The Desperate Elderly: Suicide Rate Is High, and Getting Higher

Because he was losing his sight to diabetes, a 72-year-old physician in Upstate New York killed himself with an overdose of sleeping pills.

“If I cannot see, I cannot practice medicine,” he wrote in a suicide note. “Medicine is my life. Without it, I am dead, so I choose to end my life now.”

Each day, about 14 similarly distraught people over age 64 take their own lives--chalking up a suicide rate about 50% above the national average.

Some Swallow Pills

Some, like the doctor, swallow pills because they cannot accept retirement or debilitating, chronically painful or even terminal illnesses. Others pull triggers out of loneliness, often brought on by the death of a spouse, or feelings of uselessness.

Suicide by the old and frail--who, for decades, have taken their own lives in disproportionately high numbers--has begun to inch its way into the public consciousness.

The nation as a whole is aging as birth rates stay low and longevity increases, so the problem is likely to increase. Today, about one in 10 Americans is over age 65. By the year 2030, it will be one in five.

In 1983, the latest year for which figures are available, those 65 and older had a suicide rate of 19.2 per 100,000, compared to 12.1 for the general population. For elderly white men, who historically have the highest rate, it was 40.2.

‘Not a Big Thing’

John McIntosh, a psychologist at Indiana University at South Bend who has done a number of studies on suicide among the elderly, said:

“As a society, we tend to think it is a tragedy when a young person commits suicide but not that big a deal when an elderly person takes their life.”

“Such thinking is a national tragedy and shows our ageism”--discrimination against the old, which includes branding them as “over the hill,” cranky and even burdens, McIntosh said.

Nancy Osgood, a sociologist and gerontologist at Virginia Commonwealth University and the Medical College of Virginia in Richmond, said: “As a society, as our parents’ children and as doctors, we all must show more responsibility to this senseless loss of life.”

Osgood, who has written and given lectures on the topic for more than a decade, said that she is often asked: What’s wrong, if anything, for an old and sick person, a very old and sick person, to decide to end his or her life?

Issue of Euthanasia

“It is the question of euthanasia,” she said. “My answer is that in some very, very few cases--those involving extreme pain and no chance of getting better--perhaps it may be morally or ethically correct.

“But we have a tendency as a society and as caretakers to make the easy jump from those few to the many,” Osgood said.

“Many who kill themselves wouldn’t if given the proper care--drug therapy, psychological therapy--if they were involved in activities and if their families were more involved,” she said.

Osgood said that doctors often fail to diagnose depression in the elderly, mistaking headaches or stomachaches as physical ailments instead of signs of emotional problems, and that many psychologists and psychiatrists just don’t want to bother.

“They don’t see it as productive,” she said. “They figure they won’t get any better. And, besides, they see it as a downer--the issue of death and dying.”

Osgood said studies have shown that up to 70% of the elderly who commit suicide have some sort of illness. She said there are no studies on how many have terminal diseases but estimated that fewer than half do.

Historically, suicide rates among the elderly have been considerably higher than in the overall population. From 1948 to 1981, with improvements in medical care and pension programs, the suicide rate for the elderly dropped from about 26 to 17.1 per 100,000, while the rate for the overall population rose to 12 from 10.7.

But it now appears that the suicide rate for the elderly is on the rise, climbing to 18.3 in 1982 and 19.2 in 1983.

The increases corresponded with Reagan Administration cuts in several programs that financially assist the elderly, such as Medicare, Medicaid and food stamps.

Rate Tied to Birth Year

Also, it reflected the fact that, since 1908, each group of persons born in a specific year, known as a “cohort,” has had a higher suicide rate than those born the year earlier.

Those born since 1908 are now, in growing numbers, entering old age. Within 30 years or so, the so-called “baby boomers” of the late 1940s and early 1950s will be there too.

“The baby boomers have had a higher rate of crime, suicide and mental illness” than their predecessors, Osgood said. “If the cohort explanation follows, they will have an outrageously high suicide rate when they get old.”

The New York doctor who killed himself is cited in a new book by Osgood, “Suicide in the Elderly.” Coroners’ reports and suicide notes indicate a wide variety of reasons for suicide--including love and money.

Both seemed to have motivated a retired schoolteacher who killed himself shortly before his 69th birthday. In a note to his ailing wife, he wrote:

“I can no longer provide for the two of us on my meager Social Security. At least through my death you can live on the insurance money. Please destroy this note so you will collect the full insurance benefits. I love you.”

Joseph Richman, a psychologist at the Albert Einstein College of Medicine in New York City and head of psychological services in the geriatrics unit at the Bronx Municipal Hospital Center, counsels the depressed elderly.

“The vast majority of suicides are preventable,” Richman said. “The suicidal elderly can be helped to live a meaningful and satisfying existence. Psychotherapy, especially family therapy, can make major contributions to this outcome.”

Among those Richman counsels is a retired union officer who attempted suicide a decade ago with an overdose of sleeping pills and who says he still almost daily considers taking his own life.

“I’m treating him for chronic depression and suicidal impulses and thoughts,” Richman said. “He’s self-educated. He’s an excellent artist. He is very open. He is very articulate.”

