcox, Wissow, and Baker, “Mid-Life Suicide.”
15 Kimberly Van Orden and Yeates Conwell, “Suicides in Late Life,” Current Psychiatry Reports 13, no. 3 (June 2011): 234-241, accessed June 4, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085020/.
16 Yeates Conwell, “Older Adults: Changing the Alarming Statistics,” National Council Magazine, no. 2 (2012): 62-64, accessed June 4, 2015, http://www.integration.samhsa.gov/health-wellness/NC_Mag_Web_Revised.pdf.
18 Susan L. Brown and I-Fen Lin, “The Gray Divorce Revolution: Rising Divorce Among Middle-Aged and Older Adults, 1990-2010,” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 67, no. 6 (October 9, 2012): 731-741, accessed June 4, 2015, http://psychsocgerontology.oxfordjournals.org/content/67/6/731. full.pdf+html.
20 Frederic C. Blow, Laurie M. Brockmann, and Kristen Lawton Barry, “Role of Alcohol in Late-Life Suicide,” Alcoholism: Clinical and Experimental Research 28, S1 (May 2004): 48S-56S.
21 Louis A. Trevisan, “Baby Boomers and Substance Abuse,” Psychiatric Times (July 1, 2008), accessed June 4, 2015, http://www.psychiatrictimes.com/ geriatric-psychiatry/baby-boomers-and-substance-abuse.
22 Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits, HHS Publication No. (SMA) 13-4760, accessed June 4, 2015, http://www.samhsa.gov/data/sites/default/files/ DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf.
24 Blow, Brockman, and Barry, “Role of Alcohol in Late Life Suicide.”
27 U.S. Department of Health and Human Services, National Center for Health Statistics, HHS Publication No. 2006-1232, Health, United States, 2006 with Chartbook on Trends in the Health of Americans, accessed June 4, 2015, http://www.cdc.gov/nchs/data/hus/hus06.pdf.
28 Thomas Joiner, Why People Die by Suicide (Cambridge, MA: Harvard University Press, 2005).
29 Paola Scommegna, “Aging U.S. Baby Boomers Face More Disability,” Population Reference Bureau (March 2013), accessed June 4, 2015, http://prb.org/Publications/Articles/2013/us-baby-boomers.aspx.
31 Yeates Conwell, Paul R. Duberstein, and Eric D. Caine, “Risk Factors for Suicide in Later Life” Biological Psychiatry 52, no. 3 (August 1, 2002): 193-204; and Forrest Scogin, “Depression and Suicide in Older Adults Resource Guide: Introduction,” American Psychological Association, September 2009, accessed June 4, 2015, http://www.apa.org/pi/aging/ resources/guides/depression.aspx.
32 Scogin, “Depression and Suicide in Older Adults Resource Guide: Introduction.”
33 Debra Karch, “Sex Differences in Suicide Incident Characteristics and Circumstances Among Older Adults: Surveillance Data from the National Violent Death Reporting System—17 U.S. States, 2007-2009,” International Journal of Environmental Research and Public Health 8, no. 8 (August 2011): 3479-3495, accessed June 4, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166755/.
37 Yeates Conwell and Caitlin Thompson, “Suicidal Behavior in Elders,” Psychiatric Clinics of North America 31, no. 2 (June 2008): 333-356, accessed July 6, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735830/.
39 Scott Eliason, “Murder-Suicide: A Review of the Recent Literature,” Journal of the American Academy of Psychiatry and the Law 37, no. 3 (September 2009): 371-376, accessed June 10, 2015, http://www.jaapl.org/content/37/3/371.full.pdf+html.
40 Donna Cohen, Maria Llorente, and Carl Eisdorfer, “Homicide-Suicide in Older Persons,” American Journal of Psychiatry 155, no. 3 (March 1998): 390-396, accessed June 10, 2015, http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.155.3.390.
41 Thomas Joiner, Why People Die by Suicide.
42 National Center for Veterans Analysis and Statistics, Profile of Veterans: 2012—Data from the American Community Survey (Washington, DC: U.S. Department of Veterans Affairs, 2014), accessed June 10, 2015, http://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2012.pdf.
43 Mark S. Kaplan, Bentson H. McFarland, Nathalie Huguet, and Marcia Valenstein, “Suicide Risk and Precipitating Circumstances Among Young, Middle-Aged, and Older Male Veterans,” American Journal of Public Health 102, S1 (March 2012): S131-S137, accessed June 10, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496453/.
44 “Police Retirement—The Final Trauma,” The Badge of Life, accessed June 10, 2015, http://www.badgeoflife.com/retirees.php.
45 John M. Violanti, “The Mystery Within: Understanding Police Suicide,” FBI Law Enforcement Bulletin, February 1995, 19-23.