Loneliness, debilitation, and depression blamed for seniors’ rising suicides

nprsuicide-300x224The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising,  National Public Radio reported.

NPR, noting that suicide already is the 10th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

“Approximately 80% of older adults live with a chronic disease – such as arthritis, diabetes and high blood pressure — and 77% have at least two, according to The National Council on Aging. As senior citizens lose the ability to complete once routine daily tasks, depression can set in. Physical ailments might end a senior’s ability to drive, read, engage in conversation or other activities that allow a person to stay independent or find meaning.”

Other news organizations, separately, described health concerns that can burden and concern seniors.

Drugs can impair cognitive capacities

Judith Graham, of the Kaiser Health News Service, reported in the Washington Post that an estimated “1 in 4 older adults take  anticholinergic drugs — a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders.”

The problem with these medications is that, “To various degrees, each of these drugs blocks an important chemical messenger in the brain, acetylcholine,” Graham reported. This can cause cognitive issues severe enough so patients may seem as if they suffer dementia. She added:

“Some medications have strong anticholinergic properties, others less so. Among prescription medicines with strong effects are antidepressants such as imipramine (brand name Tofranil), antihistamines such as hydroxyzine (Vistaril and Atarax), antipsychotics such as clozapine (Clozaril and FazaClo), antispasmodics such as dicyclomine (Bentyl) and drugs for urinary incontinence such as tolterodine (Detrol). In addition to prescription medications, many common over-the-counter drugs have anticholinergic properties, including antihistamines such as Benadryl and Chlor-Trimeton and sleep aids such as Tylenol PM, Aleve PM and Nytol. Common side effects include dizziness, confusion, drowsiness, disorientation, agitation, blurry vision, dry mouth, constipation, difficulty urinating and delirium, a sudden and acute change in consciousness.”

While seniors may show improvements if taken off or given reduced levels of anticholinergic drugs, the drugs also are under study to determine if they contribute not just to symptoms but also may be associated with dementia onset.

Alzheimer’s and dementia are among the conditions that Americans most dread, so cognitive decline that seems a part of either could be serious mental health matters for already anxious and depressed seniors.

Binge drinking a bane for seniors

Older Americans, of course, may be worsening their well-being with another substance: alcohol, the New York Times reported. New research by experts at New York University found that 1 in 10 Americans 65 and older binge drink, meaning that, as men, they consume five or more alcoholic drinks in a sitting, or, if they are women, they toss down four or more boozy beverages. (For the published study’s purpose, these were defined as “a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it.”)

The researchers said their findings may underestimate seniors’ bad boozing, about which they called for more study. That’s because they warned that other research shows rising alcohol abuse among seniors. Boozing also can harm older people more than others in other age groups, the experts noted.

Seniors may not be able to metabolize liquor as easily as younger people. So, alcohol may hit them harder. It may contribute to already problematic, increasing, and potentially lethal falls among the old. Booze also can create health havoc by interacting with seniors’ prescription medications or over the counter drugs they may be taking. Seniors and other motorists already experience big problems with both alcohol and driving (implicated in a third of traffic fatalities in 2014), much less boozing and mixing drugs — of the prescription and other kinds, especially marijuana.

The NYU study added yet another challenge for seniors’ well-being: Researchers found their binge drinkers were more likely to be male, African American, having less than a high school education, and current users not only of tobacco but also marijuana. With grass now legalized in various ways in a preponderance of states, dope use and abuse among seniors itself is becoming a growing concern, other researchers have found.

Staying healthy and away from medical harms

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their challenges with staying away from potentially injurious medical treatment by staying as healthy as possible.

As Americans rise in age and their health may diminish, it makes especially good common sense for them to avoid needless medical encounters. That’s because medical errors claim the lives of roughly 685 Americans per day — more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.

Seniors may want to avoid hospitalization, too. Although the fatalities have declined, preventable hospital deaths kill more than 160,000 Americans annually — four times as many lives as were lost to vehicle wrecks in 2017, more than twice the deaths attributable to opioids and drug overdoses that year, and more than the toll of stroke or Alzheimer’s disease. The disturbing report on hospital deaths comes from Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality and the Leapfrog Group, a national nonprofit founded by large employers and others concerned and focused on safety and quality in health care.

What can seniors do to optimize their health? They can exercise (or at least keep moving), watch their weight and drinking, avoid smoking, and use caution with drugs of all kinds — prescription, OTC, or recreational (marijuana). They may wish to seek pursuits that fulfill their passions or build their sustaining life purpose, whether in work or in pastimes. They should not be subject in doing so to the wrong of ageism. As much as possible, they may want to stay engaged — with friends, family, and their community. This can be challenging, and all the rest of us can be mindful about how we can support seniors who are family, whom we know, or who live nearby.

As for good doctors, they, of course, can be huge in seniors’ health and well-being, giving safe, careful, and appropriate care. This includes their taking steps to check regularly not only on their patients’ physical but also their mental well-being, as well as staying atop their intake of prescription and other drugs and alcohol and other substances.

Informed consent for seniors

If, and when, seniors start to experience health challenges, excellent practitioners will be fair and candid in discussing these with them, providing what may be a different kind of informed consent. That’s a basic right that patients have. It means they are told clearly and fully all the important facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom.

Reporter Graham, in a separate KHN column, says that seniors have different experiences and life priorities that medical caregivers must take in account when discussing treatments with them, notably big, complex surgeries:

Now new standards meant to improve surgical care for older adults have been endorsed by the American College of Surgeons. All older patients should have the opportunity to discuss their health goals and goals for the procedure, as well as their expectations for their recovery and their quality of life after surgery, according to the standards. Surgeons should review their advance directives — instructions for the care they want in the event of a life-threatening medical crisis — or offer patients without these documents the chance to complete them. Surrogate decision-makers authorized to act on a patient’s behalf should be named in the medical record. If a stay in intensive care is expected after surgery, that should be made clear, along with the patient’s instructions on interventions such as feeding tubes, dialysis, blood transfusions, cardiopulmonary resuscitation and mechanical ventilation. This is far cry from how ‘informed consent’ usually works. Generally, surgeons explain to an older patient the physical problem, how surgery is meant to correct it and what complications are possible, backed by references to scientific studies. ‘What we don’t ask is: What does living well mean to you? What do you hope to be able to do in the next year? And what should I know about you to provide good care?’ said Dr. Ronnie Rosenthal, a professor of surgery and geriatrics at Yale School of Medicine and co-leader of the Coalition for Quality in Geriatric Surgery Project.”

This sounds like a step in the right direction. But we have much work to do to ensure that we all have healthy and productive lives for as long as possible.

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