Between 1999 and 2019, America’s Health Rankings reported a 33% increase in overall suicides in the United States. Older Americans are only 12% of the U.S. population yet they account for 18% of the nation’s suicides. And overall, the rural elderly are very vulnerable.1
According to the Centers for Disease Control and Prevention’s (CDC) Fatal Injury Report of 2019, suicide was the tenth leading cause of death in the U.S. There was an estimate of over 1,000,000 suicide attempts and 47,511 successful suicides. However, the rate of suicide was highest among adults ages 85 and older. White males of this age had the highest suicide rate.2 The direct cause of suicide remains a mystery and many factors can increase someone’s risk of suicide. In adults both young and old, some risk factors include: previous attempts, a history of mental health issues, disability, chronic illness, hopelessness, cognitive decline, finances, and one’s environment.
According to the CDC, suicide is higher in rural areas over urban/metropolitan areas. “Suicide rates tend to be high in rural areas in part because there is greater access to firearms, high rates of drug and alcohol use and few health-care providers and emergency medical facilities,” says Julie Goldstein Grumet, PhD, director of prevention and practice at the Suicide Prevention Resource Center in Washington, D.C. “It’s a lethal triad.”3
Mental health and mental disorders were ranked as the fourth most important rural priority in Rural Healthy People 2020.4 There are little to no mental health professionals in many rural areas and the percent of psychiatrists per capita in rural counties is much lower per capita than urban/metropolitan counties. All this results in a lack of mental health services for rural communities. Rural counties also lack other mental health providers and many are in designated mental health professional shortage areas.
|U.S. Counties||Psychiatrists per Capita|
Rural people are more likely to be isolated than their urban counterparts, resulting in loneliness, less support, an increased number of health challenges, a lack of medical care and transportation to care, and higher level of several chronic diseases. These older individuals tend to be sicker, diagnosed at a later stage of disease, and have a higher rate of mortality. The rural population also has a much greater challenge when it comes to mental health care. Proper mental health care is essential in dealing with suicidal patients.7 Means of suicide may also differ in this age group, as sometimes it may be difficult to diagnose a death as a suicide. Older patients may use passive self-harm such as not eating or refusing medications and medical treatment.8
According to Iris Chi, Golden Age Association Frances Wu Chair for Chinese Elderly School of Social Work & Davis School of Gerontology at the University of Southern California, suicide in the older is population is more calculating and not as much of an impulsive act. Older people usually consider suicide for a long time. Older people are usually lonelier, lose friends and family members at a higher rate, are faced with their own mortality, cannot care for themselves as they used to, and have more chronic illnesses, sensory problems such as loss of hearing and vision, and cognitive difficulty. All these factors may result in a depressing and a feeling of hopelessness for people in the elderly population.9,10 On top of these factors, suicide is sometimes underreported in the elderly population. Kaiser Health News reported that older Americans are quietly killing themselves. Poor documentation in long term care facilities and assisted living centers makes it hard to get an accurate case count, and there is no federal regulation that requires reporting these deaths and many states don’t count them.11
Long term care is not usually an option in rural areas but it appears to be a risk factor for elderly suicide. According to the University of Michigan, with the hundreds of suicides each year about one per day is associated with long term care. Many long-term care residents are at risk with a third of long-term care population reporting suicidal thoughts.12 Although rural areas have less access to care, nursing homes, and other long-term care facilities, where elderly residents have a high incidence of suicide, rural American elderly still commit suicide at a higher rate.
The combination of all the above is a call for action in rural America. Rural health care has been a long-time challenge. Federally Qualified Health Centers and Rural Health Clinics can play an important role in ones physical and mental health. Training mental health providers in rural areas is vital. There are many government programs that will pay tuition to persons seeking a mental health profession and to practice in rural areas.13 The National Service Corps Loan Repayment Program is a great way to retain mental health care providers in rural areas. Financial security, peer support groups for high risk individuals, reduced access to lethal means, mental health first aid, teaching of healthy coping skills and other behavioral interventions, senior companions, support groups, and telemedicine mental healthcare could reduce the numbers of rural elderly suicides.14
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