Hello, and welcome
to "Wonderfully Made"
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Today's topic is "Crisis
Intervention for Older Adults"
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My name is Dr. Stephen Campbell
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and I will be
your host for today
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It is easy to say that
crisis is part of our world...
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A number of things that
are happening all around us
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that are creating
an awful lot of stress
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for each and every one of us...
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However, older adults
also experience crises,
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and some of them are different
from that of younger individuals
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It is said that
as you get older,
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the amount of
knowledge that you have acquired
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determines how
you adjust to life.
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But in spite of the knowledge
that older adults may have
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when faced with
serious emotional problems,
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or conflicts, they do
end up having feelings
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and doubts about themselves...
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that, at times,
may lead to suicide.
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It is safe to say that suicide
is the ultimate crisis...
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And that once a person
starts having suicide ideation,
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we have to take
that very seriously.
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We also know that suicide
tends to increase with age
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...so that one of the
highest groups of individuals
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who commit suicide are
those 65 years of age and older.
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Some startling
statistics also show that
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men, age 85
years of age and older,
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are the ones most at risk.
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In the year 2001,
over 5,393 individuals
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committed suicide in the
United States over the age of 65
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That number seems
to be quite a bit.
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Since these figures are
usually estimated based on
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information that's given
that can authentically say
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it was a suicide.
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Many times, there are deaths
that are suicide in nature
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but they have been
determined to be accidental.
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It is very important for
us to understand some of the
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things that adults go through,
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and also as they get older...
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what impact it may
have on their lives.
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The study showed that as
many as 90% of all the suicides
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of individuals over the age
of 65 seem to be as a result of
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mental illness,
or substance abuse.
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It is not safe to say that
all people who commit suicide
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are mentally ill.
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But, most of them do have
some of the same mental health
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feelings that someone who
is mentally ill has when they
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become suicidal.
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Our older adults do experience
an awful lot of stress
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that's different, and
we have to address those
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if we need to understand ways
and means of keeping them alive.
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The fact that many of
these individuals commit suicide
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who are mentally ill
is safe to say that...
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not being diagnosed
and a lack of treatment
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for these particular problems
can be a major risk factor
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for suicide ideation.
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Once an individual is
depressed, if it's not treated,
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that depression can lead
them to experience feelings of
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hopelessness, worthlessness,
and certainly can prevent them
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from having a meaningful life.
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Most individuals
who are age 65 and over,
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have lived a long life, and are
looking forward to retirement
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If, in reviewing the past,
they end up feeling a sense of
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accomplishment,
or sense of worth,
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then the life starts to
become very unmanageable
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and they start seeing
life as being meaningless,
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and start having a
lot of depressed feelings.
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These individuals are
also considered at risk.
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One of the things that we
have to pay strict attention to
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is substance abuse.
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As you know,
untreated substance abuse
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can be a major
risk factor for suicide.
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One of the reasons
that it's true is because
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people who are older
feel somewhat out of place
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when they go for
substance abuse treatment.
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When we think
of substance abuse,
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we think of young
adults and teenagers who abuse
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illicit drugs such as
marijuana and cocaine.
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However, older adults
do have a problem with
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substance abuse as well.
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The major difference between
the users and the non-users
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is the fact that older adults
tend to abuse prescription drugs
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and over-the-counter drugs.
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As a result of that, many times
the disorder is not diagnosed
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and people are not aware that
they are experiencing difficulty
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with substance abuse.
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Now in the United
states, we value life,
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and suicide is not
something that is popular.
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And, we strongly believe that
we are designed to be preserved
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and to live a long life...
and that life belongs to God.
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This view is not held
all around the world...
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However, as people get
older, they become more at risk
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simply because
physical illness sets in,
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and not all are able to
deal with the physical illness
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that they have, or the
pain that they may endure.
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As a matter of fact, of all
the people who commit suicide,
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most of them seem to
have a physical illness,
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either divorce, or widowed...
