Grandpa typically pours a few scotches and tells some long, scattered stories late into the evening. Aunt Edna always mutters that everyone would be better off if she weren’t around. Since Papa passed, Nana’s wine glass doesn’t seem to have a bottom.

Maybe there’s a problem, family members have often wondered. But maybe not; they’re getting older, and who has the right to tell them how to live their life?

The losses continue to compound as the years pass. Friends and spouses pass away, health begins to fail, social networks unravel and the struggle to safely care for oneself becomes more challenging, even impossible. Without a solid savings or retirement plan to tap, finances are another source of anxiety.

Many seniors are already prescribed various medications for chronic conditions; they have easy access to firearms; they feel socially isolated. They drink alone.

It can be a deadly combination.

Older Americans, and especially older white men, are at greater risk of suicide than any other group. In the senior population, the highest suicide rates are among those who are widowed or divorced.

Seniors overall have a disproportionately high rate of suicide — 13.5 suicides per 100,000 people. Compare this to the overall rate of 11 per 100,000 people in the United States, according to the 2008 “Surgeon General’s Call to Action to Prevent Suicide, Saving Lives.”

Those diagnosed with cancer are at any even greater risk for suicide, according to three new studies released this summer from respected universities, including Harvard’s School of Public Health.

It’s a situation local medical staff, caregivers and family members around Northern Michigan face regularly as well.

“It’s something that we screen for in every patient,” said Gwen Drews, licensed master social worker and clinical supervisor of social services with Hospice of Little Traverse Bay. “Our goal is to keep people from feeling like they have to take that last desperate step to remove themselves from the pain.”
 

‘Epidemic of loneliness’

Seniors, alcohol abuse and prescription painkiller reliance are a “silent epidemic,” according to Drews. Oftentimes, dementia and memory loss contribute to a senior’s overuse of prescriptions as well.

The American Society on Aging reports that in the over-60 population, 17 percent misuse alcohol or medications. Among older citizens, alcohol-related hospitalization rates are similar to those for heart attacks. And while older people constitute 13 percent of the population, they consume 25 to 30 percent of all prescription drugs.

Depression, emotional or spiritual pain can make the end years of life seem hopeless, said Drews, not only in the hospice setting but in the general population as well, adding, “I’d say our national epidemic is loneliness.”
The access to firearms in the house, particularly around this region, is of particular concern, according to Dr. Steven Dupuis, medical director of hospice, who has a lengthy professional background working with the elderly and end-of-life care throughout the state.

Often, the request to remove firearms is met with resistance, he added. But it is imperative, because of the risk factors that accompany seniors and suicide.

It’s not only a risk for those who are ill themselves, but those who lose a long-time spouse or companion. Drews said 90 percent of bereaved individuals will think about suicide themselves.

Added Dupuis: “It’s very difficult to separate grief from depression. When you are in that much pain, the more suicidal you are.”
 

When the diagnosis is cancer

There’s more concern for our nation’s elderly. Older Americans with cancer are more than twice as likely to commit suicide as those without cancer, according to the University of Washington in a report released this summer.

Higher suicide rates are associated with being male, white and older at the time of cancer diagnosis. Patients with the highest suicide rates were those with lung, stomach, oral/pharyngeal and larynx cancers.

The cancer patients in the study who committed suicide were more likely to have advanced metastatic disease, and two-thirds of them used a firearm to commit suicide. Most of the patients who committed suicide had seen a physician in the month before their death, and 25 percent had seen a doctor within a week before their suicide.

Identifying suicide risk factors involves observing demeanor, mood changes and listening for phrases like, “I’m becoming such a burden to my family,” “I have nothing to live for,” and “Sometimes I think we’d all be better off if I just killed myself.”

“If they verbalize it, don’t just give a pat answer. You will not plant the idea of suicide in someone’s head by talking about it,” said Drews. “Please, bring it to the attention of someone.”
 

Instilling hope

Social workers with hospice are trained to provide a safe place for seniors to talk about their feelings of depression, grief and even suicide, Drews said. Part of the conversation turns to exploring hopes and dreams, even in the face of a terminal diagnosis.

“We help them explore what their dreams and goals can be within the limitations of the illness they’re facing,” she said.

She recalled one patient who was nearing the end of life who had a great desire to reconcile with a family member across the country. The patient did not have the resources or the health to travel, so hospice staff helped arrange to bring the family member to Northern Michigan.

She said she reminds patients that despite a prognosis, there is always hope for tomorrow.

“I tell them that the plans you have made for yourself may no longer apply,” she said. “So what are your dreams for the time you have left?”

It’s important for family and friends to rally around seniors who might be depressed or facing a terminal diagnosis, she added.

“We are social beings. Be there for them. It’s very important to marshal the courage to walk with your loved one through the process,” Drews said. “Your new role is to walk with them on this journey. No one should walk it alone.”