Rational Suicide in Elderly Adults: A Clinician's Perspective

Meera Balasubramaniam, MD, MPH

Disclosures

J Am Geriatr Soc. 2018;66(5):998-1001. 

In This Article

Mr. A as a Baby Boomer

Peter Levitan, a 60–year–old business consultant, wrote a book Boomericide: From Woodstock to Suicide in 2012, in which he talked about scheduling his own death. He described what rational suicide meant to a Baby Boomer like him, describing his decision as a financial planning tool as well as a means to preserve his sense of control.[8] Baby Boomers are a demographic group born between the early to mid–1940s and the mid–1960s. This group currently comprises 76 million individuals, amounting to 24% of the U.S. population.[9] In the coming years, geriatricians will increasingly encounter Baby Boomers as patients. The term also has important cultural connotations. Baby Boomers were the generation to witness the end of the Vietnam War and the advent of classic rock music, to develop sexual freedom, to experiment with drugs, and to develop a sense of mistrust of authorities, to name a few changes.[9]

Such historical events and social shifts influence a generation's views on aging, death, and dying, individual differences notwithstanding. Baby Boomers as a cohort value youth, personal fulfilment, and the ability to remain active after retirement and generally have negative attitudes toward aging.[9] A 2009 Pew Research Center study reported that U.S. adults associated old age with failing health, loss of the abilities to drive and live independently, and difficulty navigating stairs.[9,10] Baby Boomers also advocate for death and mourning to be focused on the needs of the individual rather than society, in stark contrast to the generations before. This includes advocacy for nontraditional funeral ceremonies and end–of–life decisions.[9] A higher proportion of Baby Boomers is expected to live alone later in life,[11] with consequently greater reliance on the system and institutions to provide end–of–life care. They had a higher rate of suicide during their own adolescence than previous generations.[12] A group with greater experimentation with drugs in their youth is now exposed to prescription opioid analgesics. A 50% rise in the rate of illicit drug use for individuals aged 50 and older has been projected over a 20–year period from 2000 to 2020.[9,13] It is important to consider the possibility that the combination of negative perceptions toward aging and dependency, greater social isolation, increasing access to drugs, greater need for autonomy, and an overall generational familiarity with suicide may be accounting for a higher proportion of older adults like Mr. A expressing the wish to end their lives on their own terms.[9]

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