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and as such, loneliness sets in.
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Loneliness is a
very, very important factor
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in evaluating suicidal behavior.
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Women seem to handle
loneliness much better than men.
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For whatever reason, once man
gets to the point where he feels
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he has to live by himself,
and that his life has no
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meaning, and that his family and
friends no longer care for him
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...he does not see
any reason to continue.
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This is why, if you
look at suicide deaths,
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85% of the deaths of
older individuals are
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age of 85 years
of age, and older.
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The group that is
the most vulnerable,
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are white males
over the age of 85.
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Let us look at some of
the risk factors that are
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associated with
suicide for individuals who are
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65 years of age and older...
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Let us speak about these first
risk factors for a few minutes.
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It is very important
to know that depression
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and mental illness,
if it's left untreated,
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can lead to serious consequences
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Remember that depression
is something that caused the
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person to withdraw from society,
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caused them to lose appetite,
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caused the person to
have sleeping disorders,
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causing the person to
have feelings of worthlessness,
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hopelessness, and also
make them feel as though
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life is not meaningful.
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Keeping in mind that most
of these individuals over 65
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may have some physical ailment,
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and as they get older, these
ailments become more of an issue
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Many times, they feel that
life is not worth it because
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of the aches and pain...
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so that we have to make sure
that depression is something
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that is dealt with
on a regular basis.
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The other factor here is
a matter of looking at some
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of the family dynamics.
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If the person is not
connected with their family,
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and they are unable
to feel a sense of worth,
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that can cause serious problems
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and can also
encourage the person to think of
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committing suicide.
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Physical abuse and
sexual abuse is something
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that, unless it's
dealt with, can come back
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to create some
problems for you later in life.
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As you know, during
the stage of 65 and older,
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most people tend to reminisce
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and think of what their
life has been over the years.
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And if they can go
through that process
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and feel a sense
of accomplishment,
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feel good about who they are
and what they have accomplished
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then that's okay...
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But if life has not
been very fulfilling,
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and these thoughts of
being abused tend to surface,
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that can be a trigger
that can cause the person
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to have experience of
suicide ideation as well.
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Let us continue to look
at some of the other factors
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that are important here...
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Let us spend a few minutes
talking about these risk factors
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I think it's very
important for us to keep in mind
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that an individual who has
a history of mental illness...
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especially depression, is always
at risk because these are the
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individuals who will
start experiencing feelings of
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worthlessness, helplessness,
will start to withdraw
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from society, spend most
of the time by themselves,
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and, as a result of that, the
depression is going to continue
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to persist.
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If the depression is untreated,
it can certainly put the person
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more at risk.
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If the individual also
has a substance abuse problem,
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that is also a
major risk factor...
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since we know that most
people use drugs and alcohol
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and over-the-counter medication
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to buffer the unpleasant
feelings that they have.
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Many times, these are
not caught by physicians,
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and family members
because the person does not
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come out in the
open intoxicated...
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Most of the time, this
is a very private thing...
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If there's a
family history of suicide,
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it does not mean that there's
a genetic component to that...
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But sometimes, a family
member may imitate another
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because it becomes a
coping style that is accepted...
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so that if one family
member commits suicide,
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we have to make sure that
if someone else is depressed,
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or having suicide
ideation, will not try to
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do the same thing
as their family member.
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If there's family maltreatment,
where they have been
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abused as a child, or
being abused as an elderly
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which happens to be a problem
within our society - elder-abuse
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That person may
become very depressed,
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and also may become suicidal.
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Loneliness is such a
big issue... that we have to
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pay very strict attention
00:13:43.13\00:13:44.84
to those who are
living by themselves.
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It is said that as many
as 60% of physician visits
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are because of
loneliness, and not because of
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any major medical problem
that the elderly may have.
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There are some additional
factors that we are to take
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into consideration... that
we should address at this point
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Let us look at some of
the other risk factors...
