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研 究 報 告Eldery Suicides In Hong Kong | Youth Suicides In Hong Kong |
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EXECUTIVE SUMMARY Background Suicide ranks seventh in the ten leading causes of death in Hong Kong. While the territory has a relatively low youth suicide rate, its elderly suicide rate is one of the highest in the world. More than 30% of suicide deaths were persons aged 60 or over in Hong Kong. Elderly suicide rate is four to five times above the average for the general population. Elderly suicide is clearly an important issue in Hong Kong. However, in spite of the fact that existing suicide prevention programs have very little effect on the elderly, who rarely use them, very few studies have been conducted into elderly suicide. Indeed, the prevailing attitude appears to be that nothing can be done to help. As a result, we know very little about the problem. The launch of this study demonstrates Befrienders International? recognition of the need to provide effective suicide prevention services to this high risk group of people. The Hong Kong University (HKU) team, comprising social scientists, statisticians, and psychiatrists, was commissioned to carry out the study. The specific objectives are:
to examine the trends of elderly suicide in the past 15 years in Hong
Kong;
to describe the characteristics of the suicidal elderly;
to investigate why the elderly are in distress and become suicidal;
to formulate the service model to reach the elderly high risk group.
This research project includes three studies. The first study adopts the data archive method. Census data on territory-wide suicide is analyzed to determine the profiles of the suicidal elderly in Hong Kong over the past 15 years. The second study involves secondary data analysis. Police records of 1992 elderly suicide cases are scrutinized to establish the major reasons for the deaths concerned. The final study focuses on attempted suicide in the elderly. A small-scale qualitative study was undertaken in the Department of Psychiatry, Queen Mary Hospital. Patients who have attempted suicide and are referred to the Department are invited to help investigate the reasons for their attempts. Through these triangular studies, we can better understand the elderly suicide problem and recommend intervention methods to assist this high risk group. Findings and Discussion Suicide over the past 15 years in Hong Kong, is more serious among the elderly than in any other age group at a rate four to five times above the mean rate of the general population. The highest suicide risk groups are the older elderly (that is, those aged 75 or above), males and the unmarried elderly. This study indicates that factors such as poor health status and limited social support may be linked to the higher incidence of elderly suicide, and demonstrates that a supportive home environment and an active life style can help the elderly to cope with crisis situations. The suicide ratio of economically inactive aged persons to economically active aged persons is 10 to 1. A job for an elderly person not only means earning a living; it provides an active life style, which improves psychological well-being. The provision of job opportunities and the establishment of community support services such as multi-service centres, in particular for the homeless and unmarried, can also help to promote an active lifestyle. The study indicates that the more crowded districts with fewer facilities tend to have higher suicide rates. The crowded living environment has long been documented as an aggravation to mental health. On the other hand, due to poor urban planning, the new or developing areas in Hong Kong also lack supportive services. In general, elderly persons living in these areas have few community support services and poor medical care. Should the Government choose to fund future community support services and need to prioritise, it is recommended that the districts with high suicide rates related to limited support services be given the highest consideration. Changes in methods of elderly suicide are also noted. Jumping from height shows a marked increase over the fifteen years, while other methods have declined; the increase in the number of high-density high-rise blocks in Hong Kong has provided a readily available and effective means of suicide. This has implications for public housing estates, where placing the elderly on the lower floors may reduce access to this means of suicide. Turning to the home environment, most of the deaths were shown to have occurred either at or in the vicinity of home, and most of the suicide cases studied were alone before their deaths. Family members should pay particular attention to elderly relatives who have indicated their suicidal intentions. However, they cannot watch their elderly relatives all the time; most cases studied occurred during daytime when the younger members of the family were out at work or studying. It is therefore crucial that other sources of help be available to support these family members in caring for the elderly. The summer months showed a higher than average incidence of suicide, whereas the rate for the winter months was lower. This could probably be explained by the fact that more major holidays take place in the winter months, so that the family spends more time with their elderly relatives. The additional attention paid to aged relatives may serve to reduce feelings of isolation and depression, thus deferring their suicidal feelings. Close to 70% of the cases had indicated their suicidal idea to family members or others, and many had done so more than once. Often, however, family members do not take such help-seeking behaviours seriously. Our society tends to accept that a negative emotional state among elderly persons is normal. If they complain of distress, family members will try to comfort them, but may not necessarily consider that intervention is necessary. Often, too, complaints by elderly relatives become routine or appear to be irrelevant and are ignored. Most family members (the people whom the elderly