Suicide attempts in the elderly

The New Zealand Suicide Prevention Strategy had a little to say on suicide among the elderly. It says

While suicide rates in the elderly have been declining over time, they remain relatively high, and the risk is often overlooked in this population. This is a concern because elderly who attempt suicide usually have a strong intent to die and are more likely to make attempts that are fatal; elderly people who attempt suicide usually choose more lethal means and more often live alone, which decreases their chances of being discovered. Because of their physical frailty, an elderly person may be less able to survive or recover from a physically serious suicide attempt (p.19)

Suicide in the elderly seems to me to be a complex problem. Much of the ‘problem’ may be a simple case of checking out before the pain gets any worse, before the confusion takes over, before they have to go into a home. Should we be trying to prevent that?

Suicide due to mental illness should be fought at any age, because dying before your time when things could get better is a tragedy at 17 or at 70. Intervention strategies for mental illness should be designed for people of all age groups, and screening for mental illness should be applied to the elderly as much as it should to any other age group. Losing anyone to mental illness is tragic, and it should be actively prevented if possible.

What should we do about people who are making the calculated and conscious choice to check out? I think we should be respecting that decision, not finding ways to make people who have lived their life and have a reason to go live on against their will. Sure, it’s probably impossible to make someone who really wants to die safe, especially one who has made a logical conscious decision to die, but interventions can make it more difficult, can change minds that were made up for good reasons. When someone wants to die on their own terms rather than waste away to a cancer that will cause them debilitating pain and disability, who am I to say that their choice is wrong? Or someone in the early stages of Alzheimer’s wanting to die before they become a shell of themselves, alternately blank and distressed, and no longer the person their loved ones remember.

In short, instead of preventing elderly suicides that are not the result of mental illness, I believe that we should give them the choice to die with dignity, on their own terms. Not putting barriers in their way, not judging their reasons for dying and finding them wanting, but allowing and even facilitating a good death. Perhaps a thorough mental health check – one that does not include ‘wanting to die’ as an automatic symptom of mental illness – but then, freedom and means to die on their own terms.

Assisted dying campaigns focus on allowing the terminally ill to end their lives gracefully. I think that being old and intensely aware of your mortality, as well as the reality of the way your life and death will play out, is reason enough to allow people to die in the time and place of their choosing.

I have no practical answers for how this would work, having not thought about it in much depth before now. I do know, though, that I want to be able to die rather than lose my body or mind to disease or frailty. I want to live a good life, and have a good death.

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