00:14:08.76\00:14:12.53
Now these last few
factors are very important,
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and should be looked at
seriously if we are going to
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really help those who are
struggling with suicide ideation
00:14:40.28\00:14:46.56
Now loneliness, hopelessness,
certainly are symptoms
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of depression, and most of
us can identify with those.
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It does not mean that
feeling lonely or hopeless
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necessarily means
that the person is going to
00:14:59.38\00:15:02.70
commit suicide.
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But, if this is prolonged,
and the person is unable
00:15:04.45\00:15:07.38
to come out of those
feelings, then that certainly
00:15:07.41\00:15:10.22
will be a major risk factor.
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Another important one here
is the fact that many people
00:15:13.28\00:15:18.31
who are thinking of suicide
tend to look at the lethal means
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that they can use...
00:15:24.85\00:15:26.93
if that person has
access to lethal means...
00:15:26.96\00:15:30.57
Maybe having a gun at
home, or enough medication that
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can kill themselves, and
they are easily accessible
00:15:34.01\00:15:38.00
...That would certainly
put the person at more risk.
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It is so important that we
pay attention to the elderly
00:15:41.88\00:15:45.62
because many times
they are left unattended,
00:15:45.65\00:15:50.61
and as a result of
that, people are not aware of
00:15:50.64\00:15:53.92
what they're thinking,
or what they're feeling.
00:15:53.95\00:15:56.98
There are a number of
protective factors that can help
00:15:57.01\00:16:00.04
individuals look at
life more meaningfully,
00:16:00.07\00:16:03.80
and not contemplate suicide.
00:16:03.83\00:16:05.96
We are going to spend a
few minutes looking at some of
00:16:05.97\00:16:08.11
the protective factors now...
00:16:08.14\00:16:11.82
Let us spend a few
minutes talking about this...
00:16:34.00\00:16:37.68
It is true as we become older,
we tend to become more religious
00:16:37.69\00:16:42.66
and that's good!
00:16:42.69\00:16:44.43
The more religious the
person becomes, the more they
00:16:44.46\00:16:48.68
are able to utilize their
cultural values and beliefs,
00:16:48.71\00:16:53.87
the more connected they
would feel with society.
00:16:53.90\00:16:59.10
Also, if the person is able
to feel a sense of connectedness
00:16:59.13\00:17:06.98
that will allow them to feel
as though their life has meaning
00:17:07.01\00:17:11.70
Most of the time, as
the person gets older,
00:17:11.73\00:17:15.65
and becomes more frail,
they feel that they've become
00:17:15.68\00:17:18.97
a burden to the caretakers...
00:17:19.00\00:17:22.34
especially if
they're living at home.
00:17:22.37\00:17:25.04
It's very
important that family members
00:17:25.07\00:17:27.58
make the older
individuals feel welcome,
00:17:27.59\00:17:30.70
and that their input in
life is important to them.
00:17:30.73\00:17:35.00
As a person gets older,
they're supposed to have
00:17:35.03\00:17:38.31
a lot of knowledge that
can be shared for all ages...
00:17:38.32\00:17:42.15
and there are many ways
we can use that knowledge
00:17:42.16\00:17:44.61
to help that person
feel as though they're
00:17:44.64\00:17:47.97
making a contribution.
00:17:48.00\00:17:50.25
Let us look at some additional
factors here that can help us
00:17:50.28\00:17:53.52
preserve life...
00:17:53.55\00:17:54.83
As you can see, these protective
factors are very important.
00:18:16.74\00:18:23.00
To be able to have health
professionals who encourage
00:18:23.03\00:18:29.05
you to seek help
when you're in need,
00:18:29.08\00:18:31.81
is certainly a
protective factor.
