Paragraph 14 reads: "Don Langland had watched dementia devastate his mother, said Langland's wife, Shirley. Doctors at the Department of Veterans Affairs had tried three separate antidepressants on her husband. But he continued to have embarrassing bouts of confusion that made life unbearable for a high school dropout who once carried the equivalent of blueprints in his head."
SSRI Stories note: Confusion is listed as a frequent side-effect of antidepressants in the Physicians Desk Reference.
A dark trend that's difficult to combat
The reality in Minnesota and elsewhere is that more and more elderly residents are taking their own lives.
By JIM SPENCER, Star Tribune
Last update: March 31, 2010 – 7:48 AM
By every measure, Don Langland was a pillar of Pequot Lakes. He was a devoted family man who never cursed. He was a master craftsman who constructed beautiful homes and cabinets. He was a religious man who salvaged wood from a church fire and built an altar, baptismal font and pulpit.
When Langland bade his wife of 56 years goodbye as she headed off to Bible study one night last spring, no one had a clue what he intended to do. Langland, 79, took his glasses off eyes that no longer saw well enough to make perfect cuts. He took his wedding ring off a hand that was losing the coordination required to frame buildings. He retrieved a shotgun from a locked safety vault he had built, shuffled into his back yard on the crutch he needed to support an increasingly unsteady body, duct-taped his weapon to his crutch so his aim would be true and shot himself.
Langland's death stunned the community he served. It devastated the unsuspecting family he loved. And it became one more data point in a state and national trend that gets very little notice — suicide among the elderly.
Statistics show that the highest suicide rate in Minnesota since 1990 is for white men over 75. Among all Minnesotans who attempt suicide, people over 60 are nearly six times more likely than the rest of the population to succeed in killing themselves. In 2008, that translated into 111 senior suicides in 264 attempts.
Experts disagree about why the American public pays so little attention to suicide among its oldest citizens. But most of those who deal with the issue agree on one thing: If nothing changes, the number of seniors taking their own lives will grow large as baby boomers swell the ranks of the elderly to record levels.
"The story hasn't been told because the larger community doesn't think there is a story," said Atashi Acharya, mental health services director for Volunteers of America of Minnesota. "We have an expendable sense of the elderly."
Recently, a group of elderly Hmong women asked Acharya to speak to them about "loss and grief." To her surprise and concern, almost all talked about taking their own lives. Doctors and other health care providers say such revelations make an urgent case for better diagnosis and treatment of mental illness among seniors, because mental illness is a precursor to roughly four in five suicides. Still, myths about the elderly get in the way.
"There's an old maxim," state epidemiologist Jon Roesler said. "'A young man may die. An old man must die.' Suicide is the second leading cause of death in young people. It isn't even in the top 10 for those over 65."
In 2008, a total of 593 Minnesotans killed themselves, the largest annual toll in the state's history, although not the highest rate because of population growth. Overall, nearly five times more Minnesotans took their own lives in 2008 than were murdered, more than twice the national average. Within these figures, elderly suicide constitutes a complex public health problem. Loss of control that accompanies aging can complicate people's view of elderly suicides. "Some people call suicide a hate crime," said Dr. Steve Miles, a medical ethicist at the University of Minnesota, who also specializes in treating senior citizens. Still, Miles acknowledges that certain cases of elderly suicide "are hard to condemn."
Acharya's husband chose to stop eating after dementia and his body's failure left him bedridden with no hope of recovery. She acceded to his wish. "I was doing a suicide prevention talk in St. Cloud when he was dying by choice," she said.
For many who work with the elderly, the ability to choose rationally makes the most difference in the morally conflicted right-to-die debate. Minnesota has no right-to-die law. Miles calls right-to-die practitioner Jack Kevorkian "a serial killer." Yet Miles admits that "there is some evidence that altruism is equal to pain in driving these decisions. In that sense, [elderly] suicide becomes a way to protect the family."
Langland wasn't himself
Don Langland had watched dementia devastate his mother, said Langland's wife, Shirley. Doctors at the Department of Veterans Affairs had tried three separate antidepressants on her husband. But he continued to have embarrassing bouts of confusion that made life unbearable for a high school dropout who once carried the equivalent of blueprints in his head.
