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Scott Webb (Host): September is Suicide Prevention Awareness Month. And I'm joined today by registered nurse, Sheila Kobliska. And she's here to tell us about Senior Life Solutions, the warning signs of suicide in older adults and how we can best help our older relatives and friends who are struggling with depression and suicidal thoughts. This is Lemonade, the Family Medicine Podcast from Mitchell County Regional Health Center. I'm Scott Webb. So, Sheila, thanks so much for joining me for the first episode of Lemonade. You know, the saying when life gives you lemons, make lemonade, and that's what we're going to do here today, and what we plan on doing with this podcast.

And I know that September is Suicide Prevention Awareness Month, and it's a great time to have you on. As we get rolling here, I want to first have you tell folks, tell listeners, what is Senior life Solutions?

Shelia Kobliska, BSN, RN (Guest): is Senior Life Solutions is an intensive outpatient group therapy program. It's been designed to meet the unique needs of seniors adutls who might be living with symptoms of age-related depression or anxiety, maybe dealing with difficult life transitions, recent health diagnosis, recent loss of a loved one, et cetera.

Throughout life, we experience those things and it seems as we get older, we can experience more of them. It provides a confidential, comprehensive assessments, group and individual therapies, family therapies, medication, education, and management. When people are discharged, then we provide aftercare planning as well. So we don't just cut them off when they leave. We continue that interaction and that connection with them.

Host: Yeah, and that's great to hear. And I think, you know, as I've headed into my fifties here, I'm 53 now and my folks are in their seventies; I begin to think about some of these things and I want to keep an eye on my folks and make sure that they're okay mentally and physically, as I'm sure we all do. And I think I want to ask you now about the pandemic and how has the pandemic affected mental health and maybe specifically the mental health of older or elderly relatives, friends, family members, and so on.

Sheila: It definitely has affected all of us hasn't it?

Host: Yeah.

Sheila: What we find with our elderly people first off, if they're not able to drive, a lot of people, when they get older, they lose their license or their eyesight maybe isn't as good, or even physically they're not able to drive. So, it's difficult for them to get out anyway. And with COVID now, it's just really given more isolation to everyone, but especially our elderly people. And we find a lot in our program have suffered from that because of COVID. They used to go out to coffee in the mornings. They used to go for lunch or supper with someone. And, and now they're not able to either because they can't get there.

They are fearful for themselves because of some coexisting conditions that they're high-risk or, you know, their friends don't want to get together with them because of the fear of COVID. And it's just really affected all of them. A lot of people, they don't get as much exercise because they're not getting out.

Sometimes they kind of self-medicate, maybe they're drinking a bit more or doing some kind of drug usage to help take care of that loneliness and those kinds of things. A lot of them have fears, you know, just what's going to happen and what's going on. And of course when they're not going out, some people they're watching the TV all the time and all that information that they're getting, it's frightening as well. And it can really cause much more of that depression and anxiety to them.

Host: Yeah, I think you're so right. I think for all of us, staying mentally and physically well through this very strange time, it's a lot and it's been tough on all of us. I want to ask how prevalent is suicide among older adults, especially? Is this something that's prevalent and if so, how prevalent?

Sheila: It is prevalent and there are some interesting statistics, over 36% of people who died from suicide were 55 or older. It's the highest rate of any age group, 85% of elder suicides are males. It's a low attempt to completion ratio. Often people maybe are attempting to die from suicide and they maybe take some medications, but they didn't take the right kind possibly, or someone got there in time.

Often it happens as well that a person can die from suicide and it's never discovered because maybe they're 85 years old, 90 years old. And you just assume because of their age or any other conditions, that they died a natural death. So, sometimes it goes misdiagnosed as well or unfounded. After age 60, they do say that the rate does decline for women.

However, 66 to 90% of the people who do die from suicide do have a diagnosable mental illness and I sometimes wonder, I think it's easier for a female to go to the doctor for health things than males. So, if that's part of it, I don't know, two to 4% of people who do complete suicides do have a terminal illness.

So the social isolation, of course has a big factor for it. Their access to firearms, then major changes in social roles. They retired from their job, maybe their wife had to take over or their husband, had to take over some of those duties that they previously had done. So, they're having to completely change their role that they held all of their life, physical illness or fear of prolonged illness. That's difficult as well for people to handle and to deal with.

Host: This is really educational and eyeopening. What are the warning signs of suicide that we should be on the lookout for?

Sheila: There's quite a few warning signs. Some of the main ones that we kind of look for or hear about, of course, depression. You know that would be a warning sign. If anyone's ever had a prior suicide attempt, that would be a red flag, the marked feelings of like hopelessness or lack of interest in future plans.

We do have people, sometimes our question is, have you made any plans for the next month or year and people say no. Again, puts up that red flag to you, feelings of loss of independence, or maybe their sense of purpose. Like I was saying before, too, you know with those roles changes. You may not feel like you're needed. Medical conditions can definitely be a warning sign. Impulsivity, if they're just very impulsive on certain things and that's not usual for them, that's something to take a look at. Social isolation, family discord, or losses, the recent death of a loved one. There are some periods of time in people's lives, where they're at higher risk for suicide. If someone's been hospitalized, for a major depression or even a suicidal attempt, that time after discharge is a very high risk time. If someone's been real depressed and all of a sudden, their medication was changed a bit, they're just feeling so good and they have all this energy, that could as well be a dangerous time that they've been thinking about suicide and now they have that energy to actually complete the suicide.