00:18:31.84\00:18:34.63
It is so easy to get
carried away with the cares
00:18:34.66\00:18:37.81
of this world... that no one
listens to what you have to say
00:18:37.84\00:18:42.69
And since the elderly usually
have a lot of doctor visits,
00:18:42.72\00:18:46.88
because of loneliness,
it's very important that
00:18:46.91\00:18:50.87
some time is spent trying
to evaluate what's going on
00:18:50.90\00:18:53.91
in their lives so that
appropriate recommendations
00:18:53.94\00:18:57.66
and referrals can be made.
00:18:57.67\00:19:00.16
As you can see, being married
is a protective factor...
00:19:00.17\00:19:05.48
This was a
divine intervention...
00:19:05.51\00:19:09.14
God made us as human
beings to be together
00:19:09.17\00:19:14.32
and when someone lives alone,
00:19:14.35\00:19:17.61
and unable to find things
that give their life meaning,
00:19:17.64\00:19:21.46
and having the
emotional support of someone,
00:19:21.49\00:19:24.47
this can be a risk factor.
00:19:24.48\00:19:27.29
There is no
surprise that most older men
00:19:27.32\00:19:31.17
over 65, who lived
many years with their wives,
00:19:31.20\00:19:37.26
after they pass
away, do have problems
00:19:37.27\00:19:40.33
staying by themselves.
00:19:40.36\00:19:42.14
This type of behavior
actually increases with age...
00:19:42.15\00:19:46.36
So that the older you
are, the more at risk you are
00:19:46.39\00:19:50.65
if your spouse should pass away.
00:19:50.68\00:19:54.63
The last risk protective factor
that I'm going to talk about is
00:19:54.66\00:19:58.27
good friends!
00:19:58.30\00:19:59.49
Friends are very
important, they're lifelong.
00:19:59.52\00:20:03.23
Sad to say,
however, as we become older,
00:20:03.26\00:20:06.82
we lose a lot of friends.
00:20:06.83\00:20:09.87
It is the hope that
people who are older
00:20:09.90\00:20:12.98
should reach out
to form new friends...
00:20:13.01\00:20:15.32
Even though the individuals
may be younger than them,
00:20:15.35\00:20:18.02
friendships can be a
very good protective factor
00:20:18.05\00:20:21.83
in preventing someone
from committing suicide.
00:20:21.86\00:20:26.97
There are a number of
warning signs that are crucial
00:20:26.98\00:20:31.03
that we all should
pay strict attention to
00:20:31.06\00:20:33.99
if we're going to prevent the
elderly from committing suicide.
00:20:34.02\00:20:38.83
Let us spend a few
minutes looking at these...
00:20:38.86\00:20:41.60
Let us spend a few minutes
00:21:08.13\00:21:09.24
talking about
these warning signs...
00:21:09.27\00:21:15.56
Once the person
starts to move away
00:21:15.59\00:21:21.20
from friends and family, they
no longer want to come to dinner
00:21:21.23\00:21:28.03
They no longer want to
spend time with the children...
00:21:28.77\00:21:32.53
They are no longer
interested in their hobbies,
00:21:32.56\00:21:36.09
and activities that
they were used to...
00:21:36.10\00:21:39.11
that is a very
important sign that the person
00:21:39.14\00:21:43.30
is experiencing
some major problems.
00:21:43.33\00:21:47.83
Another important sign that the
person is not doing very well
00:21:47.86\00:21:52.46
is when they stop
taking their medication...
00:21:52.49\00:21:56.07
Some of these medications
are designed to sustain life
00:21:56.10\00:22:01.01
and if the person stops
taking these medications,
00:22:01.04\00:22:04.07
it means that their life
is going to be shortened.
00:22:04.10\00:22:08.07
If the person starts to
keep medication that if used
00:22:08.10\00:22:13.22
in large numbers,
would commit suicide,
00:22:13.25\00:22:16.85
that is also a warning
sign that the person is having
00:22:16.88\00:22:20.08
some difficulty
dealing with life.
00:22:20.11\00:22:24.05
Many of the elderly
experience some difficulty
00:22:24.08\00:22:28.26
with sleeping and eating.
