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Jan 2008
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Adding Life to Years
A grim distinction for our state and its neighbors
Nevada leads the nation in many respects. It's the state that mines the most gold. It's the most mountainous state. It gets the least rainfall. It had the fastest-growing population, percentage-wise, for 19 consecutive years until Arizona caught us in 2006.
One distinction not often mentioned is that Nevada has the highest rate of elder suicide, more than twice the national average.
Among people 65 and older who commit suicide in the United States, 81 percent are white males. Between 2000 and 2004, Nevada's suicide rate for that group was 68 per 100,000 people. Compare that to 12 per 100,000 people in the state with the lowest elder-suicide rate, Rhode Island.
Here's something else: The other states with the highest rates were all neighbors of ours: Idaho, Montana, Wyoming. And the states with the lowest rates were all in the vicinity of Rhode Island: Massachusetts, New York, New Jersey.
Is this mere coincidence, or are there reasons why seniors in the Mountain West are so much more prone to suicide than those in the Northeast?
It turns out there are reasons, according to Dr. Jerry Reed, executive director of Suicide Prevention Action Network or SPAN USA. Dr. Reed's research has looked at what's different about life in the Mountain West and Northeast and how those differences may contribute to elder suicide.
First off, the usual precursors to suicide exist in both places, factors like mental illness (especially depression) and substance abuse. Among older adults, other common risk factors for suicide include widowhood or divorce, bereavement or a serious medical illness - situations that are likely to leave anyone feeling depressed.
In his study Dr. Reed concluded that “60 to 70 percent” of the variations between the two regions' eldersuicide rates can be explained by three factors: the number of people per square mile, the divorce rate, and the percentage of households owning a firearm.
Divorce and sparse population contribute to people feeling lonely and isolated. Isolation is obviously more common in the frontier counties of Nevada than in Rhode Island. The last factor, gun ownership, is more of a practical issue. Studies show that firearms are the chosen means in nearly three out of four elder suicides.
SPAN USA wants people to understand the ripple effects of suicide. The event hurts not only family members but dozens or potentially hundreds of people who knew and cared about and possibly relied upon the deceased.
Dr. Reed notes that more people die from suicide than from homicide or AIDS/HIV. That makes it a pressing public health issue. And without action, elder suicide, in particular, is almost certainly going to become more prevalent.
That's because the suicide rate for elders is 50 percent higher than for the public as a whole. And the number of people 65 or older in our country is about to double, from 35 million in 2000 to just over 70 million projected by 2030.
What can we in Nevada do to combat elder suicide and shed our dubious distinction? If suicide has crossed your mind, the easiest first step for you to take is to call the National Suicide Prevention Lifeline, 1-800-273-TALK (8255). It's available 24 hours a day.
SPAN USA and we here at the Sanford Center for Aging are trying to bring experts on elder suicide together for a conference in Nevada sometime this year to talk about potential initiatives to address this serious public health issue.
Nevada's Senator Harry Reid, whose father, a miner in rural Nevada, committed suicide when the man was in his 50s, has introduced the Stop Senior Suicide Act. This measure, introduced in the Senate in 2007, would, among other things, provide grants to agencies with programs that help keep tabs on seniors in at-risk situations. The bill also addresses the provision in Medicare that requires seniors to pay a 50 percent co-pay on mental health services versus 20 percent of the approved amount on all other services.
Jerry Reed, who years before heading SPAN USA served as deputy chief of staff to Sen. Reid, says it's vital for primary-care physicians to take the time to talk with their elder patients about their state of mind. That goes double for male patients because four out of five people who die by suicide in the United States are male. Studies have found that 75 percent of older adults who complete suicide had seen their primary- care doctor within the last month of their life. And, no, it wasn't typically a case of their being told they had only a month to live so they decided to end it. Physicians need to know how to screen for depression and elder-suicide risk, and they need resources to treat it. We at UNR and the Sanford Center for Aging are exploring a demonstration program that would address those needs in Nevada.
In the course of an office conversation, Dr. Reed says, a patient may say something to the doctor that indicates the patient isn't doing very well emotionally. That could lead to a diagnosis of depression, which the practitioner (with proper training and resources) could then treat.
“People need to understand that depression is not a normal part of aging,” he says. “It's no more normal to be depressed at 75 than to be depressed at 25. It's an illness that's treatable.”
(Lawrence J. Weiss, Ph.D. is director of the University of Nevada, Reno Sanford Center for Aging and an adjunct associate professor of medicine. He welcomes your comments on this column. Write to him at weisslj@unr.edu or c/o Sanford Center for Aging, Mail Stop 146, Reno, NV 89557-0146.)