Mental Health Service for Older Adults

The statistics for old age suicides of Australian men over the age of 85 are rather alarming. According to the Australian Bureau of Statistics the rate of suicide among elderly men over the age of 85 was 37.6 per 100,000 for the year 2012. This rate is three times higher than the national average (Elderly men three times more likely to die by suicide, 2014). The WHO organisation recognises suicide as a public health problem that needs more attention from policy makers and governments. The problem of suicide among the elderly is even more under recognised (2016). Several social, cultural and psychological reasons have been identified for suicides among the elderly Australian men.

Since the average life expectancy of the Aboriginals and Torres Islanders is about 50 years, the problem of elderly suicide among men is more prevalent among the mainstream population in Australia.

Social causes

But since suicides are preventable and often mental health is the root cause, there is considerable stigma attached to seeking help. The number of elderly in the population is growing. Also growing is the problem of social isolation. Many elderly people suffer from chronic ailments and their mobility is severely reduced. Their frailty makes it difficult for them to leave the home and maintain social contacts with friends and family. The reasons for loneliness could include death of a spouse or bereavement. Regular social contact is important for the well-being of the elderly and can improve their quality of life. In the absence of a social connect some elderly may be driven to suicide. Men who are widowed find it difficult to share their problems with their carer, if any and suffer from greater isolation due to their difficulty in communicating. They depend on their wives to establish social contacts and do not know what to do once they the spouse has passed away. Keeping the problem to themselves plunges them into a downward spiral. Such men could get benefit from the Community Visitor’s Scheme. Through this scheme several community-based organisations called ‘auspices’ receive funding to recruit and train volunteers who pay regular visits to the elderly who may be facing social and cultural isolation. These elderly people are usually the recipients of subsidised care services of the government. Group visits or one-to-one visits to aged-care homes are made in order to improve the quality of life by the volunteers. Recommendations are received either from the aged care facility, family, friend of the aged person (Community Visitors Scheme, 2016).

Prevention of loneliness

Several interventions have been tested for prevention of loneliness among the elderly. Some of these include teleconferencing, living in retirement villages, and training of volunteers to identify those suffering from loneliness (2016).

Once diagnosed, treatment for depression is possible through medication and psychotherapy. Medication involves taking a dose of a serotonin uptake inhibitor as prescribed by the doctor. Referral to a psychologist/psychiatrist results in better outcomes for patients of depression. Changes to one’s lifestyle are also suggested to alleviate depression. Doing charity work, social work, following a hobby, joining a club, going for group activity with other residents of the aged care home, and church visits are all steps that increase social connectedness and improve symptoms of depression and can help alleviate loneliness (Tiwari, 2016).

The WHO has suggested formulation of national suicide prevention strategies. Because the formulation of a strategy evolves several means to achieve the goal of suicide prevention. It promotes research and employment of evidence-based strategies in suicide prevention. It helps to identify stakeholders so that they can be given responsibilities that led to accomplishment of mitigation strategies. The coordination between various stakeholders can improve outcomes for the target population. Gaps in provision of service can be identified more easily, and financial and human interventions can be made as per requirement. Raising awareness among the general population becomes easier through media, advocacy and awareness campaigns. More inputs by way of research can be made in suicide prevention of the elderly (Public health action for the prevention of suicide, 2012).

Mental Health and Elderly Suicide

Most people who suffer from mental health conditions, such as, depression are at a higher risk for suicidal thoughts. Also associated with depression are anxiety, slowing down of thought process, decline in memory, feelings of guilt, insecurity due to increased dependence on others, feelings of worthlessness, difficulty in sleeping, headaches, and general weakness. Many of these symptoms may be misunderstood by the carer as the signs of ageing, whereas they actually signal depression. Prolonged living in a subdued mood and less energy can induce suicidal thought (Wongpakaran & Wongpakaran, 2013).

Older men are less likely to admit that they are feeling depressed. Cultural ideas about manhood make them hide their feelings since display of inner turmoil may make them appear weak. Masculinity in the traditional sense discourages men from seeking help to treat their sadness or melancholy. The stigma around mental health discourages them from admitting their problems and discussing their problems with the doctor. This leaves the older men with untreated depression and may culminate in suicide. Men are also known to choose lethal means for suicide such as, using fire arms, and hanging.

According to the beyondblue Support Service  that helps people with depression, about 10-15% of the elderly suffer from the malady and 35% of the residents of aged care are homes my suffer from the problem. Moving to a care-settings without the spouse can often trigger severe depression (Risk factors for older people, 2016).

