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Older adults need to be part of the conversation when it comes to mental health and wellness, when it comes to family support, when it comes to social connection, when it comes to treating depression, all of it. Let's include older adults in conversations. Let's get older adults connected to mental health care when they need it. And let's start to bring this rate down for older white men, especially, but older adults in general, let's lower the risk for them. Let's include them more. I mean, this social connectedness risk really stands out to me. Because what this also says it's more back into that mindset. Why would people get connected if, when they show up, they're not going to be valued? Right. So let's all work on shifting. Myself, too. I catch myself all the time. Ageism is ingrained in us. Why would I show up if I'm not going to be valued when I get there? So let's begin to shift how we see and value older adults and make joining our programs, make coming into treatment, a place where older adults want to be and where they feel valued when they get there.

1:23
I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and family. I created the psychology of aging podcast to answer some of the most common questions I get about ageing, questions about mental health and wellness, changes in the brain like with dementia, relationships and sex, caregiving, and even end of life. Like I say in my therapy groups: no topic is off topic, we just have to have a healthy way of talking about it. So if you're an older adult or caring for one You're in the right place. Let's get started.

2:03
This is Suicide Prevention Week. And in honor of this very important week, I am going to spend some time talking about older adults and suicide, and how to help older adults who might be suicidal. Talking about older adults and suicide is really important. And I'm going to tell you why. Older white men, over 85 are at the greatest risk and have the highest rates of suicide than any other age group. But here's the thing. Older Adults are often left out of the conversation when it comes to assessing for depression, assessing for suicidal thoughts and plans, and connecting them with mental health care. So this means that older adults who do have mental health concerns are less likely to be cared for by mental health providers and more likely to be cared for in primary care. Okay, let's think about that for a minute. Primary care providers are probably some of the most overworked and under resourced medical providers out there. Primary care providers don't have the time. They don't have the resources, or often the training to provide older adults with the mental health care that they need. But older adults with mental health concerns are treated in primary care most often. We have to do something about that. That's one of the primary reasons I started this podcast is that when it comes to mental health, sexual health and wellness, older adults are left out of the conversation time and time again and I am striving to change that. I'm glad you're listening because that means, I'm hoping it means. that you're interested in changing that too. So thank you for being here. Thank you for joining me. And together, we're gonna make some shifts, I hope, in terms of access for older adults and mental health care and sexual health care. Yes, I added sexual health in there because when you think about older adults, probably the last thing on your mind is sexual health, but it's so important. In future episodes. We're going to talk about why. Okay, so back to primary care providers. So we know that they're under resourced, overworked have limited time. And then, in the midst of COVID, even if the primary care clinic is open, many older adults are not going to go to the doctor just for a mental health concern. Their physical health is much more a priority right now than their mental health, right? And so many older adults are not going to the doctor even if the doctor is open because they don't want to get exposed to COVID.

4:59
Okay, I'm gonna peel back another layer and talk about some mindset problems that we, as a society, have when it comes to older adults and mental health concerns, like depression. I'm focusing on depression because in a few minutes, I'm going to be sharing some statistics and the correlation between depression and suicide and suicide behavior in older adults. There is a false belief that somehow, as we get older, we're supposed to be depressed, or that at some point, when we've lived long enough that our lives become disposable, and that somehow suicide might be an acceptable end to a life that people deem as "haven't you lived long enough? isn't it time for you to go?" Disposable. I did not come up with this term "disposable". I got this concept and it just really struck home from a woman named Varda Yoran. I don't know if I'm saying her name right, I want to reach out to her and see if she'll be interviewed for this podcast. But she, in April, wrote a letter or just kind of an opinion piece to the Huffington Post, and it was published in Huffington Post in April. And the title of her article is "Just because I'm 90, doesn't mean I'm ready to die, or disposable". And I'm going to take a minute, it's a short article. And I'm going to take a minute to read it to you because there are some valuable lessons for all of us and understanding how our beliefs about aging and the value of a life and older life might influence suicidal thoughts and behavior. So I'm going to read this to you and then I'll explain more about what I mean by doing so.

5:10
So this is the article by Varda Yoran, "Just because I'm 90 doesn't mean I'm ready to die, or disposable".

