In my professional work experience, I would say that depression and suicide are two of the major mental health concerns facing older adults. So many of the clients I work with are experiencing depression from losses in their lives, such as family and friends dying and not being able to do the things they have always been able to do. Many of the clients I work with are home bound and need help with their activities of daily living (ADLs), such as bathing and dressing and instrumental activities of daily living (IADLs), such as meal preparation and shopping. Many of my clients are on an anti-depressant and fortunately, the program I work for now is part of the PEARLS (The Program to Encourage Active and Rewarding Lives for Seniors) program that screens for depression and offers in-home counseling if my clients want it. However, I've noticed that there is a stigma placed on counseling, especially by my male clients. For instance, I've had more than one occurrence where a client triggers a PEARLS referral and while fighting back tears, says to me, "I'm fine, I don't need help." I can only hope that I can change their mind during future visits.
While depression is not a normal part of aging, there are so many older adults who experience depression and have not been treated. They experience a sense of hopelessness that it puts them at a higher risk of suicide. According to the National Institute of Mental Health and my own work experience, as an older adults physical impairments increase and they are not able to do what they want to do, their risk of depression increases (2007). The statistics also show that the risk of depression increases as older adults need more formalized care, such as health care and hospitalization. According to the Centers for Disease Control and Prevention (CDC), older white males age 85 and older have the highest suicide rate. They are more successful on the first time attempt to take their lives and are more likely to use a gun (2010).
I was trained to take every suicide threat seriously. In my work experience, if you work with older adults suicidal ideation is something that you will encounter both on the phone and in-person. Since many of you will be returning to your home states, you may find a lot of different resources compared to here in Ohio where you are likely completing your practicum. From my experience, working in both Ohio and Kentucky you will have different resources available for you and your clients depending on funding available. As I stated above, now that I'm working in Ohio again, I have so many more resources available to help my clients. I can offer a client a referral to the PEARLS program for counseling. If someone is actively telling me they are thinking about suicide or I pickup on clues then I can make a referral to the Mobile Crisis Unit. However, when I was in Kentucky they had long waiting lists for counseling and if you did have a client who verbalized suicide, you had to call 911 and medics who may not have mental health training would have to intervene with your client. My advice to those of you who are beginning to work with older adults, please make sure you take every threat seriously and make sure you know the suicide prevention resources in the geographic area you are working. Also, make sure you know your agency's policy.
In conclusion, I remember when my Grandpa was very ill, he told me he was ready to leave this world and couldn't understand why he was still here. He said everyone who knew him when he was young was gone and he was ready to be with them again. I have to admit that I didn't completely understand since he had his daughters and grandchildren, but I think I'm beginning to catch a glimmer of what he was saying. Older adults may face a lot of loss, whether it is due to physical impairment or loss of loved ones. For instance, we had a client this week who lost his wife of 80 years! Can you imagine how lost you would feel? Fortunately, he has good family support to get him through this difficult time. It is up to us to pick up on sometimes subtle hints that our clients are depressed and connect them with resources that may help them before it's too late.
National Institute of Mental Health (April 2007) Older Adults: Depression and Suicide Fact Sheets (Fact Sheet). Retrieved from http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml#part-of-aging
Centers for Disease Control and Prevention (Summer 2010) Suicide Facts at a Glance. Retrieved from
http://www.cdc.gov/violenceprevention/pdf/Suicide_DataSheet-a.pdf
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