introduction
Suicide among adolescents and young adults is a subject that receives extensive media coverage and academic attention (and it is, in fact, a disturbing issue), while late-life suicide is much less covered and studied. At the same time, research shows that older adults constitute a vulnerable population in this regard because their suicide rates are often higher than those of young people (Conwell, Van Orden, & Caine, 2011). Individual suicide cases may reveal psychological or physical health problems, but the phenomenon in general (measured by suicide rates in a country or among specific groups) may reveal larger-scale problems with the social or health care systems. Suicide rates are different for men and women and different races. To explore the issue, it is necessary to examine epidemiological data, address the causes and factors of late-life suicide, and discuss prevention measures and efforts.
Epidemiology
According to Conwell et al. (2011), suicide rates for both men and women peak in old age in many countries. Some countries (including the United States and Canada) nonetheless demonstrate different dynamics, as there are slight decreases in rates after middle age, but there are still several points on the graph at which suicide rates grow after the age of 65. The authors provide rather disturbing statistics that show that men commit suicide in their later life significantly more often than women; in this context, white men display the highest rates, as 45 out of 100,000 white men of older age commit suicide in the United States annually, while the average is 11.5; i.e., almost four times less. Historically, people aged 65 and older constituted the age group with the highest suicide rates in the country, and it changed only in the early 2000s, when their rate decreased (and it has further decreased since then, too), while the rate among people who are 34 to 64 increased and exceeds 15 per 100,000 annually.
Despite the decrease in suicide rates, suicide remains one of the leading causes of death for men in the United States, according to Oliffe, Han, Ogrodniczuk, Phillips, and Roy (2011). The authors also show that the rate is directly connected to age; i.e., men who are older than 75 commit suicide more often than men who are 65 to 74. This is a particularly disturbing statistic if it is assumed that the decision to commit suicide is linked to the conditions (including social or health-related conditions) associated with old age, as according to the estimate referred to by Conwell et al. (2011), 20 percent of the United States population will be comprised of people older than 65 by the year 2030; i.e., more and more people will be entering this vulnerable group with high suicide risks.
Causes and Factors
Considering the factors of age and gender, it can be argued that the influences contributing to the high suicide rate among older men include psychological pressures, health problems, and social issues. First of all, Oliffe et al. (2011) stress that severe forms of depression are the primary cause of suicide in this group. From this perspective, many ways can be identified in which late-life presents more risks and more potential triggers and reasons for the development of depressive symptoms. First, older men are more likely to have had a long history of personal relationships with a high probability of having been in years-long emotional relationships with a single partner. If there was an unsuccessful marriage, depressive symptoms are likely to occur; moreover, failed marriages may prevent men from developing healthy relationships in the future, which contributes to their isolation, perceived loneliness, and lower level of maintaining an active social life. All of these are contributors to the risk of suicide.
Further, there is the issue of masculinity, which has recently attracted extensive attention from theorists and researchers in the context of older men’s vulnerabilities and health risks. Evans, Frank, Oliffe, and Gregory (2011) argue that the perceptions of masculinity and the socially acceptable image of it can often affect the deterioration of older men’s health. Specifically, since masculinity is traditionally linked to physical strength and endurance, health problems that naturally occur more frequently in older men may cause inadequate reactions, such as bitterness due to lowered perceived masculinity. Instead of making a reasonable decision to seek medical attention and assistance, older men may deny their difficulties and become reluctant to address their health-related problems. As Cleary (2012) puts it, “Hegemonic, conventional, masculinity constructs encourage men to deny their emotions and feel shame when they cannot live up to these ideals” (p. 504). Therefore, efforts aimed at achieving the image of a sufficiently masculine man are barriers to successful health care and contributors to the development of suicidal thoughts and moods.
Conwell et al. (2011) identified four major categories of causes and factors in suicide among older people: psychiatric illness, social connectedness, physical illness, and functional capacity. The first category was found to be responsible for more suicide cases than any other category, and it has been partially discussed above in the example of depression; like depression, many other psychiatric conditions are more likely to be developed late in life than earlier. Concerning social connectedness, it has been confirmed that older adults are more likely to become isolated and develop an inability to maintain social connections or make new ones (Steptoe, Shankar, Demakakos, & Wardle, 2013). When deprived of social support, or unable or unwilling to receive it, or in denial concerning their issues, the vulnerability of older men increases and with it their suicide risks.
The role of physical illness and functional capacity should not be overlooked. Difficulties associated with less energy and activity and decreased ability to cope with everyday tasks—both due to health problems—are important contributors to the psychological problems that may lead to suicide. Also, in case an older man requires a difficult medical treatment, he maybe not only discouraged to continue living with a disease but also reluctant to receive necessary psychological support (Oliffe et al., 2011). Concerning functional issues, late life is associated with changes—often dramatic changes—in occupation. If a man is retired, he may find it hard to find a type of activity that can keep him busy with something meaningful during the day. Since it is a significant part of perceived masculinity to engage in meaningful activities such as providing for one’s family (Cleary, 2012; Evans et al., 2011), men who are deprived of this opportunity may perceive their late-life as meaningless, which can make them think about killing themselves.
