Dementia and Suicide Risk
By: Melissa Tanner, Ph.D.
Old Hollywood actress Bette Davis was famously quoted as saying, “Old age ain’t no place for sissies.” While it is true that each stage of life carries its own unique set of psychosocial stressors, older adulthood has more than its share of life challenges. These include, but are not limited to, increased risk of chronic illness, increased functional dependence, loss of role and identity that comes with retirement, and increased financial strain associated with loss of income and increased medical expenses. Aging is also associated with increased risk for loss of spouse and peers, leading to the shrinking of one’s social support system at a time when one is more likely to be physically, emotionally, and financially vulnerable.
All of these factors play a role in the relatively high rates of completed suicides in older adults. It may be surprising to learn that, while rates of suicide attempts are higher in adolescents and young adults, rates of completed suicide are highest among older adults. In fact, adults over the age of 60 show the highest rates of completed suicides in almost all countries, with older men being particularly vulnerable. In the United States, the rate of completed suicides for white men over the age of 60 is more than four times the age-adjusted rate.
In addition to the life challenges highlighted above, dementia represents a unique risk factor for suicide in older adults. Persons with dementia are 3 to 10 times more likely to die by suicide, even when taking into account potential confounding variables, such as depression. However, it is important to note that the level of risk varies across the cognitive continuum. While late-stage dementia may serve as a protective factor against suicide, those in the early stage of cognitive decline are at the highest risk. The reason for this discrepancy is that the extent of impairment to executive functions experienced in late-stage dementia reduces meta-cognitive awareness of decline, meaning that those in this stage are less aware of their own deficits and less able to reflect on them. Additionally, one’s ability to engage in suicide planning declines as dementia progresses. Meta-cognitive awareness and planning skills are still relatively intact in the early stage of dementia. This, in combination with a slight increase in disinhibition, impulsivity, and risk-taking behavior, makes for heightened risk of suicide.
Knowledge of the increased risk of suicide in the early stage of dementia makes early detection and targeted support even more critical. Avoidant coping and / or social isolation are all too typical responses from older adults experiencing cognitive concerns. Unfortunately, denial and avoidance do not protect against either the dementia process or the increased risk of suicide. While the dementia diagnosis itself may be distressing, it also provides the opportunity to ensure that a person’s needs are addressed. The assessment tools available through the BCAT® Research Center are designed to make dementia detection as efficient and convenient as possible, thus helping to ensure that persons in the early stage of dementia are identified and connected to appropriate resources as quickly as possible. Doing so allows them to make empowering decisions while still capable of doing so. It also increases the likelihood that needs for therapeutic support and / or functional assistance will be met.
There are two pathways to early detection readily available through the BCAT® Research Center, the BCAT® virtual visit and myMemCheck®. The BCAT® Virtual Visit is a scientifically validated online assessment administered by a live specialist in 30 minutes. myMemCheck® is a scientifically valid, rapid, self-assessment screening tool designed to identify those in need of a more comprehensive assessment. Both provide a personalized report that is intended to be shared with a healthcare professional. In addition to these two tools, the BCAT® Test System also includes a scientifically validated measure of symptoms of depression and anxiety. When results of these measures are integrated into a comprehensive evaluation, the likelihood that older adults at heightened risk for suicide will be identified and connected to requisite support is increased. This could represent an important step towards reducing the rates of suicide in older adults.
Bette Davis may have had a point; old age may require a degree of mental or psychological fortitude that exceeds what many are able to summon when faced with such a preponderance of age-related psychosocial stressors. We can do our part to make it as manageable as possible by empowering and supporting older adults through the challenges associated with aging, including the dementia process. Check out www.enrichvisits.com to learn more about the tools described above and share them with the older adults in your life.