"Not being able to work or plan in his mind, Don was finding it more convenient to sit in a chair with the TV going full blast," Shirley Langland said. "For a real active man, I felt sorry for him, because that was not his life."
Most of Langland's family longs for a way he could have died peacefully. Yet not a member would have driven him to a doctor for an assisted suicide had the option existed.
"I'm angry at God," said Langland's daughter, Laura Hofius. "Maybe I'm angry at myself. I'm having a difficult time even praying."
Those affected by suicide typically respond with confusion, angst, isolation and resentment, said Dan Reidenberg, director of Bloomington-based Suicide Awareness Voices of Education.
Langland's family also felt "shunned."
Teri Knight knew that her mother, Chicky Dague, had battled depression her whole adult life. But Dague was healthy in every other way and had a family history of longevity. So Knight, a former Twin Cities radio personality, never expected her mom to take her own life at age 71.
Dague asphyxiated herself sitting in a running car in her garage. She had her hair done and laid her head on a pillow covered with a silk case. Dague knew that Knight would be the one who found her. So Dague baked lemon poppy seed muffins, her daughter's favorite, and left them in the kitchen.
"It took awhile to forgive her," Knight said. "Six months after she died, I saw her picture on the mantel, picked it up and threw it across the room."
Signs are easy to miss
Education is key to confronting senior suicide, experts say. Job one is understanding mental illness. "We are wired for survival," Reidenberg said. "We are not wired to take ourselves out. That's the indication of a brain being very sick."
Even if you're looking, diagnosing mental illness may not be a slam dunk. University of Minnesota Medical School Prof. Jim Pacala specializes in treating the elderly. "I had a white man in his 80s come in," Pacala said. "I was treating him for several chronic problems. He was having some pain issues. I was adjusting the meds to control the pain. I
knew he was frustrated. I told him, 'Make these changes, and I want to see you in a week.' He said, 'OK.' He went home and killed himself two hours later. It was just devastating. You wrack your brain, thinking, 'How can I miss this?' The behavior didn't suggest suicide. I think I missed the depression. I blew it."
Pacala's medical practice instituted a mandatory depression screening. Acharya says it isn't just depression. "Depression has almost become a designer mental illness," she said. "Seniors can have almost every illness."
The stigma of mental illness bothers senior citizens more than younger people, experts say. The elderly don't want to admit to medical problems that earlier generations often considered weaknesses or character flaws. Nor do seniors want to admit to conditions that could rob them of the ability to live independently.
"You've got things that don't move on to the table easily," Miles said. "The loss of sexuality, incontinence, the loss of intimacy in nursing homes, impending death. If doctors can't or won't talk about those issues, they can't tap the reservoir behind a suicidal act."
And then, there are the inevitable pain, grief and loss that come with aging. The percentage of elderly Americans in assisted living and nursing homes skyrockets between the ages of 65 and 75, Pacala said.
"In your 60s, you develop diseases that make you sick, but don't kill you for a long time," he explained.
Finding ways to delay or eliminate debilitating sickness will shrink the elderly suicide rate, Pacala predicted. So will finding ways to get old people interacting regularly with young people, he said.
Added Miles: "Antidepressants are only 20 percent of the solution. The rest is sleep, exercise and finding friends."
Throw in talk therapy and pain management and you may have found a way to reconnect senior citizens with hope.
Several years ago, a patient named Helen came to Miles for pills to kill herself. Arthritis had left her in pain. Depression had caused her to withdraw from everyone at her assisted-living facility. Instead of a lethal injection, Miles gave Helen narcotic painkillers and antidepressants. When she arrived for a follow-up visit three weeks later with her hair done, Miles suggested that she start taking meals in the cafeteria instead of alone in her room.
"Nine months later, she had a massive stroke and died," Miles said. "Two weeks later, I got this box. I opened it without reading the card and ashes spread all over the clinic."
The card was from Helen. The box held her ashes. Miles swept them up, took them home and used them to fertilize an azalea in his front yard.
"That is Helen," he said pointing to a plant. "And every year she says hi."
Jim Spencer • 612-673-4029