For the characteristics of late-life suicide specific to men, there are also evolutionary and neurobiological causes and factors (Conwell et al., 2011; Evans et al., 2011). For men, there is the “gender hierarchy” (Evans et al., 2011, p. 13), and the position of a man in this hierarchy is altered as the man grows older and his body is changing. This phenomenon of change in the perceived gender position is primarily associated with attractiveness; in late life, men are less likely to see themselves as attractive to potential romantic partners than they used to see themselves during their youth and middle age. From an evolutionary perspective—that is, the perspective of the early stages of the development of humans as a species—men’s old age was associated with the loss of power, as younger and stronger males were able to physically defeat the previous leader, who was becoming weaker due to his age. It can be argued that this perceived loss of power is still the feeling that many men experience when they grow older although their domination (e.g., in their families) may not explicitly be undermined by younger, healthier men.
Prevention
Now that major causes and factors in suicide among older men have been identified, the available prevention measures should be discussed. The main element of the prevention strategy proposed in the relevant literature consists of ensuring a higher level of individuals’ engagement in health care, seeking and receiving support, and self-care. Conwell et al. (2011) stress that engagement is a major predictor of successful suicide prevention; i.e., older persons should be willing to cooperate with health care providers, social workers, and other professionals who are there to support them and help them overcome possible difficulties associated with their illness, frailty, and depressive symptoms. Moreover, cooperation should be established not only with providers but also with close ones; e.g., family members. Steptoe et al. (2013) confirm that enhancing family ties is an important instrument for preventing mortality in older people, but the use of this tool requires those people’s readiness to be open to the support their families can provide them instead of withdrawing from family and social interactions and isolating themselves.
The process of planning preventive measures should take into consideration the specific concept of perceived masculinity. As has been demonstrated, men may be more likely than women to develop depressive and suicidal thoughts due to their decreased physical strength and healthiness. Lapierre et al. (2011) emphasize the role of communication in addressing this issue; specifically, the authors suggest the notion of “positive aging” (p. 88). Reaching more people with the idea of aging as a process that opens new life prospects, providing images of aging with dignity, and resisting the common understanding of late-life as a time of feebleness and helplessness can help decrease the suicide rate among older men. The mechanism behind this potential decrease includes improving the perceptions of what late life is like among people who are 65 and older or will be 65 soon and promoting a positive image that suggests that leading a healthy and active lifestyle is not only possible in old age but also desirable. This approach can help older men avoid viewing their age as something shameful and humiliating.
Finally, there is a need to identify more immediate preventive measures that may be needed in acute suicide risk cases than are typically found in general and population-based suicide prevention programs. Specifically, Conwell et al. (2011) state that “[e]ffective diagnosis and treatment of depression is most often cited as an example of indicated preventive intervention because of the close association between affective illness and suicide in older people” (p. 458). A major consideration in the provision of such interventions is the recognition of older adults as a vulnerable group in terms of suicide risks. Concerning men specifically, patient communication and patient education should be carried out with special care to avoid the reinforcement of patients’ perceived masculinity-related barriers to receiving proper care and practicing proper self-care. From this perspective, it is the responsibility of health care providers, social workers, and family members to enable older men to receive help in the context of their suicidal thoughts by eliminating barriers based on an erroneous understanding of aging and the processes associated with it.
Conclusion
Among older men, suicide is a daunting problem. They commit suicide more often than young men and women and more often than older women. Major causes include physical and psychiatric illness and perceived noncompliance with masculinity standards; both factors create higher risks of depressive symptoms and, subsequently, suicidal thoughts. To prevent suicide in the addressed group, it is necessary to initiate communication campaigns in which an image of positive aging will be promoted. Also, older men should be encouraged to receive support from their families and care professionals despite the possible perception of masculinity-based barriers. In more acute cases, proper diagnosis and treatment are needed. It is important to recognize older men as a vulnerable group in terms of suicide risks and ensure that this population receives more attention from professionals and researchers.
References
Cleary, A. (2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science & Medicine, 74(4), 498-505.
Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. Psychiatric Clinics of North America, 34(2), 451-468.
Evans, J., Frank, B., Oliffe, J. L., & Gregory, D. (2011). Health, illness, men and masculinities (HIMM): A theoretical framework for understanding men and their health. Journal of Men’s Health, 8(1), 7-15.
Lapierre, S., Erlangsen, A., Waern, M., De Leo, D., Oyama, H., Scocco, P., … Quinnett, P. (2011). A systematic review of elderly suicide prevention programs. Crisis, 32(2), 88-98.
Oliffe, J. L., Han, C. S., Ogrodniczuk, J. S., Phillips, J. C., & Roy, P. (2011). Suicide from the perspectives of older men who experience depression: A gender analysis. American Journal of Men’s Health, 5(5), 444-454.
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797-5801.