00:22:28.29\00:22:30.99
However, when the
person starts to get depressed
00:22:31.02\00:22:35.53
to the point where
they feel suicidal,
00:22:35.56\00:22:37.98
those eating and
sleeping habits also change...
00:22:38.01\00:22:42.17
You may find a lot more sleeping
and a lot LESS eating...
00:22:42.20\00:22:46.25
or you may find the
person eating a lot,
00:22:46.28\00:22:49.13
and staying up
awake most of the night.
00:22:49.16\00:22:53.00
It is very important to monitor
the sleeping and eating habits
00:22:53.03\00:22:56.03
of the elderly, especially
when they're depressed.
00:22:56.06\00:23:01.40
Another warning
sign is when the person
00:23:01.43\00:23:05.34
starts to make
statements such as...
00:23:05.37\00:23:08.03
"I'm not going to
be around anymore. "
00:23:08.06\00:23:12.29
"I'm very tired
with this world. "
00:23:12.32\00:23:15.07
"Nobody cares about me. "
00:23:15.10\00:23:17.21
"I wish I was dead. "
00:23:17.24\00:23:20.14
These kind of verbal
statements are what you call
00:23:20.17\00:23:24.61
"high risk
statements" that we need to take
00:23:24.64\00:23:28.00
very careful attention to
00:23:28.03\00:23:31.47
if we're going to
preserve this life.
00:23:31.50\00:23:33.80
The elderly will not
always tell you things,
00:23:33.83\00:23:38.84
but lots of times, their
nonverbal behavior can give you
00:23:38.87\00:23:42.46
a lot of subtle messages.
00:23:42.49\00:23:45.44
How do we help
someone who is having
00:23:45.47\00:23:47.35
all of these
warning signs and symptoms?
00:23:47.38\00:23:50.83
Well the first thing we
need to do is to talk to them...
00:23:50.86\00:23:55.66
We need to know exactly
what they are thinking...
00:23:55.69\00:23:57.83
what they are feeling...
00:23:57.86\00:23:59.91
We should not
try to be judgmental,
00:23:59.92\00:24:04.48
to tell them how to feel...
00:24:04.51\00:24:06.84
to tell them that they
should not think about suicide
00:24:06.87\00:24:10.76
We should not reason
with them as to whether or not
00:24:10.79\00:24:13.21
that's a good idea.
00:24:13.24\00:24:15.10
What we have to
do, first of all...
00:24:15.13\00:24:17.49
is to listen attentively
to what they have to say
00:24:17.52\00:24:20.44
Try to let them know
that you're here to help them
00:24:20.47\00:24:24.93
and you're going to stand
by their side no matter what
00:24:24.96\00:24:28.31
to try to find a way to
deal with these feelings
00:24:28.34\00:24:31.79
instead of thinking of suicide.
00:24:31.82\00:24:36.43
You want to encourage them
to talk about their feelings
00:24:36.46\00:24:38.89
openly and honestly.
00:24:38.92\00:24:41.43
You don't want to
minimize their problems
00:24:41.44\00:24:45.93
or MAXIMIZE their problems
00:24:45.96\00:24:47.80
by making it into
something that is SO big
00:24:47.83\00:24:50.44
that it cannot be resolved.
00:24:50.47\00:24:52.77
At the early stage of
listening to the elderly,
00:24:52.80\00:24:55.98
you want to make sure
that you do not try to solve
00:24:55.99\00:24:59.88
the problem... just
give them enough time
00:24:59.89\00:25:03.45
to talk about
their feelings openly.
00:25:03.48\00:25:06.37
Another thing that you can do
00:25:06.40\00:25:07.99
to help the individual who
is in crisis, and contemplating
00:25:08.02\00:25:11.35
suicide, is to be there
for them to make sure that
00:25:11.38\00:25:15.75
they are safe.
00:25:15.78\00:25:17.40
You should not leave the
person by themselves if you know
00:25:17.43\00:25:21.37
they have a suicidal plan.
