Dementia and Suicide: What a Caretaker Needs to Know

If you are the adult son or daughter of a parent recently diagnosed with dementia, you may now find your mother or father making references to suicide. In fact, your parent may be bringing up the idea of suicide with some frequency. The fact is that when an older person is diagnosed with dementia and in the early stages of the disease, the risk of suicide can be heightened. This article is designed to provide primary caretakers of an individual with dementia some basic information about dementia and suicide.

Suicide Attempts Increase in People Recently Diagnosed With Dementia

While a person doesn’t want to be an unnecessary alarmist, there is at least some cause for concern regarding a heightened risk of suicide when a person receives a dementia diagnosis. The National Institute on Aging reports:

Suicide attempts may also increase in people recently diagnosed with dementia. It is important to have support systems in place to help cope with a dementia diagnosis and possible depression symptoms that follow. More research is needed to determine effective depression treatment options for people with dementia.

Assisted Suicide and Dementia

The question fairly regularly comes up about the availability of physician aid in dying (commonly called assisted suicide) when an individual has dementia. There are some states in the United States that currently do permit physician assistance in dying. With that noted, even in those states, physician aided dying as the result of dementia is not permissible legally anywhere in the United States. 

States that do have laws permitting physician aid in dying are all relying on the same model statute or model law. The law only permits physician assistance in dying when two primary elements are in place:

  • A person who desires physician assistance in dying must have full cognitive capacity
  • A person must have six months or less to live 

Herein lies the proverbial rub when it comes to physician aid in transitioning and dying for an individual with dementia:

  • If a person diagnosed with dementia still has capacity to consent to physician aided dying, that individual has more than six months to live
  • If a person diagnosed with dementia has six months or less to live, dementia has progressed to the point that the individual lacks capacity to consent to physician aided dying 

Psychology Today has summed up the state and future of physician aided suicide for patients with dementia quite succinctly:

These laws effectively rule out any attempt to secure legal physician aid in dying for a person with dementia. Since this is the only legislative approach that has passed in the US, other states trying to pass laws in support of physician aid in dying are unlikely to vary from the successful model. In short, physician aid in dying is unlikely to emerge in the US as an option for those with dementia.

Unaided Suicide and Dementia

Over 6 million people in the United States are diagnosed with Alzheimer’s. Over 1 million others are diagnosed with some other form of dementia. One in three older Americans are said to die from Alzheimer’s annually, according to the Alzheimer’s Association. The number of individuals with Alzheimer’s is expected to increase to 15 million in approximately the next 25 years. 

The National Institutes of Health reports:

Suicide attempts were observed in less than 1 percent of all patients with dementia.

When commentating on this data, the National Institutes of Health seems to take what fairly can be called a bit of downplaying on the significance of the rate of suicide attempts among people with dementia. Yes, on the surface less than 1 percent doesn’t seem like that many people with dementia who attempt suicide. 

Upon closer examination, the number of suicide attempts among people with a dementia diagnosis is not something to be dismissed. Let’s assume there are in fact 7 million people in the United States diagnosed with some form of dementia. (The number of people who actually have dementia likely is higher, perhaps significantly so. There are many individuals who never receive a formal diagnosis of dementia for one reason or another.) 

1 percent of 7 million people is 70,000 individuals. The fact that somewhere in the neighborhood of 70,000 people attempt suicide each year because they are diagnosed with dementia is in fact an alarming number. 

Consider this:

  • Most suicide attempts by people with dementia are among those who recently have been diagnosed
  • Somewhere in the neighborhood of 250,000 new diagnoses of dementia are made in the United States each year
  • Understanding that a majority of the 70,000 suicide attempts occur among recently diagnosed the percentage of the 250,000 individuals diagnosed each year that will attempt suicide in the more immediate future is significant

Focus of Dementia

Psychology Today discusses one of the key reasons people with a fairly recent diagnosis of dementia may attempt suicide. According to the magazine:

Many people, when asked about dementia, picture someone at the very end stage: bed-bound, incontinent, mute, in pain, a burden to family. This may be accurate of some at the very end, and we need to do more to make sure death with dementia is pain free. But that end-stage image is a false picture of the overwhelming majority of people with dementia. A better and more accurate picture would be that of the older man who nodded to you yesterday at the grocery store, or the person next to you at religious services, or at the family birthday party. Most people with dementia are in the early stages, and are living at home, in your community. Our thoughts about dementia would be far more useful if we focused on this person, still up and about, and worked on how to help him or her enjoy a safe and happy life. 

Signs of Suicidal Thoughts or Suicidal Ideations of Elderly Individual With Dementia Diagnosis

Suicidal thoughts are defined as a person thinking about the prospect of suicide with no specific plan to carry out a life-ending action. On the other hand, suicidal ideation is not only thinking about suicide but formulating a specific plan to commit suicide and having the instrumentality to undertake a live-ending act. 

The signs of suicidal thoughts or suicidal ideations among elderly individuals are not all that different than those associated with an elderly individual suffering from depression for another reason or reasons. These signs include:

  • Loss of interest in hobbies or familiar activities
  • Avoidance of social activities
  • Episodes of crying or despondency “for no reason”
  • Sleep disturbance
  • Loss of appetite and an increase in alcohol use
  • Feelings of worthlessness
  • Feelings of hopelessness associated with dementia diagnosis
  • Feelings of dread about prospects of end of life with a dementia diagnosis
  • Despondency over state of life as dementia progresses

Five Action Steps to Support a Loved With Dementia Contemplating Suicide

The National Suicide Prevention Lifeline has developed five action steps that can be taken to help an older adult diagnosed with dementia who is thinking about suicide:

  • Ask. Don’t be afraid to be direct with the person at risk. Ask questions like, “How can I help you?” to initiate a conversation in a supportive and unbiased way. 
  • Be there. Physical presence eases feelings of isolation and provides connectedness. If a face-to-face visit is not possible, consider a Zoom video chat or a phone call. 
  • Safety first. Ask if the person has already made attempts on their life. Is there a specific plan that has been constructed? Does the person have access to their planned method of self-harm? Learning the answers to these questions helps to assess immediate danger. In general, the more detailed the suicide plan, the higher the risk (suicidal thoughts versus suicidal ideations). 
  • Help make connections. Establishment of reliable support systems can alleviate moments of crisis for an older adult considering suicide.
  • Follow up. Check in with the depressed elder. This can be done via phone, text, or card. The simple act of reaching out and demonstrating care can mean the difference between life and death.

Dementia and suicide are realities. An adult son or daughter of an older individual diagnosed with dementia and thinking about suicide are well served not only following the action steps provided in this article but also to seek out professional support and assistance from a therapist or counselor. There are mental health professionals who specialize in working with individuals diagnosed with dementia, including those people who are also dealing with depression or thinking about suicide.