It’s Time to Address Suicide Risk Among Older Adults, Terminally Ill

In this MedCity News article, Compassus Chief Medical Officer Kurt Merkelz, M.D., addresses the importance of being vigilant about suicide risk in older adults. He breaks down how to recognize the warning signs of suicide and strategies to intervene when someone needs help. This article was originally published in MedCity News.

Older adults — especially those with a psychiatric comorbidity or uncontrolled pain — have a higher suicide rate compared with younger adults with the highest rate among males ages 65 and older.

“What is your greatest concern today?” It’s a simple question, but it’s powerful — especially for older adults living with chronic pain or a terminal health condition.


Long-term health challenges, pain and terminal illness can significantly interfere with a person’s day-to-day life, their ability to take care of themselves, and their overall happiness. The resulting social isolation, loss of independence, and potentially strained relationships with family and friends can negatively affect a person’s mental health.


As a physician triple-board certified in hospice and palliative care medicine, family practice and geriatrics, I have seen patients and families dealing with some of the most challenging and heartbreaking feelings of fear, despair and loss.


Unfortunately, these individuals are at higher risk of suicide. They deserve special attention, our support — and hope. National Suicide Prevention Month, observed in September, is a relevant time to increase awareness of suicide risk among older adults, their caregivers and the health care workers who support them.


The statistics are concerning and should motivate us all to stay vigilant. Suicide is the 10th leading cause of death in the U.S., and it’s preventable. In 2019, 47,511 Americans took their own lives, according to the National Institute of Mental Health. That’s more than twice the number of homicides.


Older adults — especially those with a psychiatric comorbidity or uncontrolled pain — have a higher suicide rate compared with younger adults with the highest rate among males ages 65 and older. Frequent suicidal thoughts occur in nearly half of terminally ill patients with cancer expressed, and 8% express a sustained and pervasive wish for an early death.


Bereaved family members can be at increased risk of suicide after the loss of a close loved one. Caregivers and health care workers who experience high stress and burnout are at elevated risk as well.


The goal of hospice is to provide quality care that improves comfort, safety and quality of life for people with a terminal illness. It also includes bereavement support to family members for more than a year after their loved one has passed. It’s vital our colleagues understand the risk factors and recognize the warning signs for suicide in patients and families.


Those of us in the health care community are in a position simply by doing our jobs to identify suicide risks and appropriately intervene before a tragic outcome. Here’s an overview of how we can all help:

Stay vigilant. Recognize warning signs, including withdrawing from family and friends, talking about feeling hopeless, wanting to die, or feeling like a burden to others, or planning self-harm. Understand increased risk factors that include mental health issues, lack of adequate social support, life-changing illnesses or events, unbearable pain or a terminal illness or diagnosis.


Talk about it. If you observe warning signs, speak up. Talking not only helps us feel more connected to other people, but it may also be the critical first step toward getting needed help. Consider probing questions such as:


“How have you been feeling?”

“Do you ever feel so bad you think about hurting yourself?”

“Have you been having suicidal thoughts?”

“Have you made a plan to end your life? How and when do you plan to do it?” Specifically, you could ask if there’s a gun in the home, they’ve collected pills, they’ve given away possessions or written a suicide note.


Take action. If someone has a plan to end their life, don’t leave them alone. Keep them safe until they connect with the help they need or elevate your concern to emergency services, ensuring their safety and well-being.


As health care providers, we have a unique opportunity to be the one to help save the life of a patient or family member. Critically, we must also learn to recognize and respond to these signs in ourselves.


So, I ask you, “How have you been feeling?”


Always take signs or talk of suicide seriously. For help, call the National Suicide Prevention Lifeline: 800-273-8255. #BeThe1To