00:25:21.40\00:25:24.08
The best way to evaluate
the suicidal plan, first of all,
00:25:24.09\00:25:27.37
is to look at the
thoughts and feelings.
00:25:27.40\00:25:30.20
Is the person
saying to you that they are
00:25:30.23\00:25:32.32
going to kill themselves?
00:25:32.33\00:25:33.73
If the answer to
that question is... yes
00:25:33.74\00:25:37.12
then decide if there are means
to do so... if there is a plan
00:25:37.15\00:25:42.14
You want to look
at the history...
00:25:42.17\00:25:44.08
Do they have enough social
support from family members?
00:25:44.11\00:25:47.29
We know that the
more specific the plan,
00:25:47.32\00:25:51.23
and the less the support,
00:25:51.26\00:25:52.96
the HIGHER risk that a
person may carry through
00:25:52.99\00:25:56.46
with a suicidal plan.
00:25:56.49\00:25:59.02
You want to make sure
that as you talk to the person,
00:25:59.05\00:26:02.62
you do not come
across as being judgmental.
00:26:02.65\00:26:06.37
If the person is saying that
they are going to commit suicide
00:26:06.40\00:26:10.35
you should not assume that
00:26:10.38\00:26:13.06
they are just
saying that for attention.
00:26:13.09\00:26:15.16
You should not
"dare" them by saying,
00:26:15.19\00:26:16.70
"You sure that you
really want to do this?"
00:26:16.73\00:26:19.14
That type of a
statement is daring the person,
00:26:19.17\00:26:22.10
and may actually trigger them
00:26:22.13\00:26:23.39
to do it much
sooner than planned.
00:26:23.42\00:26:26.76
Since this is an
issue for the elderly,
00:26:26.79\00:26:30.53
over age 65, and this
group is the most vulnerable
00:26:30.56\00:26:34.83
it is so important that health
professionals, family members
00:26:34.86\00:26:39.63
and friends, keep a close eye
on those who live by themselves
00:26:39.66\00:26:44.56
and over the age of 65.
00:26:44.59\00:26:47.05
It's important that we
look at some of the reasons why
00:26:47.08\00:26:51.27
the elderly do so.
00:26:51.30\00:26:53.44
In summary, we really
should make sure we look at some
00:26:53.47\00:26:58.41
of the risk factors that
the elderly are exposed to.
00:26:58.44\00:27:02.67
We know that having a physical
illness, living by oneself
00:27:02.70\00:27:06.96
as a result of
divorce, or being a widow
00:27:06.99\00:27:09.82
puts the person more at risk.
00:27:09.85\00:27:12.35
We also know that when
a person withdraws from
00:27:12.38\00:27:15.45
family, friends and relatives,
that that's a serious issue.
00:27:15.48\00:27:19.86
We also know that
when the person makes
00:27:19.89\00:27:23.55
the verbal statement that they
are going to take their life,
00:27:23.58\00:27:27.02
that we must take
that very seriously.
00:27:27.05\00:27:31.01
I strongly recommend that
those over age 65 and older
00:27:31.04\00:27:37.29
find the time to
form new friendships
00:27:37.32\00:27:40.67
if they have lost their friends.
00:27:40.70\00:27:42.60
Having a strong
religious belief,
00:27:42.63\00:27:45.28
having a strong conviction,
as far as culture is concerned,
00:27:45.31\00:27:48.91
and belief in God...
00:27:48.94\00:27:50.50
could be one of the MOST
powerful protective factors
00:27:50.51\00:27:53.94
in preventing the
elderly from hurting themselves.
00:27:53.97\00:27:58.58
I strongly recommend that we
reach out to these individuals
00:27:58.61\00:28:03.36
in our daily walk of life...
00:28:03.39\00:28:05.84
And may God bless you as you
continue to look at other shows.
00:28:05.88\00:28:07.53