GERONTOLOGICAL SOCIAL WORK AND THE UN INTERNATIONAL YEAR OF OLDER PERSONS, 1999.
To highlight the United Nations International Year of Older Persons and to increase awareness of social work issues related to older people, the editor of Social Work conducted an interview with four distinguished social workers involved in gerontological social work. The interviewees identified professional needs and various policy and practice issues for social work education and practice.
In October 1992 the United Nations General Assembly decided to observe 1999 as the International Year of Older Persons. This event was initiated "in recognition of humanity's demographic coming of age and the promise it holds for maturing attitudes and capabilities in social, economic, cultural, and spiritual undertakings, not least for global peace and development in the next century" (www.un.org/esa/socdev/iyop). As we approach the 21st century both the number and proportion of older people in the population will increase. According to the U.S. Census Bureau, over the next quarter century the global population of people ages 65 and over will more than double compared with a 6 percent increase among youths ages 15 and younger and less than a 5 percent increase among children under age five. In the United States the aging of the baby boom generation means that by 2030 the populations of older people will more than double from 1997 levels to around 70 million. For social workers, these demographic trends mean increasing demands for services to this population and a corresponding need for educational opportunities that address topics and issues necessary for relevant, progressive social work practice.
In addition to demographic changes, the changing nature of aging, for example, the health status of older people and the meaning of "old," also challenge social workers to contribute toward a society that will recognize the enormous resources and potential contributions of an older population. As stated in the UN declaration, ". . . opportunities must be provided for willing and capable older persons to participate in and contribute to the ongoing activities of society" (United Nations, 1998).
To draw attention to the International Year of Older Persons and to increase awareness and generate dialogue among social workers about the importance of social work with older people, I conducted a one-hour telephone interview with four distinguished social workers with longstanding involvement in the area of gerontology, [one of which is] Gerson David.
Gerson David: The theme "society for all ages" was intentionally chosen by the United Nations because the focus should be broader than older persons. The main idea is to have a broad exploration of the situation of older people while promoting the ideal of a society that accommodates all of us. The older population is among the fastest growing cohort in the world, and with many nations a large proportion of this growing population are women. In addition, an alarming increase in poverty and chronic ill health exists among elderly people. While calling attention to these concerns, the UN's overall objective for the year is the promotion of human principles of older persons; that is, addressing the quality of life of older people, including independence, care, self-fulfillment, and dignity. The theme is intergenerational, highlighting the independence and interconnection of generations. This event can provide impetus for our profession to deal with the twin challenges that are presented by population aging and society's changing. For example, based on 1995 census data, the over 65 population of the United States will increase from 12.8 percent of the total population in 1995 to 18.7 percent in 2025. Also, in 1995 life expectancy in the United States at birth was 72.8 years for men and 79.7 for women. The United States also is being affected by social, economic, cultural, and technological changes. The living environment is being restructured by changing patterns of employment, social security, social welfare, education, health care, housing, and changing patterns of investment in consumption and savings. Then there is the spread of education and communications, breaking down prejudices that confine individuals to limited roles according to class or gender and technological innovations that are making new work and leisure accessible to all age groups.
I want to give credit to Maggie Kuhn who warned us not to accept what she termed sociogenic aging--being assigned roles as nonpersons, relegating people to playpens and warehouses. There is a lot of ageism; that is the first cross-cutting intervention we should be talking about, the prejudices against older people just because they are old.
At the White House Conference on Aging, Bob Butler (a well-known gerontologist) mentioned that knowledge is the most basic intervention serving as an antidote for erroneous and widely held beliefs. For example, we need to consider the old dehumanizing messages of old age, such as that as soon as you strike 65 you are confined to a wheelchair or something, and recognize the achievements and creativity of older people in their 70s, 80s, and 90s even.
GERONTOLOGICAL SOCIAL WORK AND THE UN INTERNATIONAL YEAR OF OLDER PERSONS ,
By: Witkin, Stanley L., Social Work, 00378046, Nov99, Vol. 44, Issue 6
Suicide Prevention Strategies
Youth and Elderly Populations
In recent years, rates of suicide in BC have tended to be highest among the young (including teens and young adults) and the elderly populations. A fairly typical trend line for rates of suicide across the lifespan, shows noticeable peaks occurring among both the younger and older age groups. While much attention, in the form of media reports, research efforts, and program development, has focused on the increasing rates of suicide among the young, the high rates of suicide among the elderly have received less widespread notice.
Part of this imbalance in overall attention may have to do with the fact that the suicide rate for young people has nearly tripled in the last several decades, with a leveling out starting to occur in the 1980s (Health Canada, 1994). Such a dramatic rise in the rate of suicidal behaviour among teens and young adults has concerned parents, policy makers, mental health professionals, and researchers alike, making youth suicide prevention a fairly high profile issue. In response, numerous books and articles have been published on this topic and several youth suicide prevention programs have been developed.
In contrast, there has been a much less dramatic public response to the high rate of suicide among the older generation, which may well be a reflection of the fact that the elderly have consistently shown high rates of suicide for a longer period of time (Health Canada, 1994). Unlike the statistics for youth, a high suicide rate for the seniors population does not represent a new phenomenon.
