Participants: Stephen Campbell
Series Code: WM
Program Code: WM000379
|
00:38 Hello, and welcome to "Wonderfully Made"
00:42 Today's topic is "Crisis Intervention for Older Adults" 00:49 My name is Dr. Stephen Campbell 00:51 and I will be your host for today 00:55 It is easy to say that crisis is part of our world... 01:00 A number of things that are happening all around us 01:03 that are creating an awful lot of stress 01:05 for each and every one of us... 01:08 However, older adults also experience crises, 01:13 and some of them are different from that of younger individuals 01:18 It is said that as you get older, 01:21 the amount of knowledge that you have acquired 01:25 determines how you adjust to life. 01:27 But in spite of the knowledge that older adults may have 01:31 when faced with serious emotional problems, 01:34 or conflicts, they do end up having feelings 01:41 and doubts about themselves... 01:43 that, at times, may lead to suicide. 01:46 It is safe to say that suicide is the ultimate crisis... 01:53 And that once a person starts having suicide ideation, 01:57 we have to take that very seriously. 02:00 We also know that suicide tends to increase with age 02:05 ...so that one of the highest groups of individuals 02:09 who commit suicide are those 65 years of age and older. 02:16 Some startling statistics also show that 02:20 men, age 85 years of age and older, 02:23 are the ones most at risk. 02:27 In the year 2001, over 5,393 individuals 02:34 committed suicide in the United States over the age of 65 02:41 That number seems to be quite a bit. 02:43 Since these figures are usually estimated based on 02:48 information that's given that can authentically say 02:51 it was a suicide. 02:53 Many times, there are deaths that are suicide in nature 02:57 but they have been determined to be accidental. 03:03 It is very important for us to understand some of the 03:07 things that adults go through, 03:10 and also as they get older... 03:11 what impact it may have on their lives. 03:15 The study showed that as many as 90% of all the suicides 03:21 of individuals over the age of 65 seem to be as a result of 03:27 mental illness, or substance abuse. 03:33 It is not safe to say that all people who commit suicide 03:37 are mentally ill. 03:39 But, most of them do have some of the same mental health 03:44 feelings that someone who is mentally ill has when they 03:50 become suicidal. 03:54 Our older adults do experience an awful lot of stress 03:59 that's different, and we have to address those 04:03 if we need to understand ways and means of keeping them alive. 04:09 The fact that many of these individuals commit suicide 04:12 who are mentally ill is safe to say that... 04:17 not being diagnosed and a lack of treatment 04:21 for these particular problems can be a major risk factor 04:25 for suicide ideation. 04:28 Once an individual is depressed, if it's not treated, 04:32 that depression can lead them to experience feelings of 04:35 hopelessness, worthlessness, and certainly can prevent them 04:40 from having a meaningful life. 04:43 Most individuals who are age 65 and over, 04:46 have lived a long life, and are looking forward to retirement 04:51 If, in reviewing the past, they end up feeling a sense of 04:54 accomplishment, or sense of worth, 04:57 then the life starts to become very unmanageable 05:02 and they start seeing life as being meaningless, 05:05 and start having a lot of depressed feelings. 05:09 These individuals are also considered at risk. 05:14 One of the things that we have to pay strict attention to 05:17 is substance abuse. 05:20 As you know, untreated substance abuse 05:23 can be a major risk factor for suicide. 05:27 One of the reasons that it's true is because 05:31 people who are older feel somewhat out of place 05:35 when they go for substance abuse treatment. 05:39 When we think of substance abuse, 05:41 we think of young adults and teenagers who abuse 05:45 illicit drugs such as marijuana and cocaine. 05:51 However, older adults do have a problem with 05:54 substance abuse as well. 05:56 The major difference between the users and the non-users 06:01 is the fact that older adults tend to abuse prescription drugs 06:08 and over-the-counter drugs. 06:12 As a result of that, many times the disorder is not diagnosed 06:18 and people are not aware that they are experiencing difficulty 06:21 with substance abuse. 06:24 Now in the United states, we value life, 06:27 and suicide is not something that is popular. 06:31 And, we strongly believe that we are designed to be preserved 06:37 and to live a long life... and that life belongs to God. 06:41 This view is not held all around the world... 06:44 However, as people get older, they become more at risk 06:50 simply because physical illness sets in, 06:56 and not all are able to deal with the physical illness 06:59 that they have, or the pain that they may endure. 07:03 As a matter of fact, of all the people who commit suicide, 07:07 most of them seem to have a physical illness, 07:10 either divorce, or widowed... 07:13 and as such, loneliness sets in. 07:17 Loneliness is a very, very important factor 07:20 in evaluating suicidal behavior. 