Ageism, Mental Health and Suicide Risk in Older Men

Adults ages 65 and older make up a large and growing segment of the U.S. population. The majority are “Baby Boomers,” a generation at high risk of suicide (and a generation that will carry this risk as they advance in years).

More than 1 in 9 U.S. adults aged 65 and older experienced a mental illness in 2020. Yet, the mental health system poses significant barriers to care for older adults: there is a severe shortage of geriatric psychiatrists, and psychiatrists overall are more likely than other specialty providers to “opt out” of Medicare – the program that provides health insurance to nearly all Americans over age 65. Additionally, available mental health services are under-used by this demographic. This unquestionably heightens the role of mental illness as a strong risk factor for suicide in older adults.

Ageism is another risk factor for suicide — it promotes the belief that depression is a normal part of aging, that older adults are preoccupied with increasing levels of illness, and that they may come to see suicide as an escape.

Older adult suicides will rise as this population grows. However, younger age groups receive most suicide prevention attention. To change the broadening mental health conversation, advocacy groups, individuals and practitioners alike should embrace anti-ageism and anti-stigma efforts.

Making these changes requires a deeper understanding of the current landscape and the impact of ageism.

Suicide Incidence in Older Men

In 2020, men aged 65-74 had a suicide rate of 24.7/100,000, and men aged 75 and older had a rate of 40.5/100,000 – both higher than the overall national rate of 13.5/100,000. Notably, older adult suicide is predominantly a male phenomenon; the suicide rate of women aged 65-74 in 2020 was 5.6/100,000, and the rate among women aged 75 and older was 3.9/100,000.

Older men at highest risk of suicide may:

• Be widowed or divorced
• Have a history of depression and anxiety
• Live with a chronic illness
• Live alone or in a nursing home
• Live with comorbid medical/neurological illness
• Have lost dignity and control
• Misuse alcohol
• Experience hopelessness and see life as pointless

Understanding Ageism

To address ageism, we first need to define it. Ageism is stigma directed toward aging and the aged. It consists of negative or patronizing attitudes, stereotypes and beliefs resulting in prejudicial or discriminatory treatment of older persons. In a national survey, 82% of older adults aged 50-80 reported experiencing some form of ageism in their everyday lives. While ageism is a common occurrence, it is a form of prejudice that is less likely to be recognized.

Ageism makes the symptoms of depression and anxiety worse, increases stress and negatively affects overall mental health; and the impact on depression is particularly high in men.

Ageism and Suicide Risk

Studies show that ageism raises suicide risk by weakening protective factors, such as self-esteem, self-efficacy and hopefulness. This, in turn, may make someone feel like a burden or make them feel disconnected from their support system. These factors can lead to suicidal ideation and suicidal intent.

Self-stigma may be the most harmful consequence of ageism. Internalizing the stereotyping, discrimination and prejudice often produces a negative self-assessment. Older people (particularly men) may come to believe that their life has no value, meaning or purpose — and that ending it would relieve others of the “burden.”

The Role of Mental Health Organizations and The Mental Health Care System

Grassroots organizations and local mental health centers are a powerful counter to the stigma surrounding mental illness. They have a unique opportunity to raise awareness of how ageism stigmatizes older populations, makes them less likely to use mental health services and contributes to suicide risk in a high-risk group.

As for practitioners, mental health providers must support geropsychiatric care, which is often in short supply in many communities. Accordingly, suicide prevention programs must put older men on the agenda at the county and state levels and implement suicide prevention programming aimed at older men.

Additionally, the implementation of 988 as a national crisis line is an opportunity to reach more vulnerable populations. However, call center staff must be sensitive to the effects of ageism and know the risk factors and warning signs of suicide in older men.

As Suicide Prevention Awareness Month ends, it’s important to think to the future, and how we can make changes every other month of the year. Hopefully, that will start with acknowledging and addressing this high-risk group.

Tony Salvatore directs suicide prevention at Montgomery County Emergency Service, a nonprofit psychiatric hospital and crisis center in Norristown, PA. He can be reached at [email protected].