"I've been a senior citizen for a quarter of a century. And I still sculpt, read and write essays. I speak five languages and I use email and WhatsApp to communicate with friends and family in Finland, China, Norway, England, Israel, Russia, Thailand, and throughout the US. I run a foundation I created that assists in mobile seniors. I attend classes, and I'm organizing a philosophy club via zoom that discusses ethics, forgiveness, anger, creativity, and various other topics. Okay, I'm just gonna jump in here and say I totally want to be in her philosophy club. Okay, back to her article. Now my routine has changed. COVID-19 has shut down everything in one shot. At age 90, I have lived through a lot of history, but I have never seen a situation like this. My daughter was concerned that, in the city, I would be a lot more exposed while facing a lower level of care. I left Brooklyn and I'm now with her, my son in law and teenage grandson secluded and safe, upstate in the peekskill mountains. My only outings, masked and gloved, are to the nearest labs for regular blood tests. Who knows in which direction the changes to come will take us. What I've seen so far is that the crisis has brought out the best in good people and the worst in bad people. What I see now is that cooperation and empathy on a massive scale are needed to bring the world back on track.

Some people may suggest that if I were to die of the Coronavirus, I at least have lived a full Life. And yes, I have lived a full life. I was born in China to Jewish parents who left Russia after world war one to seek refuge from anti semitism, famine, and pogroms. I spent the first 20 years of my life in China surviving the Japanese occupation of my town, Tinson, during World War Two. Then I spent the next 30 years in Israel. I taught Hebrew to Jewish immigrant children, served in the Air Force and worked as a graphic artist. I got married and raised two daughters. Finally, my husband's work took us to the US in 1979. I was 50 years old and unaware that this would be the start of a period during which I would grow and flourish as an artist. In my 60s, I created five large outdoor sculptures in Israel for institutions such as Tel Aviv University, and the ghetto fighters Museum of resistance. At age 70, I began to find my voice as a writer and collaborated on the defiant my husband's memoir about fighting Nazis as a partisan in Eastern Europe. At 82, I created a nonprofit organization, the rose Art Foundation, which has donated 800 Jheri recliners to immobile patients and facilities throughout the US. Even now, during the coronavirus pandemic, I get requests from patients whose quality of life has been changed by these donations. Last year, at 89, I published my second book, and there is still much to do, I'm not disposable, and I'm sad that there are people who think age dictates whether a human life is worth saving. I can tell you that I and my loved ones want me to live for many years to come. I want to attend my grandson's high school graduation and see which college he'll attend. I want to see my older grandson who's married become a father. I want to continue my joyful life. I'm unable to travel as extensively as I once did, but I want to visit Israel again.

Just because I'm 90 doesn't mean I don't have things to learn and skills to hone. I have more physical limitations and ailments than I choose to mention, but that won't stop me. I'm growing as an artist. Last September, I began a three month class at Brooklyn clay studio learning to glaze and fire in the kiln. In February, before social distancing was put in place, I sought a new approach, visited urban glass in Brooklyn, and found a teacher to show me the process. My twin sister passed away 15 years ago and, when the quarantine is over, I hope to finish a sculpture that represents our relationship, our lives, our dreams, our productivity, don't end when we turn 65, an age that society decided was old enough. Senior citizens can be productive and contribute to the world bringing to it their added dimension of age and experience. I think no limit should be set on when a person's life is no longer valuable. I'm 90, and I'm waiting for quarantine to end. As long as I'm still creative and surrounded by the love of family and friends, as long as I still enjoy life, nobody has the right to write me off."

12:20
Can we just have a mic drop moment for Varda Yoran? Okay, so why did I want to share this letter with you, especially in light of Suicide Prevention Week? So there is a valuable lesson in Varda's letter to us and I will say yes, this is to us. This is to us as a society. As senior care and mental health providers, we have to challenge and reflect on our own values in working with older adults. And not only our own values, but the value we place on older lives, especially older lives with illness, and lack of mobility, mental health concerns and so on. You know, we have all heard somebody say, "well, he just needs to die and be put out of his misery" or "how long is too long to live life?" if you work in senior care long enough, or if you work with older adults long enough, you're bound to hear a professional say that. But we really need to think about our own values and the value we place on older lives.