07:23 Women seem to handle loneliness much better than men. 07:27 For whatever reason, once man gets to the point where he feels 07:32 he has to live by himself, and that his life has no 07:36 meaning, and that his family and friends no longer care for him 07:41 ...he does not see any reason to continue. 07:46 This is why, if you look at suicide deaths, 07:49 85% of the deaths of older individuals are 07:54 age of 85 years of age, and older. 07:58 The group that is the most vulnerable, 08:01 are white males over the age of 85. 08:06 Let us look at some of the risk factors that are 08:10 associated with suicide for individuals who are 08:17 65 years of age and older... 08:56 Let us speak about these first risk factors for a few minutes. 09:02 It is very important to know that depression 09:06 and mental illness, if it's left untreated, 09:11 can lead to serious consequences 09:14 Remember that depression is something that caused the 09:19 person to withdraw from society, 09:21 caused them to lose appetite, 09:23 caused the person to have sleeping disorders, 09:27 causing the person to have feelings of worthlessness, 09:30 hopelessness, and also make them feel as though 09:35 life is not meaningful. 09:39 Keeping in mind that most of these individuals over 65 09:42 may have some physical ailment, 09:45 and as they get older, these ailments become more of an issue 09:49 Many times, they feel that life is not worth it because 09:53 of the aches and pain... 09:55 so that we have to make sure that depression is something 09:59 that is dealt with on a regular basis. 10:02 The other factor here is a matter of looking at some 10:05 of the family dynamics. 10:07 If the person is not connected with their family, 10:11 and they are unable to feel a sense of worth, 10:15 that can cause serious problems 10:18 and can also encourage the person to think of 10:21 committing suicide. 10:23 Physical abuse and sexual abuse is something 10:28 that, unless it's dealt with, can come back 10:33 to create some problems for you later in life. 10:36 As you know, during the stage of 65 and older, 10:40 most people tend to reminisce 10:42 and think of what their life has been over the years. 10:45 And if they can go through that process 10:47 and feel a sense of accomplishment, 10:49 feel good about who they are and what they have accomplished 10:52 then that's okay... 10:54 But if life has not been very fulfilling, 10:57 and these thoughts of being abused tend to surface, 11:00 that can be a trigger that can cause the person 11:04 to have experience of suicide ideation as well. 11:07 Let us continue to look at some of the other factors 11:10 that are important here... 11:34 Let us spend a few minutes talking about these risk factors 11:38 I think it's very important for us to keep in mind 11:42 that an individual who has a history of mental illness... 11:47 especially depression, is always at risk because these are the 11:53 individuals who will start experiencing feelings of 11:57 worthlessness, helplessness, will start to withdraw 12:00 from society, spend most of the time by themselves, 12:04 and, as a result of that, the depression is going to continue 12:08 to persist. 12:10 If the depression is untreated, it can certainly put the person 12:15 more at risk. 12:17 If the individual also has a substance abuse problem, 12:20 that is also a major risk factor... 12:23 since we know that most people use drugs and alcohol 12:27 and over-the-counter medication 12:29 to buffer the unpleasant feelings that they have. 12:32 Many times, these are not caught by physicians, 12:37 and family members because the person does not 12:41 come out in the open intoxicated... 12:43 Most of the time, this is a very private thing... 12:48 If there's a family history of suicide, 12:50 it does not mean that there's a genetic component to that... 12:54 But sometimes, a family member may imitate another 12:58 because it becomes a coping style that is accepted... 13:03 so that if one family member commits suicide, 13:06 we have to make sure that if someone else is depressed, 13:10 or having suicide ideation, will not try to 13:15 do the same thing as their family member. 13:19 If there's family maltreatment, where they have been 13:24 abused as a child, or being abused as an elderly 13:28 which happens to be a problem within our society - elder-abuse 13:32 That person may become very depressed, 13:35 and also may become suicidal. 13:39 Loneliness is such a big issue... that we have to 13:43 pay very strict attention 13:44 to those who are living by themselves. 13:48 It is said that as many as 60% of physician visits 13:52 are because of loneliness, and not because of 13:56 any major medical problem that the elderly may have. 14:00 There are some additional factors that we are to take 14:03 into consideration... that we should address at this point 14:08 Let us look at some of the other risk factors... 14:33 Now these last few factors are very important, 14:36 and should be looked at seriously if we are going to 14:40 really help those who are struggling with suicide ideation 14:46 Now loneliness, hopelessness, certainly are symptoms 14:51 of depression, and most of us can identify with those. 