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#JamesDonaldsononMentalHealth – Silent #Suicide: The Fatal Combination Of Old Age, Loneliness And Loss



Tom Rote, 70, sits on his distinctive jaguar motorcycle April 20 on his property in rural Harrisburg. His home is a museum of his past adventures and struggles. He was once married with dreams of a family, but his wife entered a coma after a collision with a semitrailer right after their honeymoon. That changed the trajectory of the rest of his life. “She was in a coma for nine months, and I got a couple of DWIs trying to drown my sorrow, and I went to a #mentalhealth center,” Rote said. Tom’s wife eventually awoke, but with no memory of him

Tom Rote steps outside of his house in Harrisburg on Saturday, April 20, 2019. Rote once lived a life of adventure, flying in eccentric hot-air balloons like the corn-shaped one that hangs on his wall. Now he lives in isolation and hasn’t been up in a balloon in decades.

Tom Rote looks out on his property April 20 in Harrisburg. Rote is alone much of the time and tries to connect with other people by hanging out at the senior center or the library. “It’s part of isolation; your thoughts just go around in your own little loop, and you’re not interacting with other people,” Rote said. He has a cellphone but said he is thinking of getting rid of it because no one calls him.

#JamesDonaldson notes: 

Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.

Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.

Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle


Savannah Poolman, an MU senior and Services for Independent Living volunteer, talks with Joyce Costa-Randle about her photos April 23. Poolman has been visiting Costa-Randle regularly since February as part of a service learning class for her human development and family science major. Poolman helps Costa-Randle program her TV, scrapbook her photos, go to events, watch movies or by just sitting and talking with her. “I love her. She’s awesome. She’s very interesting, she’s a very interesting person to learn from,” Poolman said.

A folded American flag, along with pictures of Joyce Costa-Randle’s late husband, Louis, in his army uniform and wedding photos hang above a mirror in her bedroom April 23. Costa-Randle’s apartment is full of collected figurines, dolls and photos. “I never thought that I would be alone without another physical person to live with; I never thought that that would happen,” Costa-Randle said.

Tom Rote, 70, lives alone on his property in Harrisburg. Many of his friends and family members have died in recent years, and he can no longer do some of the activities he used to enjoy, like flying in hot air balloons, now that he’s older.

Rote’s circumstances check every box when it comes to risk factors for #depression.

He’s a white #male, over the age of 65, living alone in a life full of loss. While these factors can increase the risk for #depression in all people, for older adults they pose a bigger threat — silent #suicide.

Among older adults, #suicide prevalence is already high — and drastically underreported

Adults 65 and older make up only 12% of the population but account for 18% of all suicides, according to the American Association of Marriage and Family Therapy.

In Missouri, the suicide rate for adults over 85 is almost 50% higher than the national average. This statistic could be higher because #suicide can be difficult to identify in the elderly.

It’s not always clear whether people forgot their medication or intentionally disregarded it, whether they were too sick to eat and drink or just didn’t want to.

Slipping away

“Silent suicide is the intention, often masked, to kill oneself by nonviolent means through self-starvation or noncompliance with essential medical treatment,” according to forensic psychiatrist and author Robert I. Simon, who taught at Georgetown University and conducted one of the only published studies on silent suicide among the elderly.

David Fleming, who specializes in geriatric medicine at MU Health, said that intervention can be difficult. If patients stop caring for themselves, doctors can only do so much.

If he notices a patient is knowingly and willfully not eating, for example, he can’t ethically force them to use a feeding tube if that patient has decision-making capacity.

“There are times we have to say, ‘OK, we’ll support you in that.’ And we let them do it,” Fleming said.

Senior living specialist Samantha McCay said she’s seen many elderly people become depressed because they feel useless or just “old and in the way,” as Rote describes himself. For people who have struggled with substance abuse in the past like Rote, this feeling can trigger a relapse.

“Silent #suicide definitely is an issue because … some people, if they used to be alcoholics, maybe at a certain point, they start drinking again,” McCay said. “There’s just a lack of care for themselves.”

Lonely struggle

Rote struggled with alcoholism after his wife was injured in a car accident on the way home from their honeymoon decades ago.

“She was in a coma for nine months, and I got a couple of DWIs trying to drown my sorrow, and I went to a #mentalhealth center,” Rote said.

His wife woke up from the coma, but she had no memory of him. They eventually divorced, and while he’s had a few girlfriends since, he never remarried.

He now lives in a small house surrounded by photographs and memories of his adventurous past life. Rote said he enjoys going to bars and coffee shops in Columbia, but that’s a 20-minute drive from his home.

During snowy winter months, just getting out of his long gravel driveway can be difficult. He never had children and spends most of his time alone, looking at old pictures or chopping firewood.

This sort of isolation from the community is another risk factor for #depression. Rote likes to spend time in a local senior center, but even there he can often be found sitting alone. The grief of losing relatives, combined with little to no interaction with others, makes it even more likely that he will experience #depression.

Warning signs

There are many warning signs of #depression in the elderly besides isolation, such as withdrawal from activities and changes in sleep and appetite. However, they are not always easy for doctors to recognize.

In fact, 70% of seniors who die by #suicide visit their primary medical care provider within a month of their death, according to the American Association of Marriage and Family Therapy.

Peter Koopman is an associate professor of clinical family and community medicine at MU who has taught about geriatric depression for more than a decade. One reason it can be difficult to diagnose #depression in elderly people is that they’re often more apathetic in describing their emotions.

Younger patients are much more likely to come in and say they feel depressed, he said, but older adults usually do not. Additionally, the majority of patients over 65 have at least one chronic illness, and doctors treat those physical illnesses as the highest priority for older patients.

“It’s easier for #depression to go unnoticed because you’re dealing with their hypertension, their diabetes, and often as physicians, appropriately, we want to deal with their chronic physical diseases and make that part of our agenda,” Koopman said.

The best way for physicians and family members alike to check for #depression is by asking what’s going on if there’s a change in behavior, even though it may be uncomfortable, he added.

“Most of the medical literature would talk about how you have to be direct about it if you’re going to ask about it,” Koopman said. “And you have to ask about it if you’re worried about #depression.”

Treatment options

After #depression is diagnosed, treatment can be a little more complicated for the #elderly population as well because some antidepressants interact negatively with other medications. Cynthia Baker, a licensed clinical social worker with a certified specialty in gerontology at The Bluffs, a senior living center in Columbia, said a combined approach including cognitive behavioral therapy is the best option.

“What we’re finding is, and the research absolutely supports, the combination of the counseling or the psychotherapy with an antidepressant or mood related medication has the best outcome for reducing depressive symptoms,” Baker said.

While #aging often requires adapting to a different lifestyle, #depression is not a normal part of getting older, according to the Centers for Disease Control and Prevention. #Depression is highly treatable, and #elderly individuals experiencing depressive symptoms are encouraged to reach out to family members and their medical care providers to receive proper treatment.

Photo by Italo Melo on Pexels.com

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