Lost in old age

The cantankerous old man in your life might actually be a man who’s contemplating suicide. The forgetful widower next door may not be suffering from early Alzheimer’s, but from major depression.

For seniors – who have the highest suicide rates in the nation – depression often manifests itself “atypically.” While a younger person with depression might be sad and withdrawn, as frequently portrayed in TV ads, an older person with depression might be verbally aggressive or exhibiting signs of dementia.

Those and other symptoms suffered by seniors can be difficult to recognize, as sufferers, relatives or care providers blame symptoms on the aging process. And depression often goes untreated among populations struggling with major losses – of loved ones, of the jobs and careers that defined them, of physical independence.

Depression, “basically the root” of suicidal thinking, isn’t an inevitable part of aging, said Pamela Sloan, Elder Services director at Frontier Behavioral Health. Depression is almost always treatable through medication, counseling or other means, improving sufferers’ quality of life, she said.

“There are a lot of people who feel that being depressed at 85 years old is kind of normal, because if I was 85 and I had eyesight problems and hearing problems and my joints hurt all the time, I might be depressed, too,” she said. Frontier Behavioral Health formed in 2011 after the merger of Spokane Mental Health and Family Service Spokane.

In fact, some symptoms associated with aging – lack of energy, weight loss, pain – may be caused or worsened by depression, Sloan said.

Suicidal thoughts stemming from depression don’t come from nowhere one day. But it’s partly because their effects tend to grow slowly that they can be difficult to recognize in others or oneself.

Depression “starts to erode the way you think and feel until you really look at things and you don’t see the future, or if you see the future it’s extremely negative,” Sloan said. In some cases, an elderly person’s thoughts turn increasingly negative, and they start to see the world without a place in it for them, themselves as a “burden.”

“You feel horrible, so horrible that death would be better than the way you feel,” Sloan said.

At the county, state and national levels, older people consistently face the highest risk of suicide. Broken down by race and gender, white men are the most likely to take their own lives – and the oldest white men face the greatest risk.

Among Spokane County residents 65 and older in 2010, the suicide rate was 16.4 per 100,000 people, according to data provided by the Spokane Regional Health District. That was slightly higher than the U.S. rate of 15.1 but lower than the statewide rate of 20.4. Men took their lives at a far higher rate than women, reflecting state and national patterns.

That’s compared with 14.2 suicides for every 100,000 people for people of all ages in Spokane County. For every 100,000 of all ages statewide, there were 14.1 suicides, and 12.4 nationwide.The rate rose for Spokane County residents 85 and older, to 21.4 suicides per 100,000 people. Again, that was higher than the national rate for that age group but lower than the statewide rate. In that oldest group, every recorded suicide was committed by a man.

In Idaho, consistently among the states with the highest suicide rates, the rate for the oldest men rose to 74.6 deaths per 100,000 men 85 and older from 2007 to 2011, according to the Suicide Prevention Action Network of Idaho. For women 85 and older, the rate was 7.4 over that five-year period.

That figure for the oldest white men in Idaho is “astronomical,” said Catherine Perusse, a mental health counselor in Sandpoint and regional director of the SPAN North Idaho. But she said the true rate is probably higher, because it doesn’t count “passive” suicides, where people might stop taking their medications or eating and drinking rather than shooting themselves with a gun.

Seniors sometimes show the same signs of depression displayed by others: feeling sad, isolating themselves, experiencing drastic changes in sleeping or eating habits, losing interest in activities they used to enjoy. An often-overlooked sign that a person is planning a suicide – no matter their age – is that they’re suddenly “overly happy,” said AJ Sanders, who runs the suicide-prevention program at the Spokane Regional Health District.

They’re not pretending, Sanders said. They’re anticipating relief.

“Everything’s going to be better,” according to the suicidal person’s thinking, she said. “When a person’s thinking about suicide, they’re only thinking of the relief from the pain. They don’t really want to die – they want the pain to end.”

But some symptoms are exhibited more often by elders, and often mistaken as signs of other problems, suicide-prevention workers say. They include:

• Crankiness. Younger adults with depression usually either sleep or eat too much or too little – classic symptoms, Sloan said.

Seniors often show depression by being agitated or anxious, Sloan said. They may act out against other people verbally, earning the label of hard to get along with or “cantankerous.”

TV ads for antidepressants often show people who are withdrawn, lacking energy, pulling away from their normal activities.

“For an older person, they might be out driving and going places, and they may be in people’s face,” Sloan said.

Health care providers and others, she said, need to determine should be whether that’s a lifelong personality trait or a new feature – but the person’s crankiness makes that difficult, and the physician or neighbor pulls away.

“They don’t want to be around the older person and the older person doesn’t want to be around them either,” Sloan said. “So it works perfectly. And the older person never gets assessed for the potential for depression.”

• Cognitive symptoms. Memory loss, distractibility and disorientation – even delusions or hallucinations – may be prominent symptoms of depression, Sloan said. Those symptoms can be misdiagnosed as dementia, leading families to move elder relatives out of their own homes prematurely.

In some cases, “Families are told, basically, ‘This person isn’t safe to be at home,’ ” Sloan said. But if the depression were treated, in many cases those symptoms would go away.

• Physical pain. Older adults with depression often report “somatic” symptoms, Sloan said. “My back hurts, my bowels aren’t working, my arm hurts – whatever. Things that are bodily,” Sloan said. “Rather than, ‘Gee, doc, I’m feeling depressed.’ ”

A patient who goes to her physician several times in several months, citing apparently untreatable aches and pains, may feel safer complaining about problems related to the body than the psyche.

“That’s a health issue, and that’s something that has no stigma attached to it. If you start talking about my brain and the fact that my brain isn’t working anymore and I’m feeling depressed, that’s not OK,” Sloan said.

But those complaints can serve be a red flag for doctors or others, she said, that the patient should be questioned about possible depression.