HD32 - The Problems of Suicide and Substance Abuse by the Elderly and the Impact of Family Care Giving on Employee Work Performance

  • Published: 1989
  • Author: Department for the Aging
  • Enabling Authority: House Joint Resolution 156 (Regular Session, 1988)

Executive Summary:
The 1988 session of the Virginia General Assembly, in House Joint Resolution 156, requested the Virginia Department for the Aging to study three areas of concern to the elderly, their families, and caregivers. The areas of concern were suicide among the elderly, substance abuse by the elderly and the impact on the workplace of caregiving to elderly by adult children. The areas were studied separately and recommended actions were made for each concern.

STUDY 1: SUICIDE AMONG THE ELDERLY

Virginia loses an elder to suicide every 2.9 days. Older Virginians commit suicide at a rate of 21.7 per 100,000 elderly compared to 19.8 per 100,000 on the national level. A most startling finding is that the elderly in Virginia have a 68% higher suicide rate than the state as a whole and 76% higher than among Virginia's s youth.

Several factors appear to be significant in describing the elderly person who is likely to be a suicide candidate: physical and mental illness, gender, race, marital status, and religiosity. A profile of a person most "at risk" to commit suicide is a white male, over 65, widowed, with no strong religious beliefs, depressed, with some painful chronic illness and a history of alcohol abuse.

In general, the suicide rate among older men is higher than women, possibly because their choice of method is extremely lethal. Older men, nationally and in Virginia, tend to use firearms to commit suicide.

The rate among white persons for suicide increases with age, the rate of suicide among non-whites peaks in the twenties and then decreases. In regard to marital status, those who have had a marriage disrupted by death or divorce are most at risk with those who have never been married the next most vulnerable. Those who are still married are the least at risk. Religion seems to have an impact on lessening the potential for suicide, probably because it provides supports and a feeling of self worth.

The methods of suicide are basically three: firearms, solid and liquid poison, and hanging. A significant fact is that older Virginians of both sexes use firearms to commit suicide in noticeably higher proportions than the elderly in the nation as a whole. For the period of 1983-1985, in Virginia, elderly used firearms to kill themselves 80.3% of the time compared to 64.9% of the nation's elderly. Virginia's older men used firearms almost exclusively and Virginia's older women in a majority of the cases.

Another significant observation is a difference in suicide rates in the regions within the Commonwealth. In the Shenandoah - North Central Area (excludes northern Virginia) the suicide rate for elderly persons for the 1978-1982 period was 29.4 per 100,000 as compared to 23.1 for the state as a whole.

Researchers conclude that a suicide prevention plan is needed to include education of the elderly, their family and service providers; a system for early detection and treatment; and development and expansion of psychosocial services. Any plan developed should also analyze the reasons for the significantly higher rates of suicide among Virginia's elderly, the significantly high rates for men, higher percentages among in Shenandoah -North Central Virginia, and the distinct disposition of Virginians to use firearms.

STUDY 2: SUBSTANCE ABUSE BY THE ELDERLY

The study of substance abuse by the elderly is hampered by a lack of accurate and reliable data or studies on the topic. However, results of this study reveal some factors worthy of attention.

Substance abuse among Virginian's elderly can be divided into three categories: prescription and over-the-counter drug abuse, alcohol abuse, and illegal drug abuse. The potential for abuse of prescription drugs or a combination of prescription drugs, over-the-counter drugs and alcohol is very significant.

Many elderly use at least two to three prescription drugs daily. As the number of prescription drugs increases so the potential for complications is exacerbated, especially if the older person uses over-the-counter drugs, prescription drugs, and alcohol in combination. The elderly abuse these substances by overuse, under use, erratic use or contraindicated use. Sedative-like tranquilizers and prescribed pain killers are most likely to be intentionally abused by the elderly.

It is also reported that one-third of the elderly do not take their prescriptions correctly. Drug-sharing and hoarding are other examples of misuse. The use of different physicians and several pharmacies can result in adverse reactions from inappropriate combination of drugs. Virtually no elderly make use of substance abuse treatment centers to help alleviate the drug abuse problems.

The profile of the elderly person most at risk for misuse/abuse of legal drugs focuses on the older woman. It is significant that older women are prescribed psychotropic drugs twice as often as men. Widows are more likely to be given such medications, but many elderly seem to increase their intake of drugs following stressful life events.

Physiological changes which occur with aging increase the risk for drug interactions and toxicity. Reduced metabolic functions and other physical changes impair the absorption rate of drugs. Impaired vision and hearing contribute to misunderstanding about directions for use of medications. Memory loss and confusion increase the risk of misuse. Older persons use drugs for two primary reasons: to ease pain from chronic and terminal illnesses and to counter the common effects of aging such as insomnia, anxiety, and constipation.

Up to 10% of the elderly population may abuse the use of alcohol. The abuse of alcohol is a particular problem for white males between 60 and 70 years of age and male alcoholics also comprise the 88% of the elderly who are receiving treatment at substance abuse treatment centers. The psychological effects of alcohol are more deleterious in the elderly than in the young. The risk of suicide among the elderly alcoholic is five times greater than among the nonalcoholic. The potential for suicide by the use of alcohol, prescription drugs, over-the-counter drugs, or a combination of these substances is significant.

The use of illegal drugs by older persons does seem to be increasing. Addicts are now living to old age and the numbers are expected to increase over the next ten years. The most abused illegal drugs are marijuana, heroin, and morphine. The most likely elderly person to use illegal drugs are white males and the young-old.

Researchers recommend a prevention plan for substance abuse to include education, early detection and treatment, development of services, and evaluation.

STUDY 3: THE IMPACT OF CAREGIVING IN THE WORKPLACE

Over 80% of the care provided the elderly in communities is provided by family members and friends. In most cases, this is provided by the spouse, daughter, or daughter-in-law. With the ever increasing cost of living and the changes in families, the work force and societal attitudes on the roles of women, many person who would have been full-time caregivers are trying to provide care while holding a full or part-time job.

The persons studied who were employed and providing care were primarily female (69%), white (79%), married (78%), had some college (64%), and most (57%) had family incomes less than $34,999. Fifty-six percent of the adult dependents do not live in the caregivers' home. The type of care provided include: housekeeping (60%), companion (57%), financial management (48%), transportation to medical appointment (42%), personal care (37%), financial support (36%), and giving medication (25%).

Caregivers experience stress at home and in the work place. The impact on the productivity of the caregiver in the workplace includes performing activities to assist the adult dependent while at work such as making phone calls, being late for work or leaving early, missing work, taking personal or sick leave, changing work schedules, and giving up paid overtime. Many caregivers have considered giving up a job, changing jobs, or have refused a more responsible position due to their caregiving responsibilities.

The conclusions drawn by the researchers indicate a need for a flexible work environment, and education for caregivers and employers. There appears to be a need for community services to supplement the services provided by the caregiver.

Researchers recommend a more comprehensive public/private response to the growing of adult caregiving to include public education and workplace support.

CONCLUSIONS

This three-part study has documented the concern that older Virginians are at risk of committing suicide at a higher rate than the elderly in the nation as a whole. It also has shown the real potential for abuse of drugs, over-the-counter drugs and of alcohol by the elderly in the Commonwealth. The need to provide assistance to the working caregiver in the workplace and in the home also was documented. The issues of suicide and substance abuse are complex and require a comprehensive plan to assure a comprehensive approach to deterring these problems. The issue of the impact of caregiving in the workplace was studied in one region of the Commonwealth and the recommendations need to be tailored to meet the needs of different work environments in the rest of Virginia.