13:32
I love the statement that she made when she said, "I am not disposable, and I'm saddened that there are people who think age dictates whether human life is worth saving." I love that, because that's very value laden. And so is our lives, our dreams, our productivity don't end when we turn 65 an age that society decided was old enough. I mean, It's so... it's remarkable at 65. I do this too, right? It's a demarcation at 65, you become an older adult, at 67 you can claim retirement. You know, there are all these sort of demarcations, and we need them in research and we need them for retirement planning, in order to draw on Social Security, right? But there are these demarcations that reduce our thinking, influencing us and making determinations on what is valuable and what's not valuable.

14:28
Okay, so now that we can agree that every life has value, let's look at some of the factors that increase the risk for suicide in older adults, and then what we can do to help and actually I'm going to be linking to a previous podcast episode that I did on suicide and expert tips for helping older adults who are suicidal. So, after this episode, please go and listen to that one. At the end of this episode, I'm going to be sharing an intervention that I created in my medical center for older adults with depression, so now that we can agree that every life has value despite age, despite ability, or might we even say, because of age and because of ability or disability, every life has value. Instead of despite maybe we need to shift our thinking a little bit there, too, we being me, Regina, myself. Let's look at some of the factors that increase the risk for suicide in older adults, and then I'm going to share an intervention that I created with older adults.

Facts about Older Adults and Suicide

So now we're going to talk a little bit about older adults and suicide. And I want to share some statistics. Research shows that in 71% to 97% of older adult deaths by suicide, psychiatric illness was present. And the majority of the time, depression was the condition 71% to 97% of the time, psychiatric illness was present. And depression was the most common condition. I repeat that because I want to stop here to remind you that depression is highly treatable in older adulthood. Right around the same time I did the other podcast on suicide I also made a podcast on late life depression. And I talked about how effective treatment is for depression in older adults. 80% of the time, depression can be treated in older adults. That is remarkable. So I'll link to that episode in the show notes. This is where the mindset comes into play. Older Adults can't get treated if they aren't connected with mental health care. Older Adults won't get connected to mental health care if we have this false belief that with age comes depression, when we know that with age, depression is not normal. It's not typical. So let's shift that and get older adults connected to treatment when we notice signs of depression. Also relevant to older adults and suicide was problematic drinking and substance use, which we also know can get treated in older adulthood.

17:13
All right, moving away from mental health concerns, physical health concerns and functional impairments also increase the risk for suicide in later life. So, in fact, the more physical illnesses an older adult has, the higher their risk. So if an older adult has three physical illnesses, like cancer, heart disease, diabetes, their risk will be higher. If somebody has seven physical illnesses, their risk will be even higher. We can also provide care and treatment when older adults have physical illness for depression. So, also relevant is physical pain. And this is especially true among men. And remember, older men over 85 have the highest risk for Suicide and the highest rates of suicide.

Other risk factors include stressful life events, like the death of somebody you're close with, or the rupture of relationships, losing family members and other sources of support, like to family dynamics and estrangement, and then serious relationship and financial problems. Those are all shown to elevate the risk for suicide.

One final risk factor that I want to talk about is the risk factor of social connection. And actually, the social connection is not the risk. It's isolation, that's the risk. So the more isolated somebody is, the greater their risk of suicide. This means also that the more connected an older person is, the lower their risk for suicide.

18:58

So this leads me to share with you a therapy that I would do with older adults that I worked with. If you heard the last podcast with Dr. Kandi Schmidt, she talked about training with me in my Geropsychiatry clinic. And in that clinic for about seven years I ran what I called a late life depression group. And the group was made up of about seven older men. And they met together twice a month for an hour. They showed up every meeting time, on time, ready to work, and met together without fail for close to seven years, most of them and this was all for men who were older, at varying levels of physical health concerns, mental health concerns, most commonly depression, and some of them with mild cognitive impairment. The mode of treatment was actually interpersonal process. And the goal was to increase their connection with each other, and that with increased connection, the idea is that this would help to create a system of support and social connection and lower rates of depression and lower risk for suicide. Now, this was a higher risk group because this was in my work with older veterans, who, some of them, had been Vietnam veterans and had been exposed to significant trauma throughout their lives. And also now were experiencing other sorts of physical assaults to their body with illness, and societal assaults to their age with ageism, and then also the social isolation that can come if folks have not been properly treated, if they have PTSD. So in this group, like I said, we met together for about seven years, twice a month. And these men showed up without fail and became each other's confidants, became each other's families. There was a period where we had many sessions talking about love. These men would talk about how they loved each other and would say that these were maybe some of this first or fewest times of expressing love toward other men. That was a deep, rich, fraternal love. It was beautiful. Toward the end of the group, when a group member was on hospice care and in the hospital frequently, there was an agreement among the group that they could visit with one another while in the hospital, and so they would sit bedside with the veteran, or the older adult, who was ill and in the hospital and lacked family, honestly. And so these men were each other's family, and they became a system of social support and connection. And I really do believe it helped these men to live a fuller, more meaningful and less depressed life as older men with significant risk.

