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Dementia and Suicide

Image courtesy imagerymajestic @ http://www.freedigitalphotos.netI should warn my readers, from the start, that this post may be disturbing to some.  It will most surely stimulate some vigorous discussion, if not here than away from the keyboard.

On May 30, 2013, the news website Express reported that an individual with dementia had become the first British citizen to die at the controversial Dignitas suicide clinic in Switzerland.  It was suggested that the 83-year-old man had the full support of his family, and that he wished to spare them further stress as his condition progressed.  He did have a letter from a psychiatrist, confirming that he was mentally capable of making this decision.

The topic of assisted suicide is one that has been much debated in many countries — from a moral, legal, and religious standpoint.  While it is legal in Switzerland under certain conditions, it is considered a criminal offense in the U.K. and can be punished with up to 14 years in prison.  Here in the U.S., assisted suicide is legal in three states — Oregon, Washington, and Vermont — although the specific requirements vary.  It is currently illegal in Australia and in Canada.

Dignitas was founded in 1998 by Ludwig A. Minelli, a Swiss lawyer.  The person who wishes to die must consult privately with several individuals from the organization, as well as with an independent doctor.  These consultations must take place on two separate occasions, with a specified amount of time in between.  There must be a legally admissible affidavit, signed by the person who wishes to die as well as by two witnesses.  If the person is physically unable to sign, he may make a short video wherein he identifies himself, states his wish to die, and affirms that this decision is made of his own free will and without coercion.  This proof of informed consent is to remain private, and used only in case of a legal dispute.  During the actual process, the person is asked several times if he wants to continue.

A study published in the journal Alzheimer’s and Dementia, in November of 2012, looked at predictors of suicide in persons with dementia.  Retrospective data was obtained from the Department of Veteran’s Affairs, from the years 2001-2005.  In particular, researchers looked at data related to persons aged 60 years old and greater, with a diagnosis of dementia.  Of 294,952 persons studied, 241 died by suicide.  Further investigation consisted of identifying possible predictors as well as methods utilized.

Factors which were associated with an increased risk for suicide included being of the white race, depression, a history of inpatient psychiatric hospitalizations, and prescriptions for antidepressants or anxiolytics.  Nursing home admission was associated with a decrease in suicide risk.  Severity of medical comorbidity did not influence risk of suicide.  It was also determined that most suicides occurred among those who were relatively new to their dementia diagnosis, and that firearms were used in 73% of cases.

A group that should also be considered here is the caregivers — those who assist a person with dementia, to varying extents.  These wonderful people exhibit higher than average rates of depression, anxiety, and feelings of helplessness.  However, the rate of suicidal ideation among caregivers has not been the topic of research to any great extent.  A study was conducted recently by Dr. Siobhan O’Dwyer and others from Griffith University in Australia.  They asked 120 participants, recruited from an online discussion board, to complete a questionnaire on line.  They were asked questions regarding measures of suicidality, self-efficacy, physical health, depression, feelings of hopelessness, anxiety, optimism, caregiver burden, coping strategies, and social support.

The results of the O’Dwyer study showed that 26% of the study participants had considered suicide more than once during the past year.  This is more than eight times as much as that seen in the general population for all of the U.S.  In addition, 30% of those caregivers questioned stated that they were likely to attempt suicide in the future.  These findings need to be researched further, but they do emphasize what has previously stated elsewhere — that we need to be supporting these caregivers, both physically and emotionally.

I have attempted, in this article, to refrain from commenting on the moral and religious/spiritual aspects of suicide.  Instead, I have tried to present some facts related to suicide risk among those who have been diagnosed with dementia, as well as their caregivers.  As to the subject of assisted suicide, I will also leave it to my readers to make their own judgments.  I will say that the facts presented here should cause us all to be more aware of the symptoms of depression so often seen in both of these populations, and to do what we can to alleviate it.  Appropriate strategies can include medication, as well as other psychological and cognitive methodologies.

I would be very interested to hear what my readers have to say on this topic.  Please do add your comments to the discussion, as well as your questions.



NIH Public Access

Dementia Collaborative Research Centres

  1. Patrick Fisher
    July 6, 2013 at 3:42 PM

    Reblogged this on Perspectives and commented:

  2. July 6, 2013 at 6:39 PM

    I live in Washington state, and I am glad that Death with Dignity is a legal option, assuming all the legal requirements are met. This is a very personal subject matter, as is the choice that individuals will make to seize the opportunity, or to reject the opportunity. There is definitely a separate element when the law is utilized for those with dementia. When is someone still capable of making the decision? A non-profit in my state, Compassion & Choices of Washington, is an excellent resource for materials and information. They have even developed an Alzheimer’s Disease and Dementia Mental Health Directive – a first-of-its-kind directive that allows people – while still competent – to document their wishes related to who will provide their care, where care will be provided, how it will be financed, how to deal with difficult behaviors that may arise, and many other issues. http://www.compassionwa.org. Bless all of you who face this horrific disease that has no effective treatment, and certainly no cure.

    • July 6, 2013 at 8:18 PM

      Thank you for your thoughtful reply. This is a subject that I think will be discussed more and more in the coming months and years, as the numbers of people diagnosed with dementia rises. I also agree that the subject of informed consent, as applied to this population, is one that the medical ethics community should address in a big way. Just what criteria should we use to determine whether a person is able to make a rational decision regarding his own treatment, whether it be refusing a medication or ending his life. I do know that there are persons with dementia, as well as caregivers, who read this blog. I hope they provide input as well on this topic.

  3. July 6, 2013 at 9:34 PM

    Reblogged this on The Memories Project and commented:
    Good information here to start an important discussion regarding suicide rates among Alzheimer’s patients and their caregivers.

  4. July 7, 2013 at 7:35 PM

    Great blog, and what I’d call a ‘hot topic’. It is an issue around the world, and Voluntary Euthanasia and Assisted suicide have been debated on my blog too. I’m for everyone having the right to make a choice, and having watched many elderly people actively starve themselves to bring about death has strengthened my resolve VE and AS need to be legalised globally. I worked as a volunteer suicide grief support worker for 10 years, and know the burden of suicide; I lost a partner to suicide when I was 27. This type of grief is truly awful, and as a person with dementia, it makes sense to offer legal alternatives to suicide, not only to reduce the burden on the PWD, but on carers, to remove the burden left behind after suicide.

    • July 7, 2013 at 9:47 PM

      Thank you for your input. You’re somewhat of a hero, in my opinion, so your words bear a lot of weight here.

      • July 7, 2013 at 9:51 PM

        WOW, how lovely to hear your opinion today… it has really lifted my spirit! And, thanks xo

  5. findingmyinnercourage
    July 8, 2013 at 8:44 PM

    Your words bear a lot of weight in my personal life! Blogging at it’s finest!

    • July 8, 2013 at 10:02 PM

      Thank you so much! I pray you find peace in your journey.

  1. July 6, 2013 at 6:47 PM

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