A key finding from the recent Royal Commission into Aged Care Quality and Safety was the challenge facing older adults in accessing services that allow them to stay in their homes.
For those who are experiencing a decline in physical or cognitive functioning, it can be a struggle to live independently.
Older adults face an intimidating and difficult to navigate Australian aged care system.
Ineligibility or delays in obtaining a home care package can lead to the unnecessary and premature admission of older adults into residential aged care.
This lack of choice and control can in turn increase feelings of hopelessness and distress.
In rural areas, this is complicated by difficulties finding service providers who deliver home care.
Our recent research, published in Social Science & Medicine, examines the relationship between health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in regional and rural Australia.
The research shows that chronic physical illness, bereavement, and concerns about becoming institutionalised in residential aged care produced considerable distress, grief, and anxiety.
Treatment and care predominantly involved medication, with few people taking part in our study receiving social care and support.
In our view, this reflects a narrow perspective of the problems and complex needs of many older adults.
The most concerning finding of the research is that those who experienced a gradual deterioration in health over several years but without a terminal illness, chose to end their lives.
These people are excluded from accessing voluntary assisted dying under recently passed legislation.
Older adults who participated in our study often communicated thoughts of hopelessness and suicide.
A significant number also received treatment from a medical specialist in the weeks before their death.
However, too much emphasis on medication meant that issues related to distress in the context of physical and psychosocial suffering were overlooked.
Despite views to the contrary, the ability to diagnose and treat mental illness is not believed to be the most important issue in preventing suicide among older adults.
Indeed, our study has shown that this approach leaves many with unmet needs and that it can create harmful environments and consequences.
With recorded global suicide rates highest in people who are aged 70 years and over, this is likely to increase due to an ageing population.
In response, we need a pragmatic and compassionate approach to suicide prevention for older adults.
This must take into account the strong desire-to-die among some older adults in order to support those who engage in suicidal behaviour, but also the need to address the fragmented and underfunded health and social care system that limits choices and increases feelings of hopelessness and despair.
To view the original research article, visit https://doi.org/10.1016/j.socscimed.2021.114196
Scott Fitzpatrick is a Research Fellow at the Centre for Rural and Remote Mental Health (CRRMH) at the University of Newcastle, Australia.