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Suicide risk and hostage/barricade situations involving older persons.

The "graying of America," a popular catch phrase, describes the present and forecasts the future demographic changes in the population of the United States. For any number of reasons, Americans are living longer. The number of older adults in this country doubled from 1950 to 1980. Today, 11 percent of the U.S. population is over 60 years of age; by 2030, estimates place that number at 25 percent. (1)

Increased longevity creates unique problems, challenges, and solutions for older persons. On the downside, rates of depression, alcohol and other drug abuse, and suicide, all germinal ingredients of crisis, are high for aging Americans. Lethal crises involving older persons likely will play out in the public sphere and be encountered by law enforcement officers. A range of critical incidents that may force a lethal response by police can include hostage taking, barricade situations, suicide threats, or police-precipitated suicide ("suicide by cop"), an increasing phenomenon. (2) In all cases, the subject likely is depressed, an alcohol or other drug abuser, and under the influence of such substances upon confronting the police. As this constellation acts to impair thinking and judgment and disinhibit impulses, violence may ensue and force a police crisis negotiator response.

In a study of 1,912 incidents of hostage taking or barricades, nearly 2 percent of the subjects were 65 years of age or older. (3) Some 13 percent previously had attempted suicide one or more times, and a significant number used alcohol or other drugs. Forty-eight percent used alcohol or other drugs during the incident, with alcohol being the overwhelmingly largest number (33 percent), and 44 percent had significant histories of substance abuse. In separate studies of suicide by cop, subjects were mostly male (94 to 96 percent), intoxicated (40 to 50 percent), depressed (60 percent), armed with firearms (46 to 63 percent), and previously had attempted suicide (38 to 50 percent). (4) With such data in mind, law enforcement officers must learn how to recognize the dangers that older persons may pose to themselves and to others in their communities.

CASE STUDY

A 77-year-old male called the 911 dispatcher and asked simply, "Is it against the law to commit suicide?" Judging by his speech and expansive manner, the dispatcher surmised that he was intoxicated. She heard his question as a cry for help. Investigation determined that the caller briefly had held his wife hostage at gunpoint. The wife had slipped out of the residence and called the police from a neighbor's apartment. As special weapons and tactics (SWAT) and hostage negotiation team (HNT) units assembled at the scene, the elderly man called 911. The dispatcher made the connection between his call and his wife's. Although not trained as a negotiator, the dispatcher established an immediate and healthy rapport with the now-barricaded man. Authorities decided to allow her to continue the negotiations from the radio room. The HNT leader and mental health consultant coached her when they arrived.

In negotiations that lasted nearly 2 hours, the man wove story after story about his times as a young soldier in World War II. His stories were interesting and amusing, but ultimately morose. They all related to guns and death. He was charming and engaging, and the dispatcher genuinely liked him. In turn, he praised her for being a good listener. He avoided any more talk of suicide, but showed no inclination to surrender. When pressed about his suicide intentions, he became agitated and angry. He admitted having a gun, but first evaded answering and then denied that he was going to kill himself "now." Negotiators believed that his risk for suicide was high. He voiced his frustrations with life and of the business from which he had just retired. After ventilating his strong depressive and angry feelings, he began to focus somewhat on his immediate situation. He gave the negotiator grudging assurances for his safety, but angrily asked, "Don't you believe me?" She replied, "You know cops, they only believe what they see, not what they hear." With that, he surrendered, and the incident ended safely.

CASE ANALYSIS

Wisely, the dispatcher heard the elderly man's call as a suicidal threat and a cry for help. A charming man, he engaged the young female dispatcher with stories and reminiscences of a time in his life when he was a young man at war--virile, indestructible, exhilarated, vulnerable, and scared. His whole life lay ahead of him. The war was a singular event, the highlight of his life, the best of times, and the worst of times. His present state of declining physical and emotional health, along with his current life's offerings and satisfactions, paled by comparison. Fifty years later, in the twilight of his life, he faced a struggle--for which few, if any, guidelines exist--to make sense, gain perspective, and integrate the war and other life experiences through a "life review." He struggled to make sense of the past, to make peace with the present, and to face the uncertain and inevitable future.

