While there has been a lot of attention to the high rate of suicide and depression among young people in Ireland, those on the other side of life’s journey, particularly those over the age of 65, can be just as vulnerable.
It is estimated that about one in five adults over the age of 65 suffer from a mental illness of some severity, including dementia.
Depression is one of the most common mental illnesses in the elderly estimated to affect 15-20 per cent of this population. Rather chillingly, depression is thought to be a factor in 80 per cent of completed suicides in those aged over 65.
Highest suicide rates
According to the World Health Organization (WHO), the highest suicide rates in Europe are reported among people aged over 65 (21.9 per 100,000 population) and 45-59 (21.5 per 100,000 population), both about 1.5 times higher than average.
The latest figures from the National Suicide Research Foundation (NSRF) in Cork reveal a total of 386 people over the age of 65 took their lives between 2001 and 2011.
While the figures for 2011 are preliminary, they estimate 18 older people died by suicide last year. Of these, 11 were aged 65-74; six were 75-84 years old and one was 85 years or older.
Depression factors
According to Dr Declan Lyons, consultant in old age psychiatry at St Patrick's University Hospital in Dublin, isolation, financial worries, exclusion from society, serious illness and or painful conditions are all big factors in depression in older people.
“If a younger person were to experience the death of all their friends and family members . . . for them to be gone just over a few years, older people experience this routinely . . . and social isolation and marginalisation through technology.
“Older people feel on the fringes, a bit dismissed, not included as much, role-less. It is a big deal but they do remarkably well, they are inherently resilient,” he says.
Lyons says it is important to note that there is a difference between transient suicidal thoughts, which can be quite common, and significant suicidal intent where someone seriously plans to take their own life.
According to Lyons, self-harm among the elderly can range from a passive self neglect driven by hopelessness, to wilful discontinuation of important treatment or medication and serious suicidal intent.
Lyons believes the suicide rate among the elderly in Ireland is probably under estimated.
“If someone dies when they are old people, say ‘well, that is due to a cardiac arrhythmia, heart attack or a stroke’ and it goes no further . . . the death certificate may be a guesstimate,” he says.
With depression at the root of up to 80 per cent of suicides among the elderly, it is vital that people know that depression is a manageable and treatable condition.
“Older people may take a bit longer to respond to treatment. Say if it is medication plus psychotherapy, younger people by and large can expect to be feeling better within a month.
"Older people may take a bit longer but they eventually do respond just as well as younger people."
Difficult diagnosis
Because depression can be a difficult diagnosis in the elderly and this population is more reticent to discuss mental health issues with their doctor, it is estimated that only 50 per cent of older people seek help and, of these, just half are actually diagnosed and treated.
“So you may be talking about one in four people with depression in older life, shocking as it may sound, getting adequate help,” Lyons says.
Help available
Samaritans Ireland offers a free and confidential emotional support and help 24 hours a day and can be contacted on tel: 1850 60 90 90 or email: jo@samaritans.ie.
St Patrick’s University Hospital runs a support and information telephone and email service. Tel: 01 249 3333 (Monday to Friday, 9am-5pm, with a call-back facility outside hours) or email: info@stpatsmail.com
