ChesterCountyMedicineSpring2019 - 34

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Abused Elders and Suicide:
What do we know?
BY TONY SALVATORE, MA
TSALVATORE@MCES.ORG., @TONYSALVATORE45

E

lder abuse and elder suicide share many commonalities.
Both are serious and tragic problems. Both are known to be
claiming more victims. Both are less recognized than abuse
and suicide in younger groups. Both affect frail, vulnerable elders
in our communities.
Domestic abuse and child abuse are risk factors for suicide.
However, there has been little study of how suicide risk relates to
elder abuse. Suicide risk in abused and neglected elders is largely
overlooked.

What is elder abuse?
Elder abuse is an intentional act harmful to an elder by a
trusted person. It may take the form of emotional, physical, or
sexual abuse, financial exploitation, or caregiver neglect. Five
million older adults fall victim to elder abuse every year in the
United States, roughly one of every ten adults age sixty and over
according to the National Council on Aging.
The Pennsylvania Department of Aging reports that there are
over 6000 substantiated elder abuse investigations in the state each
year. In fiscal 2017/2018, there were 397 cases investigated in
Chester County and 562 cases in Delaware County.
Elder abuse reporting is mandatory for staff caring for elders.
Incidents involving family members may go unreported. Victims
may choose not to jeopardize a relationship with the abuser who
may be a spouse or child and their lifeline.
Statewide, the most frequently reported form of elder abuse
is self-neglect, which comprises about 40% of all investigations.
Caregiver neglect accounts for just over 20% of substantiated
reports. Financial exploitation and physical, emotional, and sexual
abuse comprised the balance of cases.
34 CHESTER COUNT Y Medicine | SPRING 2019

What is elder suicide?
Elder suicides are deaths that result from persons aged 65 or
older intentionally taking their own lives. Here are the principal
evidenced-based risk factors for elder suicide:
* Physical and psychological harm, sexual assault, domestic
conflict, financial loss, social isolation, and psychological
disorders (Conwell & Thompson, 2008; Oyama et al., 2008).
* Social disconnectedness and cognitive impairments (Conwell
et al., 2011).
* Incapacitating medical illnesses, physical impairments, and
other impediments to independent living (Turvey et al., 2002).
Pennsylvania Department of Health statistics for 2012-2016
show there were more than 1600 reported suicides in which the
decedents were 65 years of age or older. On average, there are well
over 300 such deaths yearly. In 2016, there were 11 reported elder
suicides in Chester County and 13 in Delaware County. Elders
comprise just under one-fifth of suicides in both counties.

How do they overlap?
Most of the risk factors for elder abuse are risk factors for elder
suicide. These are social isolation, low social support, interpersonal
conflict, chronic illness, disability, and financial dependence. There
is considerable correspondence between the risk factors for elder
suicide and the various forms of elder abuse. Each type of elder
abuse is itself a risk factor for elder suicide.
Gender is the only risk factor where elder abuse and elder
suicide do not overlap. Most elder abuse victims are women while
most elder suicides involve men. However, abuse and neglect
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