Just prior to the incident, the man had transferred his business to his daughter, an attorney living in another state. He had built the business on his own after returning from the war and worked there for 50 years. On the one hand, it represented his monument to himself; it was his singular accomplishment; his source of power, status, and control; his raison d 'etre. On the other hand, the business had become a source of stress and frustration for him at a time when he increasingly was impatient, irritable, and generally less able to cope with it without feeling out of control. Turning over the business to his daughter left him feeling relieved, but, at the same time, it was another passage and another loss.

Negotiators adjudged him at high risk for suicide not only because of his obvious and overt behaviors but because of the constellation of other factors that included age, race, depression, and alcohol intoxication. He had intent, means, and a plan. Depression and alcoholism were longstanding problems for him. Alcohol, a depressant drug, had no doubt deepened his depressed mood and lowered his inhibitions, allowing him to act out his frustration and anger through his violent impulses. Drinking heavily that day and depressed about his retirement, he acted out a suicidal fantasy--to die in battle (e.g., suicide by cop)--a fabricated replay of his fabled war memories. His actions that day betrayed a marked ambivalence, the conflicted, divided, and indecisive feelings suicidal persons struggle with about choosing to live or die. That day, he ultimately chose to live.

The dispatcher instinctively let the man talk and listened with interest as he reminisced about his life experiences and ventilated his feelings. He appreciated being listened to as others, not interested or having heard his tale many times, likely had treated him dismissively. He appreciated the attention he received from the dispatcher, perhaps, partly because she was a sympathetic young woman. He felt validated; he had been heard.

EFFECTS OF AGING

The aging process includes primary aging, the irreversible changes that occur over time, and secondary aging, the changes caused by particular conditions or illnesses correlated with aging (the incidence of chronic illness increases significantly with age). Secondary aging changes are not inevitable, may be preventable, and can be reversed in some cases. (5)

For the older person, forces within the individual and society combine to form a series of learning tasks that arise at or about a certain period of life, which the individual must master to become a reasonably happy and successful human being. (6) This represents a natural evolution as learning takes place throughout the life span and continues into later years. Such developmental tasks include adjusting to decreasing strength and health, to retirement and reduced income, and to the death of a spouse; establishing an explicit affiliation with an individual's own age group; adopting and adapting social roles in a flexible way; and making satisfactory physical living arrangements. (7)

One researcher conceptualized development across the life span as eight stages, with the final one, integrity versus despair, as an attempt by older persons to bring unity and integration to their life experiences by taking stock of the personal choices and events that have shaped their lives and integrating them into a meaningful whole. (8) Many realistic reasons occur for feeling despair and pain, for fearing the future, and for facing death as certain and unknowable. (9) Some get mired in despair, bitterness, blame, and fear of death and, as a consequence, cannot accept either the past or the future. (10) Others develop a sense of pride and contentment with their past and present lives and face the future without despair.

To handle this existential task, older people become more reflective. By way of a life review, or reminiscence, individuals recall events and occurrences in their lives. Remembering the highs and lows, comparing the past with the present, and identifying accomplishments and failures allow individuals to assess their lives. They replay, reinterpret, and, finally, reintegrate memories in an attempt to make sense, gain perspective, and find meaning to their lives. (11)

Nostalgia, reminiscence, and storytelling represent elements of a necessary and healthy psychosocial process. Although helpful to older people, such reiteration may not be easy for others to listen to as the teller may have told the story many times. Also, these stories may be very personally centered, emotional, and overly detailed. Yet, it may be important to older individuals' self-worth that others acknowledge the lives they have lived.

Unfortunately, aging can become a time of crisis for those who fail to find peace at this stage in their lives. Moreover, maladaptive behaviors and disease may hinder finding that peace. With increased longevity has come increased incidence of many diseases and disorders, principal among them, depression, along with substance abuse and a higher risk of suicide.

