The United States Senate Special Aging Committee heard moving testimony about suicide and the elderly during a July 30 hearing held by committee Chair Senator William Cohen (R-Maine) in Washington, D.C.

Those testifying included psychiatrists, the survivors of suicide victims, and an elderly couple who had been helped through a publicly funded elder services program.

Hy and Esther Nelson of Spokane, Wash., testified about how Elder Services of Spokane Mental Health had pulled them both back from the brink of suicide.

"We were literally saved by Elder Services," said Esther Nelson. "Our wonderful team came out to our home and for the first time we were evaluated as a unit, the medications were sorted through. We began to feel that someone cared. When my husband's depression reached crisis proportions and he had to be hospitalized, our team was there to smooth the way. I, personally, survived because I felt that there was a safety net beneath me, day and night. When I wanted to give up and go under, they helped me to go on. . . . The Bible says that if you save one life, it is as if you saved the world. Our team saved two of us and we are very, very grateful."

Statistics provided by Jane Pearson, Ph.D., of the National Institute of Mental Health (NIMH) showed that although persons aged 65 and older accounted for only 13 percent of the population, they accounted for 20 percent, or more than 6,000, of the suicides recorded in 1993, the most recent year for which statistics have been analyzed. The suicide rate for persons aged 80 to 85 was 24 per 100,000, or double the overall United States rate.

Mark Rosenberg, M.D., of the National Center for Injury Prevention and Control, a division of the federal Centers for Disease Control and Prevention (CDC), informed the committee that the CDC was responsible for identifying the emerging trend of rising suicide in elderly Americans. Reasons for the trend are not yet clear, said Rosenberg, but probably include social isolation, depression, and, ironically, the capacity for the elderly to live longer with chronic illnesses than was possible in the past.

One of CDC's key goals is preventive intervention. Possible interventions, some of which have been successfully applied, include community gatekeeper training, screening programs, peer support programs, and crisis centers and hotlines.

An example of the community gatekeeper program_which trains persons who are not mental health professionals to recognize danger signs of depression and to then contact a professional at a designated social service agency_was provided by Ray Raschko, M.S.W., director of Elder Services for Spokane, Wash. Mental Health, the publicly funded program that helped the Nelsons. He described two cases in which gatekeepers made successful referrals for elderly people at risk. In one, a postal carrier was the gatekeeper, while in the other a utility company meter reader played that role.

Ira Katz, M.D., Ph.D., cochair of the Geriatric Psychiatry Alliance, a 1500-member, nonprofit association of geriatric psychiatrists, pointed out that approximately 35 percent of elderly people who kill themselves have seen their primary care doctors within a week of the suicide. Clearly, said Katz, general practitioners can be better trained to identify warning signals in the elderly.

He noted that the alliance is conducting a program to educate potential patients, their families, and their physicians on depression and suicide in the elderly. Depression should not and need not be seen as a normal part of aging, Katz said.

Eric Caine, M.D. of the University of Rochester Medical Center psychiatry department, said that most elderly suicides do not occur in the context of terminal illness and extreme pain. Rather, they are symptomatic of depression. If properly diagnosed, most elderly people afflicted with depression could be adequately treated, said Caine. But psychological autopsies show that few older suicide victims ever see any type of mental health professional, nor reach out by calling a crisis center hotline, he observed.

Even well-trained primary care physicians may miss clinical depression, and data collected by Caine and colleagues suggest that only half of those who need treatment receive it.

"We can be reasonably assured that opportunities to prevent suicide in the elderly are being missed," said committee chair Cohen in a statement prepared for the hearing. "Very often, patients who commit suicide have visited their primary care physician shortly before their death. Maybe their doctor did not ask the right questions. Maybe the patient was 'putting on a good face' and was reluctant to talk about his or her feelings. And maybe the doctor was too quick to attribute the patient's depressive symptoms to the fact that he or she was ill or perhaps 'just getting old'."--R.B.K.

(Psychiatric News, September 6, 1996)