Treatment of depression using medication has been largely practised but non-pharmacological treatments of depression have also been given with success. These include cognitive behaviour therapy, competitive memory training, problem-solving therapy and reminiscence group therapy. Although these therapies are effective, factors such as sensory disabilities of the visual or hearing type are important factors while giving therapy (Apóstolo, Queirós, Rodrigues, Castro, & Cardoso, 2015). Reduced mobility at an advanced age may make it a challenge for the elderly to access counselling sessions. Talk therapy is more effective for the elderly than younger people. It helps them to rediscover their ability to adapt. Personality attributes such as self esteem, feelings that enable them to accept the irritability and anger of those around them and adopting a more hopeful view of their current conditions helps the elderly to get relief from depression and anxiety (Treatment Options for the Depressed Elderly, 2016).

An expert panel studied the interventions made for treatment of depression for suicide prevention in elderly retired persons. Therapy that included group sessions and prepared people for a retired life improved the parameters , such as, hope, serenity, attitude, being flexible  and the participants reported lower levels of psychological distress and depression. The alleviation of these symptoms protects the participants from suicide when they are older (Lapierre et al., 2011). The involvement of the psychiatric nurse during care giving is important who in turn can help the care giving team to receive training in identifying behaviour that can led to suicide. When nurses lead the surveillance of symptoms of mental health care requirements in the elderly patients better patient outcomes can be reached (Atkinson & Mukaetova-Ladinska, 2012).

The overall picture appears grim. In spite of several initiatives targeted at the elderly for reduction in the incidence of suicide, problems persist. Loss of independence, absence of regular social support, failing physical health, incidence of pain or diseases like cancer make the elderly Australian men prone to suicide. It is even considered normal for the aged to be depressed whereas in reality the aged are also capable of living full and healthy lives. Many people fear old age but many old people cope remarkably well with challenges  that accompany old age, health issues, loss, and social isolation (Draper, 2014).

Conclusion

Suicides among the men aged 85 and more is reported to have occurred t a high rate in Australia. It is recognised as public health problem and the reporting of the statistics in the media has caused considerable concern among Australians. The main reasons that have been attributed to the high rate of suicide are social issues of loneliness and social isolation that plague the elderly and issues related to their mental health. Depression and anxiety commonly affect the older people and if left untreated can trigger the ultimate step of choosing to die. Cultural beliefs prevent the older men from confiding in their doctor about their mental health problems. Untreated depression worsens their health and unable to cope with pressure brought on by advanced age they commit suicide. Various programs for suicide prevention re targeted specifically at the aged. The Community Visitor’s Scheme trains volunteers to visit the ailing aged in groups or on a one to one basis and is able to solve the problem of loneliness and social isolation of the aged (Community visitor’s scheme, 2016). Living in retirement homes or using subsidised aged care facilities enable people to live in  community settings where they can remain engaged and busy. The beyondblues program for the elderly also suggests ways for senior members of the society to remain  busy and active and prevent suicidal behaviour (Risk factors for older people, 2016).

References

Apóstolo, J., Queirós, P., Rodrigues, M., Castro, I., & Cardoso, D. (2015). The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 13(6), 220-278.

Atkinson, P. & Mukaetova-Ladinska, E. (2012). Nurse-led liaison mental health service for older adults: Service development using lean thinking methodology. Journal of

Psychosomatic Research, 72(4), 328-331. http://dx.doi.org/10.1016/j.jpsychores.2011.11.018Community visitors scheme (2016). Retrieved from https://agedcare.health.gov.au/older-  people-their-families-and-carers/community-visitors-scheme.

Draper, B. (2014). Suicidal behaviour and suicide prevention in later life. Maturitas, 79(2), 179-183. http://dx.doi.org/10.1016/j.maturitas.2014.04.003

Elderly men three times more likely to die by suicide. (2014). Retrieved from http://www.abc.net.au/news.

Findlay, R. (2003). Interventions to reduce social isolation amongst older people: where is the evidence?. Ageing And Society, 23(05), 647-658. http://dx.doi.org/10.1017/s0144686x03001296

Lapierre, S., Erlangsen, A., Waern, M., De Leo, D., Oyama, H., & Scocco, P. et al. (2011). A Systematic Review of Elderly Suicide Prevention Programs. Crisis, 32(2), 88-98. http://dx.doi.org/10.1027/0227-5910/a000076

Public health action for the prevention of suicide (2012). /9789241503570_eng.pdf?ua=1.

Retrieved from http://apps.who.int:http://apps.who.int/iris/bitstream/10665/75166/1/9789241503570_eng.pdf

Risk factors for older people (2016). Retrieved from https://www.beyondblue.org.au/who- does-it-affect/older-people/risk-factors-for-older-people.

Tiwari, S. (2016). Older men and depression. Mensline.org.au. Retrieved 16 August 2016, from https://www.mensline.org.au/emotions-and-mental-wellbeing/older-men-and-depression

Treatment Options for the Depressed Elderly. (2013). Retrieved from http://www.aipc.net.au/articles/treatment-options-for-the-depressed-elderly/

Wongpakaran, T., & Wongpakaran, N. (2013). Detection of suicide among the elderly in a long term care facility. Clinical Interventions in Aging., 8, 1553-1559.

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