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among older men is significantly under-reported. Undercounting
is also a problem with elder suicides.
Both elder abuse and elder suicide occur most frequently in
those whose ability for self-care and autonomy is impaired. We do
not know how many abused elders become suicidal or engage in
suicidal acts, but suicide risk may run high in this population.

Where is the research?
In 1995, Yeates Conwell, MD, of the University of Rochester
Medical Center, noted: "Additional research is needed to establish
the strength of any relationship between abuse and self-destructive
behaviors in late life." Twenty-four years later, research on suicide
and suicidal behavior among abused elders is sparse and drawn
mostly from Asian and Asian-American samples:
* Koreans aged 65 and over, abused within their family, are
at higher risk of suicide than those never abused (Kim & Im,
2010).
* In rural Chinese elders, aged 60 and older, mistreatment
correlated strongly with suicidal ideation (Wu et al., 2013).
* Abused women, aged 55, with backgrounds of inpatient
psychiatric care had significantly higher incidence of suicidal
behavior than those without histories of abuse (Osgood &
Manetta, 2001).
* Elderly Chinese women in the Chicago area abused by family
members manifested suicidal ideation (Dong, Chen, Wu &
Chi, 2015).
Data from the National Violent Death Reporting System
indicate that some elder suicide victims may have been in abusive
relationships just prior to their deaths (Fowler et al., 2018).
Elders who neglect self-care may be at highest risk. Selfharming elders are at greatest risk of completing suicide
(Babatunde et al., 2019).

What can we do?
What we know supports at least these recommendations:
* All staff involved with responding to cases of elder abuse or
providing protective services to at-risk elders should be trained
to identify possible warning signs of elder suicide.
* All aged individuals suspected or known to be victims of elder
abuse should be screened for suicide risk and monitored for the
emergence of warning signs.
* All aged individuals who manifest any type of suicidal
behavior (i.e., ideation, threats, voicing a plan, seeking means,

or an attempt) should be assessed for signs of elder abuse.
Community-based and residential providers serving elderly
clients and patients can identify individuals at potential risk of
elder abuse and elder suicide. County suicide prevention task
forces can promote greater awareness of suicide risk in elders.
Like all forms of suicide, those associated with elders are
preventable at some point. This mnemonic may be useful in
identifying elders with dual risk:
U

Unconnected; weak social supports; loss

Negative/pessimistic view of self/future

Shame due to humiliation/victimization

Abuse and neglect

Financial dependence

Emptiness; depression; hopelessness

Who can help?
Reports of possible elder abuse or neglect in Chester
County may be made to Older Adult Protective Services at the
Chester County Department of Aging (800-564-7000). In
Delaware County, contact the County Office of Services to the
Aging (C.O.S.A.) Elder Abuse Hotline (610-490-1300). The
Pennsylvania Protective Services Hotline is 800-490-8505.
Call Valley Creek Crisis Center (610-280-3270) to help a
Chester County elder showing signs of possible suicidality. In
Delaware County, assistance is available at Fitzgerald Mercy
Hospital Crisis Services (610-237-4210) and Crozer Chester
Medical Center Crisis Services (610-447-7600). The National
Suicide Prevention Lifeline is 800-273-8255. If an elder is felt to
be in imminent danger of suicide call 911.
The Chester County Suicide Prevention Task Force
(chestercountysuicideprevention.com/) and the Delaware
County Suicide Prevention and Awareness Task Force
(delcosuicideprevention.org/) offer information, training, and
opportunities for involvement in suicide prevention. Prevent
Suicide PA (www.preventsuicidepa.org) provides information on
statewide suicide prevention activities.
Tony Salvatore lives in Springfield and is the Director of
Suicide Prevention at Montgomery County Emergency
Service (MCES), a nonprofit psychiatric crisis service in
Norristown, PA.
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SPRING 2019 | CHESTER COUNT Y Medicine 35

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