Oregon ranks near top in suicides among elderly.

Byline: THE HEALTH FILES By Tim Christie The Register-Guard

Much ink has been spilled over the suicide last month of gonzo journalist Hunter Thompson. At age 67, in the kitchen of his Colorado compound, he stuck a .45-caliber gun in his mouth and pulled the trigger.

Those who knew the hard-living, gun-loving Thompson, including his family, have said his violent, self-inflicted death came as no surprise, nor was it the result of chronic pain or depression.

"This is a triumph of his, not a desperate, tragic failure," his wife, Anita Thompson, told the Rocky Mountain News.

While Thompson was a true American iconoclast, his means of death exemplifies what public health and mental health officials say is a troubling, preventable trend in Oregon and across the country: Elder suicide.

The elderly - particularly older white men - have the highest suicide rates of any age group, by far. And Oregon has some of the highest elder suicide rates in the country.

Between 1999 and 2002, the rate of suicide among Oregonians 65 and older was 24 per 100,000 population, ranking sixth in the nation and 56 percent higher than the national average of 15.4 per 100,000.

In 2003, the suicide rate among Oregon men 65 and older was 38 per 100,000. By age 85, the rate jumped to 109 per 100,000.

Dr. Cliff Singer, a geriatric psychiatrist at Oregon Health & Science University, said it's not clear why older white men are more likely to succumb to suicide.

But the chronic illnesses that come with age often impair their ability to function in life, and that can lead to depression, he said.

"They become demoralized because they can't be as active and independent as they'd like to be," he said. "Demoralization can lead to depression and depression is a major risk factor for suicide."

Disability may hit older white males harder than other demographics, he said.

"This is a group that is more used to feeling like they had leadership roles in society and within their families," he said. "Now they feel emasculated and highly shamed by their physical frailty and functional decline. They cope with it less well than others."

Most of these men who kill themselves had recently visited a physician, Singer said.

"That tells you they are asking questions about their health and their prognosis," he said. "When they're told they have a chronic disabling condition for which perhaps only palliative care is available, they decide to end it."

Older white men are also more likely to succeed at suicide, Singer said. One of four attempts result in death, compared with one in 20 attempts among the general population.

"They tend to be nonambivalent and choose highly lethal means," he said.

Guns, in particular, are the means of choice. Among elderly Oregonians, guns are used in 80 percent of suicide deaths, according to state statistics.

State public health officials are developing a plan to prevent elder suicides, said Lisa Millet, who manages the injury and violence prevention program for the Department of Human Services.

Doctors, she said, should screen their patients for depression, and not view depression as a normal reaction to declining health and diminishing independence.

One strategy is training lay persons in intervention skills, just as many people get CPR training, Millet said. To date, nearly 3,000 Oregonians have been taught how to intervene when a friend or family member is facing a mental or emotional crisis.

Singer said it's important for doctors and family members to get seniors to talk about their feelings of hopelessness or demoralization. Talking about it can lead to treatments, such as better pain control or antidepressants.

"Just the psychological relief of the unburdening that comes through talking about a person's hopelessness, that sometimes relieves tension and buys time," he said.

At PeaceHealth Medical Group's Senior Health and Wellness Center, doctors routinely screen new patients for depression, said Sandy Sanders, a licensed clinical social worker.

Sanders counsels seniors who are feeling depressed, anxious or struggling to adjust to a major life change, such as the death of a spouse or the inability to live independently.

"It's pretty much all about loss," she said.

Singer said he sees no connection between Oregon's high elder suicide rates and the fact that it's the only state that permits doctor-assisted suicide.

"I think they're independent aspects of the same social psychology of Oregon," he said. "We are a state of independent-minded people who want to control their own destiny."

The fact that Oregon is a very secular state - our churchgoing rates are among the lowest in the country - may play a role in higher suicide rates, he said.

"Religious beliefs and spiritual practices ... have some measure of reducing suicide risk," he said.

As for Thompson, a notorious hell-raiser with a prodigious appetite for drugs and alcohol, family members insist that his suicide was the result of his desire to go out on his terms - not because of depression or chronic pain resulting from a hip replacement, broken leg and back surgery.

"Hunter did not do this in a moment of fear, desperation or despair," his son, Juan Thompson, told the Rocky Mountain News.

"I don't know why he chose this moment. But he was quite clear about what he was doing and he was going to go out on his own terms on his own time."

Tim Christie can be reached at 338-2572 or [e-mail].