Chair: Michelle Everett
Speaker: Brian Draper
- Suicide statistics for Australia (2009) – men much more common kill themselves
-The peaks also happen to males over the age of 75
-One of the unspoken things and things we dont understand, age range 45-75 yrs – massive decrease in this age group and it has largely been unexplained, the overall rates have hardly altered in Australia over all the years
-In late life there is a peak – today our health generally has gotten better people are losing their health function more now at 75 not 65 like it was many years
-Things happen in cumulative way over their life cycle, so you cant just look at older people – we need to look at whole lives as it is all relevant
Vulnerability to suicide in late life - effects of ethnicity
-Heterogeneity in rates and methods of suicide across cultures
-Some cultures may sanction suicide
-If you look at different countries different findings, rates in Aust/NZ much higher in younger people, compared to other countries – country of origin is extremely important.
-Males more likely to kill themselves (3-4:1) across this age range, this increases after age 80 in Australia to 9:1
-There are some genetic effects and some of these are indirect – such as indirect through risk of depression, early and late onset
- The importance of early life experiences has been underestimated. Traumas included Child Abuse, Holocaust, Childhood Bereavement – these were significant.
-Personality issues – a range of traits implicated such as neuroticims, openness to experience, introverted, paranoid, hopelessness, disagreeableness. There is not a lot of research in the field but abnormal personality types does affect capacity to cope with life stresses.
-Many of the failed attempts – are closely tied to suicidality
-Life events affecting older people in suicide include: number and severety of illness, disability, pain, inrease risk with cancer, CNS, cardioresp disorders, cerebrovascular risk factors.
-It is not one thing alone it can be a combination of the above stressors
-Neurobiological factors such as low brain serotonin, HPA axis changes, grey and white matter brain changes, dementia particularly AD in young - old, cerebrovascular lesions in subcortical white matters seen on mri scans in late life depression
-Life transitions such as a diagnosis particularly with cancer or dementia – the first three months often time for suicide.
-Sociocultural factors: living alone, low social interaction, less social support, financial probelms
-Relationship Issues: marital problems, family conflicts, deaths of a spouse, caregiving (many of these people are carers and there is a high rate of depression and suicide in this group- this is one area of concern)
-Access to means: firearms, pesticides, barbiturates (older people in Australia suicide primarily by hanging)
-Mental Disorders: Combined data from 15 Psych Autopsy studies – 64% of them had clinical depression – a consistant finding – depression (45%) is a key issue. Psychoses (5%) not as important, Alcohol and others listed.
-The only consistent major risk factor was depression (for older people)
-There is therefore a reason to focus on depression
-Suicide Protective Factors (older people)
-Religion and spiritual coping, resilience, personality factors, efffective and accessible health care.
-Issue of euthenasia – at best 5-6% of those – there is not much overlap between suicide and euthenasia.
Prevention:
-We need to focus on positive ageing
-The strategies need to be framed in the above way
-Ways to make older people’s life more positive
-Education – of the public, clergy, media and health care providers. Ageism is rife out there – society has not got past this, people are also having the mistaken belief that when you are old you will be depressed but its not true. Older people more likely to cope with life and cope with their emotions so when they are depressed we need to look at it.
-Social Activities – encourage all older people to participate in social activities volunteer, casual work, clubs, provide better access to affordable transport for older people. Dont stop doing what you are doing stay active! stay socially engaged. Study from Japan 2005 showed that elderly were very engaged in the community.
-Universal Depression Prevention strategies in later life – What can you do to improve you health in later life? look after your heart and your brain will go along with it, dont smoke, eat well, get your weight down etc…these are the same strategies for preventing dementia – health ageing.
-Selective Interventions (for those with pre-symptoms): promote community programs, provide support and counselling to elderly caregivers. There are studies showing you provide emotional support – the outcomes are much better – the carers do better and the people they are looking after do better.
-Study – looking at frail elderly people that lived at home, in Veneto in northern italy. Twice weekly support and needs assessment – suicide rates were much lower over the years in that community.
-Educate asymptomatic older persons with a previous history of mood disorders about the early sign of depression relapse. Focus on medical and social services.
-Chronic Pain – pain management in late life is poor, encourage recently bereaved males to get counselling
-Indicated Interventions (applied to individuals with detectabe signs):
-Train gatekeepers such as clergy, nurses, police etc and improve screening and treatment of depression and anxiety
-Last Contact with a Health Professional:
-Discusses that in last week before death around 1/3 people saw a GP, males are less likely to discuss suicidal thoughts compared to women. There is a lot of miscommunication that occurs between families and health professionals – this issue is key.
-When you look at older people compared to controls there are not major differences – they are not regular coming in talking about major life events, it is much harder to identify an acute situation re suicide prevention.
-There is evidence you can do something, GP Education – Deps GP Study – Almeida et al, in press: older adults treated by GPs assigned to the intervention expereicned signifcant reduction on self harm behavioiur over 24 months. It is important as it is a controlled study.
-Antidepressants – decline in suicide rates in older age groups attributed to increased exposure to antidepressants but they ingored the longer term trends where rate reduction had been greater in the decades before 1990.
-We know that how we provide services combination of services – if you can bring it together well you can get good outcomes – its a challenge to get it right.
Summary
-No single approach likely to be successful alone
-A common understanding between stakeholders about the problem
-Removal of stigma
-Community readiness and political will – babyboomers are greatest chance for change
-Funding – there has been no consideration for older age funding – much of it is going to youth demographic
Discussion
1. What means do the older people suicide?
Response (Brian) : majority is by hanging
2. There was finding in national study of people beginning to self injure in their 60s can you make sense of it?
Response (Brian) we see people that are clinically depressed , as depression improves it reduces the incidence of self injury
3. Self determination has been shown to have an impact on many marginalised groups – shown to be effective – older peple are often losing control over their own lives
Response: Yes feeling they are a burden on family, common theme, perception that if they were to kill themselves they would be a less of a burden, interesting clinical wway of realising how profoundly depressed they are, the patient often hasnt got capacity to see impact of suicide brings up how deep depression is. Can be a challenge to get that self determination for those that are older
4. Pathway – package of care (mental health and ageing) are siloed – can you comment on this issue?
Response (Brian): There is a national framework but acknowledges still problems in this area in service delivery.
5. Min Butler (Ageing and Mental Health) has the two areas can you comment
Response: Butler doing good job but there is still some way to go in terms of collaboration – less silo approach etc…
6. I’m interested in online technologies – now there are mobile services going out to older people etc what are your views on this ?
Response: older people are tuned into technologies and increasingly so, lots of services worldwide, one evaluation done of residentail aged care facility one of the things they did was that they had an internet room, – and it was popular.
7. Comment: I did a Phone survey in region (62 calls) – about ageing – there was a lot of fear and it was suprising, – fear by professionals,
Response- many staff are poorly trained in the aged care facilities, many dont have good English language skills, even among trained nurses and doctors in general parts of hospitals is terrible their understanding is very poor.
8. What you have mentioned in terms of prevention is not technical it is more about community building but how do you put it in the water supply?
Resources: Things change fast, before you know it there is a restructure so hard to get momentum going. So how can we get a change re Govt mantra – dont have the answer for that but important.
