The phenomenon of suicide has long been at the center of social debate and discussion. It’s been theorized and analyzed by psychologists and sociologists through a variety of lenses for over a century, been the topic of intense media focus and has become part of the dialogue
of mainstream culture.
Yet, when discussing preventable suicide, few make mention or think of older adults.
After many years of decline, suicide rates have been rising across all demographics since 1999. Despite increased awareness in recent years, few are aware that older adults, particularly older men, are dying by suicide at an alarming rate. In fact, according to the Centers for Disease Control and Prevention, men are dying by suicide at a rate nearly four times that of women, with men aged 75 and older dying at a rate nearly 30% higher than any other age group.
And yet this “silent epidemic” has rarely been discussed, and there remains a paucity of research around older men and suicide.
With the number of older adults set to increase dramatically and with increased life expectancy, more complex health-care challenges are bound to develop.
How we age varies from person to person, though. Life at 50 or 75 for one person can be far different from the next. Yet, for all of us, as we age, the inevitable happens: Our bodies and minds feel the impact of the aging process, and suddenly the baseline of our abilities, as well as our connections to others, start to change.
Responding to changes
As it turns out, both how we respond psychologically to these changes throughout life — and how we in turn manage our own health-care habits — can have a lot to do with gender.
In the 2018 review, Suicide in Older Adults, researchers identified specific risk factors for suicidal thoughts and behaviors among people over 65: “psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses and physical and psychological pain.”
These contributing factors for suicide may be different for older adults than those of younger groups. So too, they may be different for men than for women.
In fact, in an analysis of suicides over the previous 15 years in the United Kingdom, it was found that anxiety and associated depression were factors in one in six deaths of older adults who died by suicide. These individuals were more likely to be male and to live alone, with isolation and physical disability being more prominent contributing factors to the suicides.
As we age, we’re more likely to experience health-related setbacks that impact our physical abilities, challenge our ability to work or do other tasks independently, and these in turn influence our income, autonomy and social standing.
Aging also impacts relationships, including potential loss of a spouse or partner, or a circle of friends. The variables that often define the essence of a person’s life can change, and often disappear, with aging.
Successful aging has been linked to the ability to adapt to these difficult but inevitable changes. Individuals who age well, in other words, are better able to bend and flex, and to pursue new alternatives or solutions that still provide a sense of control over what is still within their control.
This research further suggests that individuals who struggle to adapt to the inevitable changes associated with aging are at increased risk of suicide.
Throughout the lifespan, men have traditionally been conditioned, taught or told to “man up” and “handle it.” As a result, many men may engage in or refrain from activities that, whether inadvertent or intentional, sabotage or fail to maintain their own health. In fact, men are far more likely to have seen a general practitioner for physical health reasons than to have seen a mental health professional in the month prior to suicide.
With messages around masculinity being entrenched in the very essence of a man’s identity, an older man who’s found a way of living and developed a routine he’s built his life around, may struggle to adapt to the changes and losses that inevitably occur.
Gender can have an enormous influence on how we “do” health care. For men, the social expectations imposed on their gender seem to amplify detrimental cycles of behavior. Research has consistently shown that men experience comparatively greater social pressure to conform to the influence of societal gender norms. As we age, many men may, therefore, find their traditional markers of masculinity compromised.
Theory often suggests that masculinity is expressed by men by way of job title and income, physical fitness, social positioning, independence in action and thought and ability. Inevitably, as we age, these are the areas of life that become challenged.
A loss in any of these domains constitutes a greater risk for suicide in men. Moreover, these losses — when they come in many areas — ultimately impact the individual in a cumulative way, raising the risk of suicide exponentially.
Activities for men
In my work with dementia, I found it consistently more difficult to engage men in activities. Of course, some activities enforced what were seen as traditional male and female gender roles. Men’s participation in baking club wasn’t expected to be too high. But even when activities were geared toward the specific interests of the men on the unit at that time, getting the men engaged was a challenge. It seemed they didn’t want others to see they needed help, and they certainly weren’t eager to ask for it.
This was particularly true if it was an activity they enjoyed, which may be counterintuitive. As the disease progressed, however, they stayed in their rooms more. They chose to do what they could still do, without anyone questioning it: watch sports or other TV, alone.
This vicious cycle of feeling disconnected from others, and the grief associated with the loss of the ability to do the things once enjoyed, can lead to isolation.
This may lead to more anxiety around social interaction, which further amplifies the sense of loneliness. That can generate depression. Depression then propels the cycle to prime the conditions for a perfect storm.
For many of the men I worked with, it was important to continue to offer support, and offer invitations to the activities they enjoyed even if they decline the offers seemingly every time. Being there for someone who is experiencing depression, isolation or any form of mental health challenge can save a life. This may be especially true for men, who may be more prone to draw inward and isolate as the inevitable aspects of aging begin to take their toll and challenge their sense of identity.
Adopting a chronic-care model and adjusting for social disconnectedness, neurocognitive impairment and disability are crucial components of successful suicide prevention programs for older adults.
These approaches also must take into account what is noted as a gap in the literature: What is the influence of the caregiver dynamic on men’s health?
Asking for help can be a difficult thing for anyone. Societal norms have historically deterred men from asking for help, which may be a contributing factor to why so many retreat into the darkness of isolation, and ultimately, end their life by suicide.
For the men I worked with in the field of dementia, many of whom were living with mental health challenges, complex health scenarios and had very little family or outside support, it was crucial that I not give up on offering invitations or support.
The pattern of isolation can be challenging to break. But by continuing to check in, offer help and not buying into the all too common belief that the person wishes to be alone “all the time” or “always says no,” a new pattern can emerge — one that can help bring these men, and the challenges they are facing, out of the darkness.
Nate Cannon is a Twin Cities based author, public speaker and dementia specialist. If you or an older adult in your life are experiencing isolation or depression, please call the Institute on Aging’s 24-hour Friendship Line at 1-800-971-0016 or call the Senior LinkAge line at 1-800-333-2433 and ask about mental health resources.