Anxiety and Depression  |  Suicide  |  Supporting Seniors & Elderly

Suicide in Older Persons: An Alarmingly Overlooked Tragedy

BY DR NG WAI CHONG

6 August 2020  |   8 min read

I will always remember the first time I witnessed how fatal the consequences of a poorly supported aged caregiver in distress can be.

I was the home-care physician for Mr Q who was in his eighties when he suffered multiple strokes and depression. He lived with his wife, Mrs Q, and daughter in Tiong Bahru.

Mr Q needed help to sit up in bed and to be transferred from the bed to the wheelchair. He frequently called for help from his wife either to be brought to sit on a chair, or be brought back to bed.

Even in his illness and disability, I could tell he was the “man of the house”. I obtained most of the information I needed regarding Mr Q’s conditions directly from him, not his family. He was eloquent and spoke fervently about his suffering. The equally aged Mrs Q was, in my impression, a dutiful homemaker who was quietly supportive of her husband. Whenever I visited to check on Mr Q, she would make me a cup of hot Milo and return to the kitchen, only to tend to Mr Q whenever he called for her.

After yet another stroke, Mrs Q called me. She told me that Mr Q was feeling frustrated and being exceedingly demanding. As she spoke to me on the phone, I could hear him shouting in the background.

Just as I would with any other caregiver requesting for a home visit, I asked Mrs Q what the “problems” are and why the need for me to visit so urgently.

The next thing I heard from Mrs Q was out of character. She said in Hokkien,“If you’re free, you can come. If not, never mind.”

My instinct told me something was wrong, and I hurried over to their home immediately. When I got there, I noticed that the door to their flat was not shut. I knocked on it.

That was when I heard Mr Q shout: “DOCTOR, QUICK, COME IN! HELP!”

“Ok, Mr Q!” I replied and dashed into his bedroom.

Lying in bed, Mr Q frantically asked me to check on his wife, who was lying on the single bed opposite his, next to the bedroom entrance.

I saw Mrs Q dressed elegantly in her sarong kebaya (that was how I realised she was a Nyonya) with her eyes shut and her hands clasped together on her lower abdomen. Next to her pillow, was a medication bottle labelled ‘Theophilline,’ a type of medication for asthma, and a pile of emptied blister-packs labelled ‘Panadol’.

She had taken 60 tablets of Panadol. Overdosing on these medications can be fatal. She was drowsy but she was still breathing. I called for an ambulance and sent both of them to the Singapore General Hospital.

Thankfully, after three months of being in the ICU, Mrs Q survived. However, she was severely disabled. Both Mr and Mrs Q had to move into a nursing home.


What are the risk factors we should watch out for, to prevent suicide in seniors?

These are attributes of people who are at a higher risk of self-harm and suicide:

1

Age

Two groups of people are at higher risk — those who are very young, for example, in their teens, and those in old age. So, seniors are of higher risk.

2

Gender

Men are at a higher risk.

3

Physical health

Those with poor health, such as when there are multiple chronic illnesses — especially those that are debilitating, terminal and causing pain.

4

Mental health

Persons suffering from depression are at higher risk. Those with a history of substance abuse such as alcoholism, or who are lonely, have poor self-esteem, and feel helpless and hopeless.

Those with previous suicide attempts are also at higher risk.

5

Social resources

Those from lower socioeconomic backgrounds, with lower educational levels, and those who are employed or retired are at higher risk.

Also, those who are isolated and poorly connected with families and friends.

People who came from broken families, or who were unhappy in their youth and middle age are at higher risk too.

6

Stress

People suffering from stress due to current or anticipated significant life changes can potentially threaten their sense of value of living.

7

Organised plan

Having an actual plan for suicide makes the risk extremely high.

Adapted from Kane et al, “Essentials of Clinical Geriatrics”, 6th Edition, Table 7-1.

People suffering from stress due to current or anticipated significant life changes can potentially threaten their sense of value of living.

What are the ‘protective’ factors that help to prevent suicide?

It is important to recognise the protective factors that prevent seniors from self-harm. What are they? The ‘opposite’ to the risk factors above.

1

Physical health

Relief of physical pain and symptoms of illness.

Rehabilitation, such as physical therapy and home modification, to improve the ability to be independent in walking and other activities of self-care.

Having knowledge on self-care about chronic diseases and access to good primary care doctors is an important aspect of preventive health.

Knowing friends who suffer from similar health conditions is very helpful. When the suffering is shared, it is halved.

2

Mental health and wellbeing

Mental illness sometimes runs in the family. Medication helps.

Access to mental health care is critical. All primary care doctors are trained to manage mental health. They will also know when a specialist such as a psychiatrist is required.

Stigma around mental health is a huge barrier in seeking help. We should understand and accept mental illness just like physical illness, as part of the spectrum of normal human experience. No one is immuned. It is not a sign of weakness. 

3

Social connectedness

Loneliness, helplessness and boredom (the “Three Plagues”) have many causes. Social isolation and marginalisation due to physical disability and an “uncaring” community make it worse.

Communities should be made aware of the plight of seniors who are socially isolated and do their best to connect with seniors who are alienated due to limited mobility or just due to the “winds of societal change”.

Loving companionships, dignified participation caring for one another, having choices and being open to spontaneous and enjoyable activities, all contribute to alleviating the Three Plagues.

For families and friends, be good listeners. Good listeners listen without judging. Who knows, we could save lives by being good listeners!

4

Societal and family resources

Of course, a cohesive and harmonious family, with strong intergenerational bonds is protective, especially if everyone is thriving in health, wealth and relationships.

Unfortunately, sometimes things are not so rosy. That is when the community and the society at large plays a role.

There are many schemes and services available in Singapore to support people with physical and mental health issues, social isolation and social disadvantages.

Family service centres, polyclinics, GP clinics, counselling helplines and aged-care services operated by social service agencies are all widely available. They are manned by highly skilled and caring professionals.

The Agency for Integrated Care (AIC) has many good resources for supporting seniors and their caregivers in holistic ways. You can find their resources here.  

 

How can we help someone with a risk of suicide?

Among the list of risk factors above, risk factors 3, 4, 5 and 6 are potentially amenable to interventions. Many physical ill-health and mental illnesses can be overcome with timely medical attention. Stress and a sense of helplessness and meaninglessness are always transient, and can be managed with psychological support either through professional counselling or skilful communication offered by friends and families

Risk factor 7, once discovered, is a red flag. We would need to increase our engagement with the senior and facilitate access to professional psychological help.

Last but not least, be the protective factor for our seniors and make use of the other protective factors listed above.

Here are helplines you can reach out to:

  • Samaritans of Singapore (SOS) – Tel: 1-767
  • Institute of Mental Health – Tel: 6389 2222
  • Singapore Association of Mental Health – Tel: 1800 283 7019

The contributor is the Founder and CEO of social enterprise start-up NWC Longevity Practice Pte Ltd. He was formerly Chief Clinical Affairs of Tsao Foundation, a non-profit organisation specialised in caring for seniors living in the community.