14:55 It does not mean that feeling lonely or hopeless 14:59 necessarily means that the person is going to 15:02 commit suicide. 15:04 But, if this is prolonged, and the person is unable 15:07 to come out of those feelings, then that certainly 15:10 will be a major risk factor. 15:13 Another important one here is the fact that many people 15:18 who are thinking of suicide tend to look at the lethal means 15:24 that they can use... 15:26 if that person has access to lethal means... 15:30 Maybe having a gun at home, or enough medication that 15:34 can kill themselves, and they are easily accessible 15:38 ...That would certainly put the person at more risk. 15:41 It is so important that we pay attention to the elderly 15:45 because many times they are left unattended, 15:50 and as a result of that, people are not aware of 15:53 what they're thinking, or what they're feeling. 15:57 There are a number of protective factors that can help 16:00 individuals look at life more meaningfully, 16:03 and not contemplate suicide. 16:05 We are going to spend a few minutes looking at some of 16:08 the protective factors now... 16:34 Let us spend a few minutes talking about this... 16:37 It is true as we become older, we tend to become more religious 16:42 and that's good! 16:44 The more religious the person becomes, the more they 16:48 are able to utilize their cultural values and beliefs, 16:53 the more connected they would feel with society. 16:59 Also, if the person is able to feel a sense of connectedness 17:07 that will allow them to feel as though their life has meaning 17:11 Most of the time, as the person gets older, 17:15 and becomes more frail, they feel that they've become 17:19 a burden to the caretakers... 17:22 especially if they're living at home. 17:25 It's very important that family members 17:27 make the older individuals feel welcome, 17:30 and that their input in life is important to them. 17:35 As a person gets older, they're supposed to have 17:38 a lot of knowledge that can be shared for all ages... 17:42 and there are many ways we can use that knowledge 17:44 to help that person feel as though they're 17:48 making a contribution. 17:50 Let us look at some additional factors here that can help us 17:53 preserve life... 18:16 As you can see, these protective factors are very important. 18:23 To be able to have health professionals who encourage 18:29 you to seek help when you're in need, 18:31 is certainly a protective factor. 18:34 It is so easy to get carried away with the cares 18:37 of this world... that no one listens to what you have to say 18:42 And since the elderly usually have a lot of doctor visits, 18:46 because of loneliness, it's very important that 18:50 some time is spent trying to evaluate what's going on 18:53 in their lives so that appropriate recommendations 18:57 and referrals can be made. 19:00 As you can see, being married is a protective factor... 19:05 This was a divine intervention... 19:09 God made us as human beings to be together 19:14 and when someone lives alone, 19:17 and unable to find things that give their life meaning, 19:21 and having the emotional support of someone, 19:24 this can be a risk factor. 19:27 There is no surprise that most older men 19:31 over 65, who lived many years with their wives, 19:37 after they pass away, do have problems 19:40 staying by themselves. 19:42 This type of behavior actually increases with age... 19:46 So that the older you are, the more at risk you are 19:50 if your spouse should pass away. 19:54 The last risk protective factor that I'm going to talk about is 19:58 good friends! 19:59 Friends are very important, they're lifelong. 20:03 Sad to say, however, as we become older, 20:06 we lose a lot of friends. 20:09 It is the hope that people who are older 20:13 should reach out to form new friends... 20:15 Even though the individuals may be younger than them, 20:18 friendships can be a very good protective factor 20:21 in preventing someone from committing suicide. 20:27 There are a number of warning signs that are crucial 20:31 that we all should pay strict attention to 20:34 if we're going to prevent the elderly from committing suicide. 20:38 Let us spend a few minutes looking at these... 21:08 Let us spend a few minutes 21:09 talking about these warning signs... 21:15 Once the person starts to move away 21:21 from friends and family, they no longer want to come to dinner 21:28 They no longer want to spend time with the children... 21:32 They are no longer interested in their hobbies, 21:36 and activities that they were used to... 21:39 that is a very important sign that the person 21:43 is experiencing some major problems. 21:47 Another important sign that the person is not doing very well 21:52 is when they stop taking their medication... 21:56 Some of these medications are designed to sustain life 22:01 and if the person stops taking these medications, 22:04 it means that their life is going to be shortened. 