Simply by virtue of his age, 93-year-old William Rose of Newton is at heightened risk of death. But the threat that came closest to taking his life was not old age, or illness.
It was suicide.
According to the Massachusetts Coalition for Suicide Prevention, men age 85 and older have the highest suicide rate in the state. So when Rose told his home healthcare aide that he was thinking of killing himself after his daughter died, she took it seriously.
Fortunately, Rose's aide, Elina Dubovsky, knew what to do. She had attended a program on how to help prevent suicide in seniors, offered by the Geriatric Institute of Jewish Family and Children's Services in Waltham.
The training offered helped Dubovsky recognize depression in her patients, including Rose.
"They stop their regular activities, don't eat, some of them stop taking their medications," said Dubovsky. "They may tell you they're OK, that they're taking their medication, but when you test their blood pressure or blood sugar, you see they don't take their medications."
Rose has the usual complaints about being old - difficulty getting around, the deaths of relatives and friends his own age. But in general, he said during an interview in the lobby of his Chestnut Hill high-rise, "I had a good life. I can't complain." He can acknowledge the positive things in his life: He's been with his girlfriend for more than 20 years, and he just came back from a 10-day cruise to Bermuda.
But this past February came what he still calls "a disaster" - his daughter died unexpectedly in her sleep.
After that, he said, he started to see his long life as a curse, a punishment. He felt alone. He missed being strong, healthy, and active. He worried about how much more he would lose if he became seriously ill. In fact, that concern still troubles him.
The thought of killing himself hasn't disappeared, but he said he wouldn't do it now.
His path away from suicide began after he confided his feelings to Dubovsky. She connected him with a medical social worker. He began seeing a psychologist, and says that he now feels more in control of his depression. He said Dubovsky's visits help keep him going, because he sees her between one and three times each week - more often than he does his doctors.
The Geriatric Institute began running its suicide prevention program for the elderly last year, said Kathy Burnes, the institute's project manager. It's one of several programs aimed at translating research on the elderly into practical solutions to the problems of old age. The Jewish family services agency also runs a general mental health program, and one of the motivations in creating the geriatric suicide prevention program was the discovery that about 60 percent of the mental health clients were 55 or older.
The institute is nonsectarian and works with clients regardless of their religion. Its suicide prevention program, adapted from research and materials from Cornell University's Homecare Research Project, began by training agency home healthcare aides on how to recognize symptoms of depression in the seniors they cared for. The training was expanded to aides affiliated with two Boston agencies, Midtown Home Health Services and Kit Clark Senior Services. It also holds sessions to teach doctors and nurses how to train other healthcare workers. So far, the program has trained 400 home health aides, doctors, and nurses. The materials have been translated into Russian, French, Spanish, Chinese, and Vietnamese.
"The thing we're really trying to communicate is that depression is not a normal part of aging. It's a serious medical illness," Burnes said. "Seniors who have disability, medical illness, and pain are more likely to be depressed, but many are experiencing major depression for the first time in their lives, and this is not something that they'll get over [without help]."
One of the program's primary goals is to destigmatize depression for the healthcare workers as well as the patient. Sessions include brain scans comparing the brains of depressed and nondepressed people, to reinforce the idea that depression is not an issue of willpower or a character flaw. A "tool kit" of brochures and fact sheets describes to health workers signs of depression - sleeping more than usual, crying easily or often, and losing interest in going outside or doing usual activities, for example. It also gives hints on how to determine whether a patient is suicidal, and if so, what the home healthcare worker should do.
But Burnes said that one of those next steps - referral to a mental healthcare professional - can be the most difficult to accomplish. There's a nationwide shortage of psychologists, psychiatrists, and counselors, particularly those who can deal with non-English-speaking patients. Medicare and other insurance programs sometimes offer only low reimbursement rates for mental health services.
"You want to know, once you make that determination, that there will be someone there actually following up. You really want to hope that there are referrals that you can make stick, but it's tough out there, not just for elders, but for all ages," Burnes said.
Sy Friedland, The Jewish Family and Children's Services executive director and the holder of a PhD in clinical psychology, said this shortage is one reason training of home healthcare aides is important. Although they can't provide treatment themselves, they can play an important role in monitoring whether that treatment is working.
"Doctors have a rough job. They only have 20 minutes with you," said Rose. "Elina is there all the time."
Stephanie V. Siek can be reached via e-mail at firstname.lastname@example.org .