Suicide in old age

There are subjects we don't like to talk about. We prefer to look the other way, as if that were enough to obviate the existence of what we find ugly, what we don't like, what causes us fear or even what shakes some of our deepest beliefs. It happens with countless issues and we do it every day, denying parts of reality. We try, perhaps by not naming it, to make it go away. And so we continue to tiptoe around certain issues, leaving them semi-obscured in the daily information battle. And I understand: I myself dislike this subject I am writing about today, because of all the pain it refers to and contains, both for those who leave and for those who remain. However, it seems to me that it is very necessary, so today I want to talk about suicide among the elderly. If we talk about suicide in general only in passing, suicide among the elderly receives even less attention. 

It has been suggested that talking about suicide in the media seems to generate a "call effect", which seems to me to simplify something that is by no means simple. In my view, talking about suicide is necessary in order to prevent it, while revising the approach to this conversation, leaving aside "sensationalist" issues and not forgetting that when we talk about suicide we are talking about suffering. The World Health Organisation recommends talking about it and talking about it in a proper way, so that it is no longer a taboo subject: around 700,000 people commit suicide every year in the world, and we need to work hard to deal with it. We need to talk about it so that we can prevent these deaths, so that we can prevent the immense pain that leads to them and the immense pain of those who survive the person who decided to end their life. 

I felt the need to write about this when, more than a month ago, Verónica Forqué was found dead in her home. She was 66 years old. She was a Spanish actress and director, winner of four Goya Awards. Forqué had been an icon, a reference in Spanish cinema, a desired and admired woman. Verónica was in the media, but the 3,941 people who committed suicide in 2020 did not appear: we do not know their situation, their past or their names. 

As the Suicide Observatory points out, this is the leading cause of unnatural death in Spain: it produces 2.7 times the number of deaths caused by traffic accidents, 13.6 times more than homicides and is, after tumours (330 deaths) the leading cause of death among Spanish youth (15-29 years old). This represents an average of eleven (ELEVEN!) suicides per day, which means that approximately every two hours, one person in Spain takes his or her own life. The vast majority of these suicides go unnoticed, and it seems that only when the protagonist is a public figure (the actor Robín Williams, the DJ Avicii, the designer Kate Spade or Verónica Forqué) who is successful, loved, envied, do we realise that suicide is a reality that we must address and that it is by no means a simple or straightforward issue.

If the figures are frightening, even more so are the attempts that are not fatal: according to WHO estimates, there are around 20 attempts for every suicide, while, according to other epidemiological studies, between 5% and 10% of the Spanish population think about committing suicide. This means that in a year there could be around 80,000 suicide attempts per year in Spain and that between two and four million people experience suicidal ideation during their lifetime. It seems to me that the urgent need to talk about it is more than justified. 

If, worldwide, suicide is the fourth leading cause of death among young people aged 15 to 19, life experience does not seem to work as a protection tool: according to the annual report by the Spanish Foundation for Suicide Prevention, more than 1,000 people over the age of 70 commit suicide every year in Spain. In 2020, 32.5% of all suicides were committed by people over the age of 65; if we count those over 55, we are looking at more than 50% of all deaths by suicide. This is not a minor, isolated issue, nor do we see its decline over time: suicide in people over 79 years of age has increased by 20% compared to 2019, both among men and women. Women attempt it 3 times more than men, but men use it 3 times more than women. 

Spain does not have any state plan or strategy for suicide prevention: only around 40 countries in the world have one and, although Spain stands out as a bold and determined country with many social policies, I am sad to say that we are not one of them. There are some pioneering suicide prevention plans in some regions, such as Galicia, the Basque Country or the Balearic Islands, but suicide is still a little studied and stigmatised social problem, which makes it even more difficult for us to put a stop to it. 

At the international level, and although the United Nations offers advice on how to create these plans, we see that they are not widespread. Even fewer plans exist that specifically target suicide prevention among older people. In fact, it is very little studied and receives little attention. Some reports/articles (such as this one) point out that the main cause of suicide among older people is unwanted loneliness, which, again, points to the need to address this evil that is so characteristic of our society today. 

There also appears to be a very close link between depression and suicide, as well as self-harm and suicidal ideation. Depression is a very common illness among older people, affecting around 14% of those over 65. Although it is the third most common reason for consultation in primary care, it is often under-diagnosed (source). And no, neither depression nor unwanted loneliness is a natural consequence of ageing. In addition to social isolation and depression, other important factors in suicidal ideation are poor physical health and disability. 

We need to address suicide as a public health issue, creating local, regional and national plans to prevent it. Some ways could be helplines and community support programmes, improved access to mental health services and the urgent need to destigmatise everything around psychiatry and psychology and those who do therapy. We certainly need educational programmes and, ultimately, adequate and appropriate treatment of depression. There is very little research on the nature or effectiveness of suicide prevention programmes for older people. It would also be necessary to consider the collaborative care approach to the treatment of older people with depression, but there are certainly many more ways that we need to develop together. What would you propose?

You are not alone.