22:08 If the person starts to keep medication that if used 22:13 in large numbers, would commit suicide, 22:16 that is also a warning sign that the person is having 22:20 some difficulty dealing with life. 22:24 Many of the elderly experience some difficulty 22:28 with sleeping and eating. 22:31 However, when the person starts to get depressed 22:35 to the point where they feel suicidal, 22:38 those eating and sleeping habits also change... 22:42 You may find a lot more sleeping and a lot LESS eating... 22:46 or you may find the person eating a lot, 22:49 and staying up awake most of the night. 22:53 It is very important to monitor the sleeping and eating habits 22:56 of the elderly, especially when they're depressed. 23:01 Another warning sign is when the person 23:05 starts to make statements such as... 23:08 "I'm not going to be around anymore. " 23:12 "I'm very tired with this world. " 23:15 "Nobody cares about me. " 23:17 "I wish I was dead. " 23:20 These kind of verbal statements are what you call 23:24 "high risk statements" that we need to take 23:28 very careful attention to 23:31 if we're going to preserve this life. 23:33 The elderly will not always tell you things, 23:38 but lots of times, their nonverbal behavior can give you 23:42 a lot of subtle messages. 23:45 How do we help someone who is having 23:47 all of these warning signs and symptoms? 23:50 Well the first thing we need to do is to talk to them... 23:55 We need to know exactly what they are thinking... 23:57 what they are feeling... 23:59 We should not try to be judgmental, 24:04 to tell them how to feel... 24:06 to tell them that they should not think about suicide 24:10 We should not reason with them as to whether or not 24:13 that's a good idea. 24:15 What we have to do, first of all... 24:17 is to listen attentively to what they have to say 24:20 Try to let them know that you're here to help them 24:24 and you're going to stand by their side no matter what 24:28 to try to find a way to deal with these feelings 24:31 instead of thinking of suicide. 24:36 You want to encourage them to talk about their feelings 24:38 openly and honestly. 24:41 You don't want to minimize their problems 24:45 or MAXIMIZE their problems 24:47 by making it into something that is SO big 24:50 that it cannot be resolved. 24:52 At the early stage of listening to the elderly, 24:56 you want to make sure that you do not try to solve 24:59 the problem... just give them enough time 25:03 to talk about their feelings openly. 25:06 Another thing that you can do 25:08 to help the individual who is in crisis, and contemplating 25:11 suicide, is to be there for them to make sure that 25:15 they are safe. 25:17 You should not leave the person by themselves if you know 25:21 they have a suicidal plan. 25:24 The best way to evaluate the suicidal plan, first of all, 25:27 is to look at the thoughts and feelings. 25:30 Is the person saying to you that they are 25:32 going to kill themselves? 25:33 If the answer to that question is... yes 25:37 then decide if there are means to do so... if there is a plan 25:42 You want to look at the history... 25:44 Do they have enough social support from family members? 25:47 We know that the more specific the plan, 25:51 and the less the support, 25:52 the HIGHER risk that a person may carry through 25:56 with a suicidal plan. 25:59 You want to make sure that as you talk to the person, 26:02 you do not come across as being judgmental. 26:06 If the person is saying that they are going to commit suicide 26:10 you should not assume that 26:13 they are just saying that for attention. 26:15 You should not "dare" them by saying, 26:16 "You sure that you really want to do this?" 26:19 That type of a statement is daring the person, 26:22 and may actually trigger them 26:23 to do it much sooner than planned. 26:26 Since this is an issue for the elderly, 26:30 over age 65, and this group is the most vulnerable 26:34 it is so important that health professionals, family members 26:39 and friends, keep a close eye on those who live by themselves 26:44 and over the age of 65. 26:47 It's important that we look at some of the reasons why 26:51 the elderly do so. 26:53 In summary, we really should make sure we look at some 26:58 of the risk factors that the elderly are exposed to. 27:02 We know that having a physical illness, living by oneself 27:06 as a result of divorce, or being a widow 27:09 puts the person more at risk. 27:12 We also know that when a person withdraws from 27:15 family, friends and relatives, that that's a serious issue. 27:19 We also know that when the person makes 27:23 the verbal statement that they are going to take their life, 27:27 that we must take that very seriously. 27:31 I strongly recommend that those over age 65 and older 27:37 find the time to form new friendships 27:40 if they have lost their friends. 27:42 Having a strong religious belief, 27:45 having a strong conviction, as far as culture is concerned, 27:48 and belief in God... 27:50 could be one of the MOST powerful protective factors 27:53 in preventing the elderly from hurting themselves. 27:58 I strongly recommend that we reach out to these individuals 28:03 in our daily walk of life... 28:05 And may God bless you as you continue to look at other shows. |
Revised 2014-12-17