Help Older Adults Connect with Mental Health Care When They Need It

22:36
So I say that to say, while this is a Suicide Prevention Week, there is so much that we can do to help prevent suicide. At any of these points, we could intervene with treatment for depression, if we know that depression has the highest risk for turning into suicidal thoughts and behavior, right? That we could let the primary care provider know make sure that the primary care provider knows how to get connected with other mental health providers that specialize in older adults. And actually, I'm going to make this easy for you. I, In my show notes, will link to resources for how to find mental health providers near you if you're concerned that your loved one is struggling with depression. That's one of the simplest intervention points. If your loved one is struggling with depression and refusing to go to the doctor, I'm going to link to an episode to that as well, "what to do when your loved one is refusing to go to the doctor". Also, next week, I'm going to be sharing an episode on what to expect in mental health care if you're an older adult, and I'm just gonna break it down, what does an intake look like? And then you can share that with your older loved ones as well and begin to dispel the process, dispel the myth of mental health care. Okay, so getting connected to primary care and getting referrals from Primary Care to mental health providers or just mental health providers directly could be very helpful. Others are helping older adults to remain socially connected. So if you're a provider caring for older adults, can you create a program like mine? Can you create a zoom program? You can reach out to me I'm happy to share what my model looked like of that late life depression group. Other factors, like especially if we know that stressful life events like losses through bereavement or grief, increase the risk? Are we assessing grief and bereavement? are we providing support surrounding grief and bereavement if we know that the rupture of relationships with family members or other sources of support also increase the risk? Are you in your own senior care or mental health care practices including family helping to resolve some of the challenges that exist in families and strengthen the bonds between family members? Do you do that in your work? And so some of that could be very helpful, especially if you're working with somebody who's higher risk, especially for working with an older adult who's higher risk.

23:24
The bottom line here is, while the risk for suicide is high in older adults, there is so much that we can do to help give support, increase social connection, treat depression. You're doing it, you're doing a little bit of it just by listening to this episode and hearing me when I say that older adults need to be part of the conversation when it comes to mental health and wellness, when it comes to family support, when it comes to social connection, when it comes to treating depression. All of it. Let's include older adults in conversations. Let's get older adults connected to mental health care when they need it. And let's start to bring this rate down for older white men, especially, but older adults in general, let's lower the risk for them. Let's include them more.

I mean, this social connectedness risk really stands out to me. Because what this also says... it's more back into that mindset. Why would people get connected, if when they show up they're not going to be valued? Right? So let's all work on shifting, myself too. I catch myself all the time. Ageism is ingrained in us. Why would I show up if I'm not going to be valued when I get there? So let's begin to shift how we see and value older adults and make joining our programs, make coming into treatment, a place where older adults want to be and where they feel valued when they get there.

Subscribe & Leave a Review

25:16

Be sure to subscribe and leave a review subscriptions and reviews help people to find this show. And here's why this is so important. You've heard me say it before, and I'm gonna say it again until older adults are included in conversations as much as middle aged adults and younger adults. But older adults are often left out of the conversation when it comes to mental health and wellness. So we have to do our part to include them. And you can do that by subscribing and leaving a review wherever you listen to podcasts.

As always, the information shared in this episode is for educational purposes only, and should not take the place of licensed medical or mental health care. I'll see you next week. Same time, same place. Lots of love to you and your family. Bye for now.