On the other hand, the lack of visibility regarding the issue of suicide among the elderly may also be a reflection of ageist values, where the lives and concerns of the young are seen as much more important than the quality-of-life concern of the elderly. Without question, we live in a culture that places a high premium on youth, vitality, physical beauty, independence, and sex appeal. In the eyes of a youth-valuing culture, when an elderly man kills himself at age 78, it is somehow viewed as “less of a tragedy” than when a young man of 17 kills himself, even though both deaths may have been precipitated by identical circumstances and social conditions, such as: unbearable losses, major depression, social isolation, a lack of meaningful work (or role), and abuse of alcohol. In this article the commonalities between youth and elderly suicides will be highlighted and specific opportunities for prevention will be discussed.
Risk Factors for Suicide
Suicidal behaviour is complex and cannot be understood to be the result of any one single factor acting in isolation. Several individual factors (e.g. depression or previous suicide attempts) interact with other social factors (e.g. unemployment of alienation) to produce a potential vulnerability to suicide. Stressful life events can then exacerbate an existing vulnerability. For example, the loss of a significant relationship can further heighten the risk for suicidal behaviour.
Even though many of the risk factors for suicide are well known through research efforts and by reviewing thousands of cases of completed suicide, we still cannot predict with any certainty which people will actually go on to kill themselves. For example, many people experience several risk factors but do not commit suicide.
We can, however, use the existing knowledge about suicide risk factors to help us identify those who may be vulnerable to self-harming behaviour so that we can intervene early and hopefully avert a suicidal outcome. The risk factors for suicide among youth and elderly populations are highlighted next.
Similarities Between Youth and Elderly Suicide
Risk factors for youth and elderly suicide are not that dissimilar and include: a history of suicidal behaviour, presence of a psychiatric disorder, substance abuse, social isolation, access to the lethal means for killing oneself, unemployment, and health problems. Men of both age groups kill themselves more often than their female counterparts.
Declining health, adjustment to retirement, and significant losses such as widowhood are stressful life events associated with aging that can increase the vulnerability to suicide among the elderly population. On the other hand, the risk of imitative suicidal behaviour following exposure to peer suicide or sensationalized media reports s greater among youth populations.
Irrespective of their age or stage in the life cycle, the bottom line is this: people kill themselves because they are in unbearable psychological pain and they see suicide as their only option. However, with proper support and intervention, suicidal individuals can be assisted to make a choice in favour of life, and family members and friends can play a critical role in offering their support.
Providing Help to a Suicidal Family Member
Understanding the developmental challenges and life cycle tasks facing youth and elderly populations can prepare family members to provide assistance to a loved one who is experiencing an emotional or suicidal crisis. For example, a key developmental task of adolescence is identity formation. Successful mastery of this life cycle stage will likely include separation from parents and family and increased identification and need for acceptance from one’s peer group.
When an adolescent is faces with rejection from a peer or the break-up of a relationship, family members need to know that this is a serious threat to the equilibrium of the young person and is not to be taken lightly or dismissed as unimportant. Family members can communicate their concern and provide empathic understanding, while still respecting the adolescent’s need for privacy and autonomy.
At the end of the life cycle, family members should be alert to the potential crises being faced by their older relatives. A key developmental challenge for those over the age of 65 is mastering the transition from work to retirement. For many seniors, this adjustment can prove to be very difficult, resulting in a temporary loss of identity and role confusion. Again, family members can provide support and reassurance and communicate their faith in the person’s ability to master the challenge.
In either of these cases, determining whether or not the person in crisis is considering suicide is very important. Asking the question, “Are things so bad that you are thinking of suicide?” will not put the idea into the person’s head. Instead, it will open up an opportunity for a potentially life-saving discussion to take place. Only by asking the question, can we establish whether or not suicide is an issue.
If the person acknowledges that he of she is considering suicide, family members can be helpful by doing the following:(a) reassuring the suicidal person that help is available; (b) letting the suicidal person know that the family loves them and will do whatever they can to ensure that they will not hurt themselves; (c) finding out what community resources are available to support the person in crisis, including family physician, local mental health centre, 24-hour crisis line; (d) making arrangements to get the suicidal person the necessary help, which could include taking them to the hospital, making an appointment with the family physician, advocating on behalf of the suicidal person, or going with them to see a counsellor.
Denial Will not Make it Go Away
It is always upsetting to see someone we love in pain, and dealing with a family member who is suicidal is definitely scary business. For some people it might even be tempting to avoid the topic of suicide altogether in the hopes that it will go away. It won’t.
Suicidal people need the opportunity to tell their stories and they need to know that help is available. They need to know that they will not feel this way forever and they need to hear that family members will do whatever is necessary to make sure that they do not harm themselves. Family members also need to get support for themselves and they need to be reminded that they can never be responsible for another person’s choice to live or die. Sadly, some people kill themselves in spite of the fact that they had families who loved them.
What is most important to remember is that help is available to suicidal individuals. Family members can play a critical role in assisting someone in crisis by providing non-judgmental support and by knowing which local community resources are available to provide assistance.
Jennifer White is the Director of the BC Suicide Prevention Program at CUPPL, Department of Psychiatry, UBC.