Depression

While all elderly people experience losses, depression is not a normal part of aging anymore than it is at any age. (12) Often treated dismissively, older people's complaints may go unheard, and, as a consequence, their depression may be more difficult to detect. Symptoms may go unreported, be incorrectly attributed to the aging process, or be overshadowed by a concurrent medical condition. Research indicates that depressive symptoms occur in approximately 15 percent of elderly persons living in the community and 15 to 25 percent of those living in nursing homes. Nearly 5 million of the 32 million Americans 65 years of age or older have some form of depression. (13)

The human experience of loss and grief causes depression at any age, and aging is a time of loss. Depression in the elderly population differs from that in the young due to critical losses typically experienced after age 60. Primary losses include the death of spouses, friends, and family members; loss of employment through retirement or disability; loss of strength, mobility, and stamina; loss of lifelong home; and loss of sensory input through reduced vision and hearing. Along with the primary losses come those attendant to them. These secondary losses include the loss of social support, familiarity, security, and sentimental anchors; loss of status, income, power, purpose, and relationships; and decreased ability and independence. With these losses come an overall sense of diminished well-being, meaning, purpose, and control.

With depression, feelings of hopelessness and helplessness may develop, and, with them, thoughts of suicide may emerge. Some may turn to mood-altering drugs as a means of coping with and escaping from their despair.

Substance Abuse

The use and abuse of alcohol and other drugs generally decline in old age, although this may vary with the class of drug. While less is known about the scope of drugs of abuse other than alcohol, these substances may represent the greater problem. Alcohol, however, remains a significant factor, the third most common psychiatric dysfunction in older persons. (14)

Most alcoholics have a lengthy history of alcohol abuse from their young adulthood; however, some may not have initiated heavy drinking until middle age or later. Substance abuse may be a chronic longstanding problem or may be of the "late-onset" type, beginning after age 60. Late-onset alcohol and other substance abuse problems can represent responses to age-related stresses. (15)

Alcohol abuse is an even more serious problem for the elderly because of their vulnerability to the effects of the drug. Biological sensitivity to alcohol and most psychoactive drugs increases with age. Metabolic and brain changes can make older persons more susceptible to the effects of alcohol, including cognitive impairment, anxiety and depressed mood, decreased tolerance, and physical symptoms. In the aging population, 33 to 35 percent of suicides were facilitated by alcohol. (16)

Other drug abuse includes both the use of illegal substances and over-the-counter and prescription drugs. The potential for drug interactions creates more difficulties as older persons often take large numbers of medicines for chronic diseases associated with aging. Problems may arise from drug interactions with over-the-counter and prescription drugs, multiple prescriptions, and difficulty with correct self-administration. Concurrent use of alcohol may further compound these problems.

Suicide Risk

In the United States, the highest rates of suicide occur in the elderly population. Rates remain level until ages 65 to 69, when they rise steeply. For this age group, 25 suicides occurred per 100,000 individuals; for those 70 to 74 years of age, 30 people per 100,000 took their own lives; and for those from 75 to 84 years old, the number continued to climb until peaking for individuals 85 and older, where 65 per 100,000 committed suicide. (17) While people 65 and older accounted for 13 percent of the population in 1992, they accounted for 20 percent of all suicides. Rates rose 36 percent between 1980 and 1992 (18) and are expected to double by 2030 as the oldest members of the "baby boom" generation turn 65 in 2011. This generation already has a higher rate of depression than the World War II generation that comprises today's elderly population. (19)

Risk factors for older persons differ from those for the young. Substance-abusing, divorced or widowed, white males in assisted living or nursing care facilities have the highest risk. Among the elderly, the greater incidence of depression, social isolation, multiple losses, and physical illnesses also may contribute to the higher rate. Principal among the factors is depression. In 90 percent of elderly suicides, a psychiatric diagnosis, principally depression with co-morbid substance abuse (i.e., "dual diagnosis" (20)), was warranted. Older persons who attempt suicide are less likely to warn of their intent, seem more determined to carry out their plan, make fewer attempts for completed suicides, and commonly choose more lethal means, such as firearms. (21)

CRISIS NEGOTIATION STRATEGIES

Crisis negotiation strategies with older persons in hostage/barricade/threats-of-suicide situations should take into account those developmental life-span issues that concern and characterize older persons. Because of the significant triple threat of substance abuse, depression, and suicide in the elderly, negotiators must consider these factors in planning a negotiation strategy.

