Q. Are there other signs and symptoms to watch for?

A. Suicide can be related to stressful circumstances, including losses and physical problems, which also increase the risk for depression. So times of loss or other stressful events may be a time for increased concern. Older people who are suffering from depressive illness may become withdrawn and less communicative, begin drinking more alcohol or stop caring for themselves as well as they have in the past.

Other signs of depressive illness or increasing suicide risk include giving away possessions, using medications inappropriately and acquiring potential methods for suicide (for example, obtaining firearms or stockpiling medications). Some symptoms may be mistaken for common reactions to the stresses of aging. But it is critical to recognize that depression is not a normal part of aging. It is not normal for people to lose interest in things that they have enjoyed doing or to experience a profound loss of energy.

Q. What steps should be taken if concerns arise?

A. It is important to simply ask people how they are - to sit and talk and ask how they are doing. Older individuals also may not appreciate that what they are feeling and experiencing is not normal. It is extremely useful to understand how older people feel about their circumstances and their lives under everyday circumstances and under unusual conditions.

Sometimes people hesitate to ask whether someone they care about is having suicidal thoughts out of a fear that they will "put the thought in their heads." This is a myth.

It is also a myth that people who talk about suicide are less likely to take their own lives. This is not true - talking about suicide is a signal that something is wrong and that additional help is needed.

Q. Are there effective strategies for preventing suicide in the elderly?

A. Just as there is no single factor that causes suicide, no single intervention is going to prevent all suicides. The success of prevention efforts depends on the "alterability" of factors that contribute to suicide. But there are many factors that can be changed or enhanced that will help reduce the risk of suicide in older people.

We know, for example, that social support - having strong connections to family and community - protects against suicide risk. Receiving effective care for mental, physical and substance abuse disorders is another protective factor.

Providing access to adequate health care and social services is critical, as is providing support to the health care system to assure adequate diagnosis and management of pain, impairment and physical illness in the elderly. Older people who receive the best care are going to want to live and we all have a role to play in making sure our elderly population is cared for well.

Help or Harm?
The Controversy Over Assisted Suicide

One of the more controversial and hotly debated ethical and legal issues has been the question of whether physicians should be allowed to help terminally ill patients end their lives.

A recent Harris Poll indicates that a majority of adults in the United States support the right to physician-assisted suicide for patients who are believed to have fewer than six months to live. When asked by Harris whether the law should allow doctors to comply with the wishes of a dying patient in severe distress who asks to have his or her life ended, 65 percent of the adults surveyed said yes. Sixty-one percent also said that they would favor a law in their own states like Oregon's "Death with Dignity Act," a citizens' initiative that was approved by voters in 1994 and again in 1997.

In North America, two arguments have traditionally been advanced in support of physician-assisted suicide, says Sandra J. Taylor, Ph.D., co-author with Carlos Prado of Assisted Suicide: Theory and Practice in Elective Death (Humanities Press, 1999).

The arguments are respect for autonomy/self-determination and mercy/compassion. In the autonomy view, competent individuals should be able to exercise control over their own lives and deaths. In the mercy view, it may not always be possible to alleviate suffering, therefore assistance in dying may be a compassionate response.

Arguments against physician-assisted suicide typically have been based on the principle of the sanctity of life and the potential for the abuse of the option of assistance by overburdened family members or care providers.

A debate continues among health care providers and in the bioethics literature regarding the distinction between passively letting someone die (for example, through cooperating with their refusal of treatment) and actively assisting someone in dying. "The law treats these actions differently now," says Taylor, "but many ethicists will argue that they are the same."