When elderly people give warning of suicide.

BACKGROUND: The study has a dual objective: (1) to investigate the extent to which, and how and to whom, elderly people gave warning (according to the definition of the term given by the American Association of Suicidology) prior to suicide; (2) to investigate how these warnings were perceived by the recipients of them, and what reactions the recipients had to the warnings. METHODS: This is a psychological autopsy study based on qualitative interviews. Sixty-three informants were interviewed about 23 suicides by individuals aged over 65 in Norway. The informants comprised relatives, general practitioners (GPs) and home-based care nurses. In general, the analysis of the interviews follows the systematic text condensation method. RESULTS: The interviews contained four main themes regarding reactions to the warnings: "not taken seriously," "helplessness," "exhaustion," and "acceptance." A total of 14 of the 23 elderly people gave warning before the suicides occurred. The warnings were given to relatives (11), home-based care nurses (5), and GPs (2). CONCLUSIONS: Even though more than half of the elderly people had given warning (most frequently to relatives) before the suicide, the warnings did not initiate preventive measures. Together with passive attitudes, the lack of recognition of both the risk of suicide and the opportunities for treatment prevented possible measures being implemented. The paper discusses the grounds for the reactions as well as how suicide warnings given by elderly people can be taken seriously.

Elderly people who committed suicide--their contact with the health service. What did they expect, and what did they get?

OBJECTIVE: Contact between elderly patients and healthcare professionals may be crucial for suicide prevention if suicidal tendencies are revealed and help is to be provided. The objective of the study was to investigate how elderly suicide cases had perceived the health service and what characterised their contact with it. METHOD: This is a psychological autopsy study based on qualitative interviews with people who had known 1 of the total of 23 suicide cases aged over 65. The 63 informants were relatives, general practitioners (GPs) and home-based care workers. The systematic text condensation method was applied to analyse interviews. RESULTS: Many of the elderly expressed distrust of health service once their functional decline began. They feared losing their autonomy if they became dependent on help, and many therefore refused health service provisions. Communication between them and helpers failed. As they gradually became more dependent on medical care, many experienced that they were not given the desired help, which confirmed their distrust. CONCLUSION: Contact between these people and the health service must inspire confidence for it to prevent suicide. Elderly people at risk of suicide are vulnerable: they feel degraded if their autonomy is threatened by health personnel. The structure and organisation of the health service, and each worker's contact with the elderly, must preserve their dignity. Dignity must be evinced through the healthcare professionals' treatment of elderly people and a system that meets their needs.

Why suicide? Elderly people who committed suicide and their experience of life in the period before their death.

BACKGROUND: The objective of this study is to acquire an understanding of the suicides among a group of elderly people by studying how they experienced their existence towards the end of life. METHODS: This is a psychological autopsy study based on qualitative interviews with 63 informants in relation to 23 suicides committed by persons aged over 65 in Norway. Informants who knew the deceased persons well describe what the elderly person communicated to them about their experience of life in the period before the suicide and how they as informants saw and understood this. The informants comprise relatives, family doctors and home-based care nurses. The analysis of the interviews follows the systematic text condensation method. RESULTS: The descriptions are divided into three main elements: the elderly persons' experiences of life, their perception of themselves, and their conceptions of death. "Experience of life" has two sub-topics: this life has been lived and life as a burden. Everything that had given value to their life had been lost and life was increasingly experienced as a burden. Their "perception of themselves" concerned losing oneself. Functional decline meant that they no longer had freedom of action and self-determination. "Conceptions of death" involve the following sub-topics: acknowledgement/acceptance and death is better than life. Life had entered into its final phase, and they seemed to accept death. For some time, many of them had expressed the wish to die. CONCLUSIONS: The results lead us to argue that their suicides should be considered as existential choices. The sum total of the different forms of strain had made life a burden they could no longer bear. Age meant that they were in a phase of life that entailed closeness to death, which they could also see as a relief.

"Why do they become vulnerable when faced with the challenges of old age?" Elderly people who committed suicide, described by those who knew them.

BACKGROUND: Suicidal behavior among the elderly is a research field in which qualitative and quantitative methods can and should supplement each other. The objective of this qualitative study is to investigate whether the descriptions of elderly people who committed suicide, given by those who knew them, can provide common features that create recognizable patterns, and if so whether these patterns can help to shed light on the suicidal process. METHOD: This is a psychological autopsy study based on qualitative interviews with 63 informants concerning 23 suicides committed by persons aged over 65 in Norway. The informants were relatives, their family doctors, and home-based care nurses. In general, the analysis of the interviews follows the systematic text condensation method. RESULTS: The descriptions have three main topics: life histories, personality traits and relationships. "Life histories" includes the sub-topics ability to survive and action-oriented achievers. They describe people who came through difficult circumstances when growing up and who were action-oriented in life in general and in crises. "Personality traits" includes the sub-topics obstinacy and controlling others. The informants saw the elderly people as strong-willed, obstinate and possessing a considerable ability to control themselves and those around them. "Relationships" includes the sub-topics I didn't know him and He showed no ability to meet us halfway, and describes the informants' experience of emotionally closed persons who kept a distance in their relationships. CONCLUSIONS: On the basis of the descriptions of the elderly people given in this study, we argue that these individuals will find difficulty in accepting and adapting to age-related loss of function since their self-esteem is so strongly associated with being productive and in control. Loss of control reveals their vulnerability - and this they cannot tolerate.

[Suicide among the elderly in Norway]. / Selvmord blant eldre i Norge.

BACKGROUND: We wanted to generate more knowledge about elderly people who commit suicide in Norway, especially in relation to demographic conditions, somatic and psychiatric disease, suicide methods and suicidal communication. MATERIAL AND METHODS: The material consists of 287 cases of suicide in people aged 65 years or more who were examined at the Department of Forensic Medicine of the University of Oslo during the 1992-2000 period. Sources of information were the forensic autopsy records and police reports. RESULTS: In a majority of the cases the deceased had suffered from psychiatric disease (62%), mostly depression (41%). Somatic disease was less often a prominent factor (22%). A majority had an established contact with the health services at the time of suicide. Suicidal thoughts had been expressed by 29%; previous suicide attempts had been reported by 15%. INTERPRETATION: Health personnel must pay attention to elderly people with symptoms of depression, especially those who express suicidal feelings and have made previous attempts.