Select from the following set of readings for this module.
SECTION 1: AGING, ILLNESS AND SUICIDE Twenty-five percent of all suicides in the United States are attributed to the older adult population. This number may actually be underrepresented. Suicide statistics are derived from death certificates and only a proven suicide is listed as such. People hide suicides due to social stigma, insurance and legal reasons. Many deaths from auto accidents and self-starvation may be unrecognized as suicide. Older males are four times as likely as older females to commit suicide. Factors that place elders at risk for suicide include retirement, bereavement, having more than two chronic illnesses, living alone, alcoholism, drug abuse, and living with the threat of dependence. Depression is only a risk factor for suicide in the presence of hopelessness, a negative expectation for one's life situation. The risk for suicide increases by having more factors present. In older adults, suicide represents a permanent solution to an intolerable life situation. When they feel life no longer has meaning and they feel helpless to alter present life conditions, they loose hope that life will improve (Osgood, 1985). This is very common with the presence of a chronic illness that will eventually lead to dependency in a person who has been very independent and productive most of their life. Another reason for contemplating suicide with illness is the fear of pain rather than the fear of dying. Compared to suicides in younger age groups, most older adult suicides are successful on the first attempt. They usually keep their plans to themselves, making very few threats. Usually, once they have made up their mind to commit suicide, they are no longer depressed. It is at this time they appear to be putting their affairs in order, such as giving away their most beloved belongings. They use a lethal method such as hanging, drowning, and pills. They also make sure they will be alone when they commit suicide, reducing the chances of being rescued in time. Treatment for the prevention of suicide in older adults has greater success by keeping them in the community instead of hospitalization. The rate of success also increases with social support intervention. Social support reduces stress for older adults, but it is important to remember that it is the quality of the relationship not quantity of relationships that matters.
SECTION 2: MENTAL HEALTH AND AGINGMental health can be measured by the capacity to cope effectively with relationships and the environment, and by the satisfaction experienced in doing so. According to Ebersole and Hess (1985) "Mental health is like a violin with strings of interaction, behavior, affect, and intellect. All these together may produce a pleasant or stimulating melody, or they may be discordant and irritating. The tune continually changes. No one is entirely mentally unhealthy, and no one is fully healthy at all times." Coping can be viewed as an active process involving specific thoughts and behaviors of an individual intended to protect one's self from physical and emotional harm by taking control of physical, psychological, and environmental resources to affect a positive outcome to a stressful life situation. Elders become practiced at coping with life because of the many years of experience dealing with gains and losses. Coping is dependent upon two basic factors:
A comprehensive assessment of an older adult includes the status of physical and mental health, social and economic factors, functional abilities, and environmental characteristics. There are standardized tools available to generate this information. It is important to remember that this data is truly irrelevant when trying to distinguish normal from pathology if not considered in context of the elder's past life, and their hopes and expectations for the future. SECTION 3: DEATH, DYING, AND GRIEFIn textbooks we read about death and dying as an event. We accept that death is an inevitable part of life, and yet cannot perceive dying as a life process. After the death of someone we love, we continue to mourn our loss through calendar dates of birth, death, and holidays. Healing evolves when we begin to celebrate their life and how that life touched ours. In the book Refuge, the author relates her experience of the death of her mother. She eloquently integrates the human life experience within the natural course of nature. She writes "The losses I encountered at the Bear River Migratory Bird Refuge as Great Salt lake was rising helped me to face the losses within my family. When most people had given up on the Refuge, saying the birds were gone, I was drawn further into its essence. In the same way that when someone is dying many retreat, I chose to stay". Lying peacefully next to her mother... " Death is no longer what I imagined it to be. Death is earthy like birth, like sex, full of smells and sounds and bodily fluids. It is a confluence of evanescence and flesh". After her mother's death... "I felt as though I had been midwife to my mother's birth" (Terry Tempest Williams, 1991). Ebersole, P. & Hess, P. (1985). Toward Healthy Aging. St.Louis: Mosby. Osgood, N.J. (1985). Suicide In The Elderly. Md: Aspen. Williams, T.T. (1991). Rufuge. NY: Vintage Books. |