Any access to lethal means, if they're talking about guns, if they buy a gun, you know, and they've been depressed or something that would be a time, a warning sign to take a close look at them. Sudden personality changes, alcohol misuse, of course, any verbal threats and another big one too, is giving away prized possessions. If you have somebody who suddenly starts doing that and you think they'd been a little bit depressed, that as well could be a strong sign if they are considering.

Host: Sheila, how can someone help someone who is struggling with suicidal thoughts? What can we do for them?

Sheila: It's difficult to talk about those kinds of things and to know how to approach someone who's struggling because we have a lot of discomfort with that very often. However, it could just save a life by approaching them and trying to do something about it. So, the five steps that have been published, and this is by the National Suicide Prevention Lifeline, and kind of their title is #betheone.

And it means be the one to help someone who's in emotional pain. So, the five steps that they talk about is ask, are you thinking about killing yourself? I mean, it's not an easy question, of course, but studies have shown that asking at risk individuals, if they are suicidal, does not increase the suicide or suicidal thoughts.

The second one they talk about is keep the person safe by reducing the suicidal person's access like to highly lethal items, such as guns, as we talked about or places is an important part of suicide prevention. So they say, well, it's not easy asking if the at-risk person has a plan and removing or disabling, the lethal means can really make a difference.

The third point is be there, listen carefully and thoughtfully with the person and learn what the individual is thinking and feeling. Research has suggested that acknowledging and talking about suicide may in fact reduce rather than increase suicidal thoughts. So the fourth item is help them connect.

So save the National Suicide Prevention Lifeline Number, which is 800-273-TALK. And the Crisis Text Line, which is 741741. So saving that in your phone and the person's phone, so that they're there if you need them. You can also help make a connection with a trusted individual, like a family member, friends, spiritual advisor, or a mental health professional.

And lastly, they say, stay connected, staying in touch after a crisis or after being discharged from care can really make a difference too. Again, the studies have shown that the number of suicide deaths goes down when someone follows up with the at-risk person. So I, I think what I really have taken away from these points, something that I really hadn't thought of before, but I do think a lot of people do feel if I even ask about suicide or bring it up, if they weren't thinking about it, they're going to start thinking about it.

And we shouldn't worry about that. You know, just ask them, are you okay? You know, or are you thinking of killing yourself? Just ask it in a nice way, of course, but just talk to them about it.

Host: As we wrap up here and we know that we want older and elderly and really everyone to get their COVID-19 and flu vaccines, I just want to stress that before I ask this question, so important, please get them. But here's the final question for you? Why is it important to talk about mental health and wellness for older and elderly adults?

Sheila: Well, it is so important because a lot of our older adults are suffering from mental health, depression, anxiety. Someone told me once, you know, it's supposed to be the golden years, but they ain't so golden. And you know, unfortunately that's true for a lot of people. So, through our program, that is kind of, one of our goals is to make their golden years golden again, if they're not at that time.

But, when they talk about the suicide rates being higher among adults ages 45 to 54, and even over 65, like we had said, these symptoms often go unnoticed or overlooked and even the person experiencing them doesn't even realize that they're suffering from that. And a lot of people think that's just a normal part of aging.

Of course, you're going to get a little bit depressed and anxious. You're getting older. You can't do as much, but that is not true. They can have a happy, fulfilling life. Our population's growing more rapidly. There's going to be a lot more older adults now, as baby boomers are getting older and Mental Health In America says at about 58% of people, 65 and older believe it's normal for people to get depressed as they grow older, but we want older adults to know they're not alone. And there are ways to restore their quality of life. That's one of our big goals to restore their quality of life and help keep them in their home as long as possible. Mental health and physical health goes hand in hand.

Kind of like the chicken or the egg, you know, did that ulcer come first or the anxiety or depression come first. And they really affect each other. So, if you're suffering from anything like that, then reach out to your primary care physician. A lot of them do a depression screening for the annual Medicare physicals, which is wonderful.

And we get a lot of referrals from our primary care physicians, because of that and they know the program works, but yeah, just people need to not be afraid and try to break down that stigma mental health it's truly just like diabetes or kidney disease. It's a disease. And it can be helped. It can be treated. With COVID and the flu vaccine, of course, the season is now to be getting the flu vaccines and COVID vaccines as well.

Our program and our hospital strongly encourages both of them. It helps to keep people alive longer, healthier, of course. And it's so important to do what we can to keep ourselves as healthy as possible. As I said, mental health and physical health go hand in hand. And if you are already, struggling from a little bit of anxiety or depression, if you do come down with COVID or the flu, it can really accentuate those feelings and make you much worse. So go out there and get your vaccines.

Host: That is definitely one of the key takeaways. We want everyone to get the COVID-19 and flu vaccines, so important, especially for older and elderly patients who maybe already have comorbidities. So, we want everyone go get them. Of course, especially as we head into flu season. And you mentioned earlier about the, the golden years should be golden and that really should be the dream, really should be the goal here.

So thank you for telling us about Senior Life Solutions and the work that you're doing, which is just fantastic. Thanks again, Sheila. And you stay well.

Sheila: You're so welcome. Thank you.

Host: For more information on Senior Life Solutions, go to mcrhc.com. And thanks for listening to Lemonade, the Family Medicine Podcast from Mitchell County Regional Health Center.

If you've found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. And remember when life gives you lemons, make lemonade. I'm Scott Webb. Stay well.