trust most and to whom they would reveal their suicidal idea) are concerned and care for their elderly relatives, but they are not trained to detect suicidal or help-seeking behavior. It is therefore important to arouse public awareness of elderly suicide and to educate family members about early warning signals and about reassuring elderly relatives of their love and care. It is also important for family members to seek external help; however, it is very difficult for family members to seek help to prevent elderly suicide in Chinese culture. They are worried that others may think that they are not fulfilling their filial obligations since it is Chinese tradition that family should take good care of its elderly members. Most of the cases studied suffered from chronic diseases; few of them, however, were totally dependent. Older persons may choose to kill themselves rather than be a burden to the family. This raises the issue of the efficacy of technological development in medical care. Advancement in medicine may keeps us alive longer, but it does not promise a higher quality of life in old age. For those among the study who committed suicide to end their prolonged suffering from chronic diseases, an extended life was not worth living. Perhaps it is time for medical professionals to re-examine their priorities in developing the science of medicine. While some might feel that suicide, and assisted suicide, among the terminally ill should be ethically and legally acceptable, most of the suicides studied did not result from a terminal illness but from social bias and professional neglect. Of the cases studied, about 40% and 27% respectively had consulted medical practitioners and psychiatrists in the months before their deaths. This is not uncommon, as not only do the elderly tend to trust physicians more than other professionals, but they also tend to conceptualize emotional distress as physical problems. There is clearly a need for medical practitioners to provide proper counselling when the elderly seek treatment, or at least to warn the families about the possibility of suicide and refer them to voluntary agencies. In Hong Kong the clinical session a physician spends with out-patients is very limited. Also, many doctors may be unfamiliar with mental health needs of the elderly, and when distress is presented in physical terms, they feel there is little they can do to help. The tendency is to discourage elderly patients from talking about their distress. The proportion of elderly suicides with psychiatric problems is relatively low compared with young age groups. Nevertheless, those elderly people who do suffer from psychiatric problems in general receive less medical care than the younger age groups. A long waiting period for psychiatric and other specialty treatments is not uncommon. More than 80% of the elderly suicides studied suffered from at least one type of chronic illness. It may be too simplistic to describe all cases as health-driven, but had better a medical service been available (in the form of shorter waiting periods and longer consultations), it would have reduced the pain and doubts caused by the illness. 5% of the cases studied lived in aged homes, about the same percentage as lived in residential settings. These persons were supposed to have been cared for and supervised 24 hours a day by someone trained in aged care. This raises the question of the quality of training given to aged home care staff. Many aged care providers in Hong Kong at present are not properly trained. Even where training is given, the focus is on the physical rather than the emotional or psycho-social needs of the elderly clients. All the cases of attempted suicide testified to a feeling of worthlessness and not wanting to be a burden on those who looked after them. They neither planned beforehand, nor made any effort to avoid discovery. All of them said they would appreciate more attention, time and general emotional support while suffering discomfort, whether physical or mental. Whilst they were unsure whether, before the attempt, they would have welcomed a voluntary worker or befriender to listen to them, they did say that if the befriender was good (sympathetic, understanding) they would welcome further befriending if they had problems and would communicate their suicidal feelings to them if asked. These findings are encouraging, as they demonstrate that befriending of the distressed elderly seems possible as well as desirable. Recommendations Intervention in aged suicide will be a complex task and should involve changes at different levels of the current aged care system. Based on the study findings, our recommendations are as follows. At policy level
Promote public awareness on the issue of aged suicide.
Strengthen family life education programmes to include aged care.
Improve medical services to meet the needs of elderly persons.
Develop community-based outreach counseling services for the elderly.
Promote an active lifestyle, particularly for the isolated elderly.
At practice and training levels:
Strengthen the assessment of suicidal risk in elderly persons.
Develop innovative intervention strategies focused on aged suicide.At training level
Enhance training of medical professionals.
Intensify counselling skills of staff working in residential settings.
Focus of training should include attitude assessment and psycho-social
needs.Conclusion Elderly suicide is an issue loaded with value judgement. It cannot be discussed from factors such as negative societal stereotypes and myths of the elderly, social isolation, inactive lifestyle and health-related stresses. Education and public awareness are vital to the prevention of elderly suicide. Campaigns to improve these should be targeted at the elderly themselves, mental health professionals, health care providers, volunteers, caregivers, family members, the media and the community at large. The elderly suicide phenomenon is a social problem that is not going to cure itself; it is a challenge to raise our collective consciousness, to develop innovative intervention programs to address the needs of our senior citizens. |