A crisis played out as a hostage/ barricade incident or suicide by cop constitutes a desperate act--an attempt at problem solving, however misdirected and unconstructive. It may be the desperate act of an otherwise adequate person struggling under the overwhelming stresses of old age or a continuation into old age of a lifelong pattern of dysfunction and bad judgment. In either case, a precipitating event likely has interacted with the person's age, ethnicity, depression, and substance abuse.

To deal with such situations, negotiators need to employ strategies designed to incorporate the effects of aging and the older individual's reactions to the aging process. First, they should encourage older people involved in hostage/barricade situations to reminiscence through active listening. (22) This can establish rapport with older persons, allowing them to ventilate pent-up emotion and to feel heard and, thereby, validated. It also enables negotiators to learn more about these individuals as their stories convey themes and underlying emotions that negotiators then can use to engage the subjects, "hooks" that they can exploit in negotiating with the older person. Recalled past events about which subjects may feel proud, from a time when they were younger, felt more adequate, and were more hopeful about the world and themselves can help negotiators find fruitful avenues to pursue while, at the same time, aid in bolstering subjects' wounded egos. Family memories, old times, athletic and academic achieveme nts, courtship and marriage, military service, career and financial security, all before the vicissitudes of aging, retirement, and loss took their toll, are some of the likely reminiscences.

Second, and similarly, recalled past events about which subjects may feel ashamed or embarrassed or over which they express deep regrets also can help negotiators find further areas to explore. This can include helping subjects see that "unfinished business" remains, such as reestablishing lost or estranged connections with others, making amends, finding meaning and purpose in their remaining lives, or anything that denotes a mission unfinished. Helping subjects picture themselves enacting their mission projects them into the future and on the other side of their present feelings and circumstances (i.e., tomorrow is a better day).

Finally, getting subjects to verbalize aloud their thoughts and feelings about death helps them feel validated and less frightened; paradoxically, they may value living more. Along with this, negotiators should point out to subjects that intoxication and depression color their world view and distort their judgment, just as they produce the effects and symptoms associated with each condition. Therefore, subjects should not make critical decisions while in that state. (23)

CONCLUSION

All too often, the popular caricature of older persons, which younger generations widely accept, describes them as forgetful, if benign, fools who live in the past and retell the same stories over and over again to the consternation of everyone. In fact, this reiteration represents a universal medium through which older persons examine their lives out loud. The need for existential self-examination and validation by others drives them to review their lives to find meaning, unity, and integration as they contemplate their nonexistence. They catalog successes and failures, weigh regrets and resentments, recall lost loves, and attempt to tie down loose ends.

Problems arise, however, when older persons, facing the numerous challenges and losses associated with aging, become depressed, abuse alcohol and other drugs, and contemplate suicide. Such actions can result in critical incidents that will require law enforcement intervention. Dealing with older persons in hostage or barricade situations who see no alternative to their pain and loneliness other than by killing themselves or prompting a suicide-by-cop incident represents a truly difficult task for officers and even for highly skilled negotiators. However, by understanding the effects of aging, actively listening to older persons describe their pasts, and employing strategies specific to negotiating with the older person, officers can bring a crisis to a successful and safe conclusion.

RELATED ARTICLE: Internet Resources

Centers for Disease Control and Prevention National Center for Injury Prevention and Control http://www.cdc.gov/ncipc

Health Resources and Services Administration http://www.hrsa.gov

National Institute of Mental Health (NIMH) Suicide Research Consortium http://www.nimh.nih.gov/research/suicide.htm

Substance Abuse and Mental Health Services Administration http://www.samhsa.gov

Office of the Assistant Secretary for Health/Surgeon General http://www.surgeongeneral.gov

Source: The Surgeon General's Call to Action to Prevent Suicide, 1999: At a Glance, Suicide Among the Elderly; http:www.surgeongeneral.gov/library/calltoaction/fact2.htm; accessed May 9, 2002.

