Vitamodo School · Bundle 2: Suicide Recognition & Prevention · Brochure 8 of 10 · Version 1.0
Andris Saulitis, MD
If you are yourself currently considering suicide, this brochure is not the right place to start. Please reach out to a crisis line or emergency service now.
Latvia: 116123
European Union: 112
United States: 988 (Suicide & Crisis Lifeline)
United Kingdom: 116 123 (Samaritans)
For other countries: findahelpline.com
For those who: are the adult child, partner, caregiver, or close family member of an older adult who seems not quite right, and want to know how to read what may be happening and what to do about it.
Not for those who: are themselves at risk — see the crisis lines above and reach out before reading further.
What this is — the clinical reality
This brochure is for the adult child, the partner, the caregiver, the close family member of an older adult who has begun to seem not quite right, or who has been managing alongside accumulating losses, or whom you have recently been worried about without quite knowing why. Older-adult suicide is one of the most under-recognised clinical situations in psychiatry. The risk is higher than in the general population in most countries — substantially higher in men over seventy-five — and the warning signs are quieter. Knowing how to read them, and knowing what to do, is the most important thing a family member in your position can carry.
Three things you need to know.
The first is that older-adult suicide presents differently. The teenager and the young adult often shout — through language, through dramatic withdrawal, through visible distress. The older adult more often does not. The signs are smaller: a change in the quality of conversation, a settling of affairs that looks like good organisation, a withdrawal from activities that the family attributes to aging, a new flatness in the voice on the phone. The family misses these signs not because the family is inattentive but because the signs do not match the cultural picture of suicide risk. The clinical picture of older-adult suicide includes a quietness that often passes for coping.
The second is that older-adult attempts complete at much higher rates than younger ones. This is a fact, not a fear. Older adults are more often alone, use more lethal means, are less likely to be discovered in time, and have less physiological resilience to survive an attempt. The implication is not that the situation is hopeless. The implication is that the gap between worry and action is small. The conversation that might wait a week for an adolescent often cannot wait a week for an older adult.
The third is that risk factors specific to this age group are predictable and identifiable. They are not always seen by the family because they are mistaken for the natural texture of older life. The death of a spouse. The diagnosis of a serious illness. The loss of autonomy through reduced driving, reduced mobility, reduced cognitive sharpness. Retirement that is felt as role-loss rather than relief. The dilution of social network as friends die. Chronic pain that has become daily. New medications that interact badly. The recent need for help with tasks the person had always done themselves. Each of these, in clinical practice, is a meaningful risk factor for suicide in the older adult. Several of them, together, in a person who has not been talking about how they are, is a clinical situation.