The Harrowing Realities of Aging and Neglect

Let's share the story of an elderly woman named Hafeeza (name changed), whose tragic death by suicide was influenced by feelings of isolation and a lack of social support. Abdul Rehman, her husband, just a few years away from retirement, spent a significant part of his life in a government quarter with his wife. Despite having two children pursuing Masters in Information Technology, Hafeeza distanced them from their extended family, even during important events.

The couple's constant bickering over trivial matters led to a toxic environment. Post-retirement, Abdul Rehman wanted to move back to his ancestral village, but Hafeeza opposed the idea. Eventually, they settled in a developing colony at Zakura with poor road connectivity and limited amenities. As the children got married and moved abroad, Abdul Rehman and Hafeeza found themselves living a secluded life.

They faced difficulties in managing daily chores, including hiring a non-local servant who left due to the couple's erratic behaviour. During a harsh winter, Abdul Rehman suffered a severe injury while trying to light a fire. The roadblock caused by snow delayed his access to medical help, resulting in his death.

Following Abdul Rehman's death, Hafeeza's isolation intensified. Despite suggestions to return to her ancestral village, her long standing animosity with in-laws prevented her from doing so. Even after her husband's death, attempts to repair relations were met with hostility. The children, unable to accommodate her, sold the ancestral property and engaged a domestic helper.

As Hafeeza struggled with multiple health issues, including arthritis, diabetes, high blood pressure, and diminishing eyesight, she reached a point of unbearable pain. In a heartbreaking call to her daughter, she expressed regret for not being a good mother or wife. Tragically, Hafeeza ended her life, highlighting the vulnerability of an often-overlooked group—senior citizens—especially concerning mental health.

This poignant episode sheds light on the challenges faced by this "forgotten" population, emphasising the importance of addressing the mental health needs of senior citizens.

Causes of Suicide among Senior Citizens

Loneliness:  One of the most predominant factor is loneliness. Senior Citizens  often live in isolation and may be struggling with the death of a lifelong husband or wife, or with the grief of losing other close family or friends.

Loss of Spouse: Research has shown that grief is "disproportionately experienced by senior citizens " and can often trigger physical or mental health issues  like "major depression and complex grief." Senior citizens who live long enough may begin to lose valued family members and friends to old age and illness. They may struggle with their own mortality and experience worry about dying. For some, this “age of loss” is devastating and can intensify feelings of loneliness and hopelessness.

Loss of autonomy: Senior citizens who were once able to dress themselves, drive, read, and lead an active life may struggle  with a loss of identity. They may lament the independent, vibrant person they once were.

Severe disease and pain: Senior citizens  are more likely to experience chronic illness  such as arthritis, cardiac  problems, high blood pressure, and diabetes. These conditions can bring on pain and mobility issues that compromise quality of life. Senior citizens  may also experience diminished vision  and other sense impairments which induce a sense of hopelessness in them

Cognitive degeneration: Senior citizens with mild cognitive impairment and dementia have a higher risk for suicide. Decay in cognitive functioning can affect a person's decision-making ability  and increase impulsivity.

Financial strings: Senior citizens  living on a fixed income may struggle to pay their bills or keep food on the table. For someone who is already experiencing  health issues or grief, financial stress can be activate  suicidal thoughts.

What are the warning signs of suicide in Senior Citizens ?

The first step in preventing suicide is knowing the warning signs. In addition to a clear expression of suicidal intent, there are certain abnormal behavioral manifestations that can warn a senior citizen  is thinking about committing suicide . These include:

• Loss of interest in activities they used to cherish
• Giving away treasured items or fluctuating their will
• Restricting social interactions
• Neglecting self-care, medical care
• Demonstrating a obsession with death
• Lacking concern for private safety

How to support someone with suicidal thoughts

1. Enquire: Do not feel shy to interact with the person at risk. Ask penetrating questions like, “Are you thinking to commit suicide?” and “How can I help you?” to initiate a conversation in a supportive and impartial way. Be sure to listen prudently to their answers and recognize their emotional pain. Help the person stay focused on all the reasons why they should want to keep living.
2. Be there: Try to meet physically a senior citizen at risk in order to ease feelings of isolation and provide a sense of connectedness. If a face-to-face contact is not possible, be there for them via mobile phone or video calls. Be sure not to make any promises that you are unable to keep.
3. Ensure their safety: Find out if the senior citizen at risk has already made any attempts to end their Do they have a explicit plan or timing in mind? Do they have access to their planned method of committing suicide ? Learning the answers to these questions can help you understand whether this senior citizen  is in immediate danger. They need immediate guidance and counseling
4. Ensure their connectivity: If a senior citizen in your vicinity is thinking about committing suicide, it’s important for them to establish support systems they can rely on now and in future moments of crisis. This includes suicide prevention helplines as well as resources available in their local community. Find out if the at-risk senior citizen is currently seeing a mental health counselor. If not encourage him to meet the one for building his mental resilience.
5. Vigorous Follow up. Research has demonstrated that follow up can reduce suicide-related deaths in high-risk populations. Once you've had an initial conversation with the vulnerable Senior citizen and helped them establish a support network, make sure to maintain a vigorous follow up .

BY Dr. Zubair Saleem and Dr Showkat Rashid Wani

Dr Zubair Saleem is a Senior Geriatric Consultant and Gerontologist and Dr Showkat Rashid Wani is a Senior Coordinator, Directorate of Distance Education, University of Kashmir