Doctors Often Miss Mental Illness in Seniors

45% of all older people who commit suicide visit their primary care physician within one month of their death.

While the suicide rate increases with age, the prevalence of psychiatric treatment decreases.  Many physicians just don’t recognize the signs of mental distress in their elderly patients. Fewer older individuals engage in self-harming behaviors than younger cohorts, and fewer attempt suicide. But far more succeed when they do attempt. 

For white men over age 65 the suicide rate is four times the national average. And while the causes of suicide attempts are clear, doctors spend less time assessing and diagnosing these individuals for mental health problems.

Seniors rarely kill themselves for legal or financial reasons, but often do so out of bereavement or the effects of physical illness.  Other causes include late onset mental illness and cognitive impairment through strokes or dementia.

It would seem obvious to screen for depression someone who has lost his spouse or is newly diagnosed with a serious disease.  Such specific situational stressors are the factors that most often lead to suicide in the elderly.  An in-depth conversation with a physician could uncover these stressors.  But in many cases these stressors are never recognized.

In fact, according to the National Institutes of Health, depression is notoriously underdiagnosed and undertreated in the elderly.  Anxiety brought on by factors such as social isolation or loneliness also often goes undetected by doctors.  When it is detected older patients with anxiety are more medicated and given less psychotherapy than younger patients. 

Yet anxiety fueled depression is the cause of one in six elderly suicides.

Perceived social connectedness greatly influences suicidal ideation in seniors as well.  People who consider themselves part of a cohesive group are less likely to consider suicide than those who feel isolated.  Psychotherapy could uncover feelings of loss of social connectedness.  If it were offered.

Psychotherapy could help in times of bereavement, a key social stressor that especially impacts older men.  Woman who are widowed are more capable of establishing new social connections than men who become widowers.  This contributes to men’s higher suicide rate.

People who belong to a religious group or live in community are less likely to commit suicide than those who feel or live alone.  If families and therapists can help seniors establish and maintain membership in such communities, their older relatives’ or clients’ mental health will hold up better than if their seniors are isolated and left alone.

But someone has to talk to them first.

Sensitive doctors can help seniors who feel especially distraught more positively approach their life and their problems. Still, doctors must be more careful to assess, and give more time to investigate, possible suicidal thoughts in geriatric patients.  For of those patients who saw their doctor within one month of committing suicide, only 20% were referred to psychiatrists.

Since noticeable situational stressors play such a large role in suicide in the elderly, and since psychotherapy can be so effective at addressing situational stressors, more mental health services should be made available to older patients.

The incredibly high and growing rate of suicide in people over age 65 is evidence that this is not happening.