Endnotes

(1.) National Clearinghouse for Alcohol and Drug Information, Older Adults; retieved on May 13, 2002, from http://www.health.orggovpubs/phd827/o1der.htm.

(2.) L.C. Pyers, Suicide by Cop: Results of Current Empirical Studies, 2001; retrieved on May 9, 2002, from http://www.pyers.com/cable/sbcstudy.htm.

(3.) U.S. Department of Justice, Federal Bureau of Investigation, Crisis Negotiation Unit, HOBAS: Statistical Report of Incidents (Washington, DC, 1999).

(4.) Supra note 2.

(5.) Kathleen S. Berger, The Developing Person Through the Life Span 4th ed. (New York, NY: Worth, 1998). This author also reveals that aging is an interaction of many genes with each other and with external forces, such as lifestyle. Aging affects appearance, sense organs, and other body systems. Psychological changes include changes in information processing, memory, knowledge base, and control processes.

(6.) Robert J. Havinghurst, Developmental Tasks and Education 3rd ed. (New York, NY: David McKay, 1972).

(7.) Ibid.

(8.) Erik H. Erikson, Identity, Youth, and Crisis (New York, NY: Norton, 1968); and Erik H. Erikson, J.M. Erikson, and H.Q. Kivnick, Vital Involvement in Old Age (New York, NY: Norton, 1986).

(9.) Ibid.; and supra note 5.

(10.) Supra note 5.

(11.) Supra note 5.

(12.) The Surgeon General's Call to Action to Prevent Suicide 1999: At a Glance, Suicide Among the Elderly; retrieved on May 9, 2002, from http://www.surgeongeneral.gov/library/calltoaction/fact2.htm.

(13.) Ibid.; and U.S. Department of Health and Human Services, National Institutes of Health, Diagnosis and Treatment of Depression in Late Life, Consensus Development Conference Statement, November 4-6, 1991; retrieved on May 13, 2002, from http://consensus.nih.gov/cons/O86/O86_statement.htm.

(14.) Ricky L. George, Counseling the Chemically Dependent: Theory and Practice (Englewood, NJ: Prentice-Hall, 1990).

(15.) Ibid.; and "Elderly Suicide Statistics," Salt Lake Tribune, June 12, 1996; retrieved on March 26, 2001 from http://www.fe.psuzedu/exs~194/Stats.htm.

(16.) J. Lucinda Aguilar, Recognition of the Rising Rate of Suicide in Our Aging Population; retrieved on March 26, 2001, from http://www.nmsu.edu/~socwork/papermlucindaaguilar.htm.

(17.) National Institute of Mental Health, U.S. Suicide Rates by Age, Gender, and Racial Group, 1999; retrieved on May 9, 2002, from http://www.nimh.nih.gov/research/suichart.htm.

(18.) "Suicide by Elderly Men on Rise," Psychiatric News, January 1, 1999; retrieved on May 9, 2002, from http://www.psych.org/pnews/99-01-01/men.html.

(19.) Supra note 15 ("Elderly Suicide Statistics").

(20.) Supra note 18.

(21.) Supra note 18.

(22.) For additional information, see Arthur A. Slatkin, "Enhancing Negotiator Training: Therapeutic Communication," FBI Law Enforcement Bulletin, May 1996, 1-6.

(23.) For additional information, see Arthur A. Slatkin, "Negotiating Skills: Dealing with an Alcohol-Impaired Hostage Taker or Barricaded Subject," Law and Order, April 2000, 123-126.

Dr. Slatkin, a psychologist with the Kentucky Department of Corrections, Division of Mental Health, serves as a mental health consultant to the Louisville, Kentucky Division of Police hostage negotiation team.
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Title Annotation:Related article: Internet resources; police negotiation strategies for dealing with elderly people in crisis situations
Author:Slatkin, Arthur A.
Publication:The FBI Law Enforcement Bulletin
Geographic Code:1USA
Date:Apr 1, 2003
Words:3747
Previous Article:Law enforcement. (Bulletin Reports).
Next Article:Officer Thomas Cullen of the Johnstown, Pennsylvania, Police Department. (The Bulletin Notes).
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