Depression and Suicide in the Elderly

Depression and Suicide in the Elderly

Depression is quite common in older adults, is often unreported and unrecognized, diminishes quality of life, and can lead to suicide.

Depression Facts

■ Depression often occurs with other serious illnesses such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. ■ Older adults are subject to various social and economic difficulties. ■ Health-care professionals should not assume that depression is a normal response to illness and loss. ■ Depression should be treated when it occurs alone or with other illnesses; untreated depression can delay recovery from or worsen the outcome of other illnesses. ■ Up to 25% of nursing home residents are depressed. ■ Cognitive-behavioral therapy and interpersonal therapy with antidepressant medication are effective in 80% of older adults with depression. ■ Older adults are more likely to die as a result of suicide than younger persons. ■ Older adults often use highly lethal methods and are less able to recover. ■ Events associated with suicide in older adults include death of a loved one, physical illness, chronic pain, fear of dying a prolonged death; fear of becoming a financial or physical burden to their families, social isolation, loneliness, and feeling useless.

Signs and Symptoms of Depression

Physical ■ Aches, pains, stomach problems ■ Changes in appetite ■ Insomnia or excessive sleeping ■ Feeling tired all the time Emotional ■ Unrelenting feeling of sadness ■ Apathy and diminished pleasure ■ Crying for no apparent reason ■ Indifference to others ■ Feelings of hopelessness and helplessness ■ Feelings of worthlessness Cognitive ■ Impaired concentration ■ Problems with memory ■ Indecisiveness ■ Recurrent thoughts of death and suicide Behavioral ■ Neglecting personal appearance ■ Withdrawing from others ■ Increased alcohol consumption or use ■ Agitation/anxiety

Signs of Suicidal Intent

■ Talking about death as a relief ■ Giving away possessions ■ Failing to take prescribed medicines ■ Obtaining a weapon

Nursing Interventions

■ Assess patients for signs and symptoms of depression. ■ If patient is depressed, ask if he or she has thought about committing suicide. ■ Show interest and offer support; elders may want to talk about their lives. Called life review, these talks can help the older adult identify the main themes of their lives, express regret, and talk about their legacy. ■ Avoid giving pat answers or advice such as “you have a lot to live for” or avoiding the conversation altogether. ■ Identify the patient’s support among friends, family, clergy. ■ Remove implements or medications that can be used for suicide. ■ Notify other staff, document your findings, and participate in the plan of care.