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Suicide First Aid: supporting older people through loneliness, bereavement and physical health concerns

“The sixth age shifts
Into the lean and slippered pantaloon
With spectacles on nose and pouch on side;
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice
Turning again towards childish treble, pipes
And whistles in his sound[1].”

So, the final stages of life are explained in Shakespeare’s poignant soliloquy from As You Like It. The Bard pulls no punches in his description of older age and its accompanying reductions in physical appearance and limitations on an erstwhile active life. Old age still brings many challenges today. Suicide rates around the world are statistically highest among older adults, especially after the age of 70[2].

This can be for all kinds of reasons, as is the case for people at any age. However, certain challenges rise in impact and occurrence as we age, including physical health conditions, difficulties in maintaining an active social life, instances of depression, facing bereavement and coming to terms with reaching the latter stages of our own lives.

Sobering thoughts, indeed. The good news is that there is lots that can be done to support older people, raise their quality of life and reduce the likelihood of someone taking their own life. Even better news is that many ideas, actions and initiatives are things that we can all do and contribute towards with simply a little forethought, knowledge and compassion.

Depression and older people

Depression can affect around one in five older people who live in the community, with the figure rising to two in five among those in residential care[3]. Signs of depression in older people include losing interest in life, frequently feeling tired for no reason, losing appetite and feeling anxious, worries or irritable. People can struggle to concentrate, suffer from insomnia and find themselves thinking more about suicide than before.

Physical illnesses and pain are major contributing factors to depression in older people, as is loneliness and social isolation. So, support the older people in your circle in visiting their GP. Drive them to appointments and go in with them to offer moral support and back-up if required. Offer help with arranging hospital consultations and act as their advocate if they come up against obstacles. Earlier diagnosis and treatment of developing conditions not only help to slow down or even halt progression, but it also enables people to alleviate symptoms, renew energy levels and feel more like their old selves sooner.

One is the loneliest number

The impact that loneliness can have on older people highlights the importance of social connections. Simple actions, such as smiling, hugging, talking and socialising can help keep loneliness at bay. These acts of human kindness are free and open to all. It is amazing how much having someone there to listen to concerns, share news with and check in with to make sure everything is OK can change an older person’s attitude towards life. Keeping as physically active as possible is important too. While someone’s home can be a huge source of comfort to them, hiding away from society for too long a period of time is not always a healthy thing to do.

This was shown only too clearly during the recent COVID-19 lockdowns. Many older people reported feelings of isolation, especially in the first lockdowns before support bubbles were brought in to address issues around social isolation. The long-term effects that COVID-19 and our response to it will have on global suicide rates will not be known for a while yet[4]. Ironically, the very group of people whose protection became paramount in those early, confused days ended up experiencing problems of a different kind, brought about by being cut off from the shops, medical services, visitors and support groups they relied on for regular human contact. 

Happily, the arrival of FaceTime and Zoom (other social media and videoconferencing tools are available…) has opened up new avenues for human contact. We particularly discovered their value when we were able to see and speak to friends and family all over the world during the COVID-19 lockdowns, despite international travel restrictions. Helping older people familiarise themselves with this kind of technology can also play a large part in alleviating loneliness and counteracting thoughts about suicide.

The final curtain

As we age, our bodies begin to experience increased physical problems and limitations. We are often more susceptible to simple coughs and colds, as well as to progressive, life-limiting or terminal medical conditions. The realisation that we can no longer do the things that we used to enjoy can be extremely sobering. As can the thought that our lives may soon be coming to an end. Sometimes, the mental anguish that this causes can be harder to cope with than any physical pain or discomfort[5].

Experts say that the risk of someone becoming depressed increases as their illness progresses – and it is not hard to see why this could be the case. Supporting older people in this situation to keep up with medications, therapies and medical appointments is key to helping them retain as much control as they can over their own prognosis. Helping them find suitable help and treatment options for feelings of depression can also make a big difference to their quality of life.

Spending time with older people socially when they are ill (where allowable) is also crucial to help them feel like they still have more to offer than the contents of their medical notes. This can be done in all manner of ways. Regular meet-ups for coffee or dinner, for example. Recording their life story to pass down to future generations. Reminiscing over photo albums and family artefacts could be helpful too, not only for the older person, but to provide their loved ones with happy memories after they have passed away.

Coping with bereavement

As well as the reality of facing one’s own demise, a sadly inevitable part of growing older is losing one’s spouse, friends and family members to illness and old age. In 1967, Swiss-American psychiatrist, Dr Elisabeth Kubler Ross defined five stages to explain the progression of grief after a bereavement. These were denial, anger, bargaining, depression and acceptance[6]. Later, more work was done on the subject by grief experts such as Kessler and Wright, with additional stages added around pain and guilt and reconstruction and adjustment to a new ‘normal’[7].

However, designing models and drawing diagrams to explain grief is one thing; actually living through the emotions is quite another. Grief is not a tidy, linear process. Bereavement is experienced differently by every single person affected by it. People veer between stages, sometimes coming back to earlier ones or staying much longer in certain phases than others. It can be hard to talk to someone who has recently been widowed or bereaved. There is fear over saying the wrong thing, somehow making things worse or inadvertently offending the person.

Yet, bereavement can be a very lonely place and, as already discussed, human connections are very important. Key points to remember include avoid telling the person how they are, or should be feeling. Remain non-judgemental, empathic and open-minded. Talk about the person who has died and remember happy memories about them – acknowledge how important they were and celebrate the contributions they made to those around them.

Help is at hand

Suicide First Aid is a course created, licensed, and owned by the National Centre for Suicide Prevention, Education and Training (NCSPET) devised to help people support older people struggling with suicidal thoughts, troubling emotions and challenges with their mental health. It covers several aspects, from understanding suicide risks and trigger factors through to learning what to say, what not to say and when to seek emergency medical or specialist support[8].

For more information about the course and to sign up for your place, please get in touch today. Knowing how to respond to an older person who has expressed thoughts about suicide, self-harm or depression can make a huge difference at an earlier stage.

[1] Source: As You Like It, by William Shakespeare, Act 2, Sc. 7

[2] Source: When it is Darkest, by Rory O’Connor,2021, p23

[3] Source: Accessed 11 November 2021

[4] Source: Source: When it is Darkest, by Rory O’Connor,2021, pp27-30

[5] Source: Accessed 112 November 2021

[6] Source: Accessed 11 November 2021

[7] Source: Accessed 11 November 2021

[8] Source: Accessed 22 September 2021

Post Author: Gayle Young