‘I Feel Like a Zombie’

“I’m 72 years old,” the man said in a telephone interview. “My emotions are dead. I feel like a zombie. My condition is disturbing my relationship with my wife. She wants more time to herself, but I can’t be left alone.

“I consider suicide frequently, almost daily. Most of my life has been a battle, and now that I’m retired it is still a battle.”

His wife, who joins him at therapy sessions, took the phone and told her side of their story.

“We’re very much alone,” she said. “Things are tough. But I would never abandon him. Never. I love him. He is a good man. He has always been good to me.”

However, she recalled a day when his talk of suicide became too much.

“I finally said (to him): ‘I can’t hear this all the time. It’s too terrible. It’s like a constant threat. If things are so terrible and you absolutely can’t live--go ahead and do it. Just don’t do it in the house.’ ”

She laughed and said, “That stopped him a little bit.

“I think (he) very much wants to live--not die. But he can’t live this way, the depression, the anxiety.”

In 1983, the National Center for Health Statistics reported that elderly white men had a suicide rate of 40.2 per 100,000 persons.

That was double the figure for the overall elderly population and triple the rate for the general population. The suicide rate for black men and black women ages 65 to 74 was 13.6 and 1.3, respectively.

Several factors are cited for the higher numbers among white men, including:

--As a group, they did best during their working years and thus had the biggest “emotional fall” after retirement.

--In retirement, husbands are more dependent on wives than wives are on husbands. Widowers are more apt to feel helpless and, in fact, have higher suicide rates than widows.

--Minority members and women, throughout life, learn to deal with discrimination, so, when they reach old age, they are better able to cope with “ageism.” Minority members are more likely to have an “extended family” providing support.

--Studies show that elderly white men are the most socially isolated. They tend not to belong to groups, particularly if they are widowers.

On July 20, 1982, a retired life insurance salesman, an 86-year-old white man suffering from terminal lung cancer, leaped from the 11th-floor window of his New York apartment. He was survived by his wife and two children.

“In a note, my father wrote that he was at peace with himself, that he loved his family and that he felt he had lived a good life,” his daughter said.

When contacted through a support group for survivors of suicide victims, called Seasons, she agreed to an interview provided that her identity, as well as that of her father, be withheld.

Didn’t Want to Be Dependent

“My father had cancer of the lungs. He knew he didn’t have long to live. He didn’t want to wait until he became totally dependent and a vegetable. He very much, I think, didn’t want to die in a hospital.

“I don’t feel anger any more. My father had a right to end his life the way he chose.

“What I do feel is that my father should have had the opportunity to end his life peacefully,” she said. “I believe, if a person makes the choice to die, they should be able to do so” by obtaining lethal and painless drugs.

In the United States, it is illegal to help someone take his or her life.

Here is one well-publicized case in point.

In Yonkers, N.Y., on Oct. 17, 1983, Ida Rollin, 76, suffering chronic pain from inoperable ovarian cancer, swallowed a lethal amount of a sedative along with an anti-nausea drug.

Her daughter, Betty Rollin, wrote a book last year, “Last Wish,” telling how her mother planned the suicide and how Betty Rollin “indirectly” assisted by researching drug information.

The New York district attorney’s office has refused to comment on whether it plans to take any action against Betty Rollin, a longtime network television correspondent.

“My mother, in fact, killed herself,” Rollin said. “I didn’t directly help her. She wouldn’t even let me touch the pills she took.”

‘She Summoned Death’

Rollin begins her book:

“Two hours before my mother killed herself, I noticed she had put on makeup. This shocked me, but it shouldn’t have. Whatever the occasion, my mother liked to look her best. That was her way. Just as it was her way to die as she did--not when death summoned her, but when she summoned death.”

In separate interviews in January, Rollin and psychologist Richman disagreed strongly.

“I have gotten a lot of mail and, oddly enough, I have had only one negative letter,” Rollin said. The letters “are primarily from people who had parents and spouses who died horrible deaths.”

“A lot say they wish they had the strength to do it,” she said.

Richman opposes euthanasia.

“Physical pain is rarely ever the cause of a person committing suicide. Pain can be dealt with,” he said. “It is the emotional pain, particularly in terminal cancer patients, that drives people to suicide.

‘Too Painful’ for Friends

“Friends stop seeing them because it is too painful. Family members suffer a great deal. The terminally ill see this and say: ‘I’m hurting everyone. It is better off I get out of the way.’ ”

“That’s baloney,” Rollin said. “My mother did what she did for herself, no one else. Guys like Richman talk about controlling pain, but too often it just doesn’t happen.”

Rollin said her mother had a tumor pressing against her bowels.

“When she wasn’t in pain, she was nauseous,” she said. “The only time she had any relief was when she was asleep. Is that life?”

However, Richman believes that “a major problem in alleviating the plight of the suicidal elderly is not their right to die but the fact that the most seriously suicidal do not seek help.”

Few Counseling Centers

Osgood, the gerontologist, said that many do not know where to turn. She said there are relatively few counseling centers for the elderly. Some of those in operation are run by local mental health groups.

“I’ve gotten mail from people who have read my articles . . . saying there is nothing for them,” she said. “There is no place to go. They don’t have a job. No one cares.

“There are a lot of people who could benefit from therapy, who could benefit from getting involved in activities, even if it is just arts and crafts. But they just aren’t being reached.”