Exploring suicidal thoughts in the very elderly: a Swedish study

The Elf Mother has just passed 80 and she’s not too impressed with old age. Another Elder Elf in this bit of the woodland disagrees. “It has its advantages”, she was telling me; “all those things you don’t have to do, and people you don’t have to see!” Elf Mother did concede she has a point. But what about people next to whom this octogenarian pair look like spring chickens, those living in their late nineties and beyond? This week we’re looking at research concerning people in their later years and we start with the very elderly and some research that attempts to address a gap in our knowledge about their mental health, relating to thoughts of death and of suicide.

Studies of people in later life have found that between 2% and 16% have suicidal thoughts and this figure rises amongst people in nursing homes. Mental and physical illness, reduced functional ability and social factors can all put older people at risk. But little is known about this phenomenon in people in extreme old age, men and women in their late nineties, to whom research findings relating to ‘younger’ seniors might not apply.

As part of a research study being conducted with people in their late nineties in the Swedish town of Gothenburg, a group of 97 year olds without dementia were studied to estimate the frequency of thoughts of death and suicidal feelings amongst them and to identify factors associated with these. 269 people were included, of whom 197 were women. The people taking part in the study were asked not only about thoughts about death and suicide but also about many aspects of their health and also social factors, such as relationships with friends and family. Here’s what they found:

  • 26.7% reported thinking about their own death more than once a month
  • 1 in 10 reported some level of suicidal feelings in the past month, and this was more common in women
  • Thoughts of taking one’s own life were reported by 3.8%, but serious contemplation of suicide by only 0.8%. None had attempted suicide in the past month
  • Frequent thoughts of death were more common in those reporting suicidal feelings
  • Most of those reporting suicidal feelings did not fulfil the criteria for either minor or major depression and no association could be found with anxiety disorder or psychotic disorder
  • Nearly 90% of those with suicidal feelings were dissatisfied with sleep, compared with around two-thirds of those without such feelings, and this association remained after adjustments were made for depression. The number of hours of sleep reported was similar in both groups
  • 40% of those with suicidal feelings had aches and pains, a much higher proportion than in those not reporting such feelings
  • None of the participants reported their health as very poor and only 13% regarded it as poor, with no difference between groups
  • A strong association between unsatisfactory frequency of social contacts (such as spending too little time with friends) and suicidal thoughts remained after adjustment for depression

The researchers note that 35% of people eligible to take part in the study chose not to take part and that it’s possible that those with suicidal feelings might have declined to participate to a greater extent than those without. This could result in an underestimate of suicidal feelings in the past month, but it is not clear how it might influence the associations seen. Also the fairly small sample did not allow for analysis of those who seriously contemplated suicide.  It’s important to remember too that the design of this study does not allow conclusions to be drawn about causation; it can only show associations, which can be in either direction.

But there are important messages here, for those living or working with our most aged ones, summed up by the authors:

Screening programmes that aim at the identification and treatment of depression may fail to identify persons who have reached extreme old age and who could benefit from interventions. The results of this study suggest that attention to pain and sleep issues as well as increased opportunities for social contacts might constitute targets for the reduction of suicidal feelings in very late life.

“No man loves life like him that’s growing old”, wrote Sophocles, the Greek tragedian, who was 90 when he died in about 405 BC and so knew a thing or two about old age. But perhaps he was lucky enough to be surrounded by friends and family still and to be busy and fulfilled. There are varied accounts of his death, which range from a tale of choking on a grape to dying from the strain of reciting a very long sentence without taking a breath. We don’t have to look far to find many things written of old age back across centuries and these can help us make sense of our own experience of it. But we really need more research like this Swedish study to help us understand the issues affecting our aging population and how we can best help them. Later in the week we’ll be looking at a trial which explored a home-based physical activity programme for our younger seniors.

Link:

Fässberg MM, Östling S, Börjesson-Hanson A, Skoog I, Wærn M. Suicidal feelings in the twilight of life: a cross-sectional population-based study of 97-year-olds. BMJ Open2013;3:e002260 doi:10.1136/bmjopen-2012-002260

 

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Sarah Chapman

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My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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