reflections - the human side of optometry
An Unhappy Ending
Suicide is on the rise among seniors. Here's how you can help your patients.
BY PAMELA J. MILLER, O.D., F.A.A.O., J.D.

I am the survivor of a successful suicide." With these words, Donna told me of her father's death. We had seen 70-year-old Carl only three months earlier, the victim of sight-robbing macular degeneration in the last stages. Carl was a retired professional, widowed for almost five years and still living in their home of 40 years. He had mentioned to his friends that he would kill himself once he became blind. True to his promise, Carl ended his life using the gun he kept for protection against intruders.

It's no longer the unthinkable

According to a recent article in The Los Angeles Times, suicidal thoughts are common among the elderly, with someone over the age of 65 committing suicide every 95 minutes. Most commonly, it is an 84-year-old white male, with men four times more likely than women to kill themselves. Both sexes often use a gun; access to firearms is associated with increased risk for suicide. These people are not mentally ill or terminally ill and most have seen their doctors within the previous month.

This is one of the fastest growing problems in our country today and is easily treatable, requiring little more than paying better attention to our older patients' medical care. Almost one fifth of all suicides are in the elder population, the Times article stated, and this figure is expected to rise dramatically as we reach an estimated 77 million seniors by 2030.

Put yourself in their position

Contrary to some beliefs, depression is not a normal part of aging. However, our senior population is often faced with failing health, financial concerns and pressures put upon them and their families. This is a group that frequently suffers from a lack of social support, loss of friends or relatives and poor sleep patterns. Very often, this is a patient who is losing vision, independence and the ability to engage in the activities that he or she has spent a lifetime enjoying.

Here's where we come in

What can you and I do? First of all, be proactive. We need to ask our senior patient if he or she is depressed. If the answer is yes, ask if the patient has contemplated suicide. Some states (like Oregon) and cities (like San Francisco) have even developed public health campaigns or dedicated 24-hour help lines for seniors.

Don't be afraid to broach issues such as loss of friends and family support, loss of vision, financial concerns, etc. Do your patients feel nervous, empty, worthless, or tired? Are they not enjoying life like they used to? Are they eating or sleeping more or less than normal? Do they have persistent headaches, stomachaches, or chronic pain? Perceived poor health, rather than actual poor health, is often a sign of depression. Let your patients know that there is help and that you are going to guide them to it. Refer immediately to the primary care physician for possible medication, as well as a mental health specialist.

It is the responsibility of every health care professional to help our patients, not just with their vision, but with their quality of life. The senior death wish is preventable and treatable and we can make a difference in this fast-growing segment of our society.

References available upon request.

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENé LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@LWWVISIONCARE.COM. OM OFFERS AN HONORARIUM FOR PUBLISHED SUBMISSIONS.