Illness, isolation: AIIMS expert explains why older adults face suicide risk

The latest National Crime Records Bureau (NCRB) data shows how senior citizen suicides have grown faster than other demographics, with India recording 1,70,746 suicides in 2024. For those aged 60 and above, illness, isolation, loss of autonomy, bereavement, and the erosion of professional identity can intersect and trigger self-harming tendencies. NCRB says illness accounted for 18% of suicides in 2024, second only to family problems. Globally, the World Health Organization estimates that people aged 70 and above account for 16.6% of suicide deaths.

“All of us need transition guidance. As we age, perhaps the hardest transition is not retirement itself, but confronting the gradual loss of authority, status, relevance, independence, financial autonomy and physical strength that once seemed integral to who we were. You will not get what you once had in your peak, which doesn’t last. Even the most accomplished and self-assured can become insecure when the roles that gave them status begin to recede, or when a body that once obeyed without question begins to impose limits. Most people interpret acceptance as defeat, not a milestone for self-development,” says Dr Mamta Sood, professor of psychiatry at the All-India Institute of Medical Sciences (AIIMS), Delhi.

It means taking pride in what has been achieved, preparing early for physical frailty and greater dependence, and deliberately building new sources of purpose, activity, relationships, and meaning. “The lens needs to shift. Ageing is a transition to another chapter of life rather than a confrontation with irrelevance,” she tells The Indian Express.

What can turn apparently manageable problems into a psychological crisis?

There are many triggers. These include losses in physical and cognitive functioning, reduced autonomy, loneliness and social isolation, depression, chronic illnesses, multiple medications, loss of friends or a spouse, perceived burdensomeness, poor social or financial support, poor interpersonal relationships, loss of meaningful occupation or professional identity.

Diabetes can increase the risk of dementia and depression. High blood sugar over a long time can cause inflammation, stress, and damage to blood vessels, which can reduce blood flow to the brain and affect memory and thinking. Diabetes can also affect brain chemicals that control mood, while the stress of living with a long-term illness can increase the risk of depression.

Is there a “tipping point” when the person begins to see problems as impossible to escape?

A single or multiple risk factors can produce emotional distress — depression, anxiety, fear or agitation — which can lead to hopelessness and then suicidal thoughts or an attempt. The tipping point may show up behaviourally: making a will, becoming secretive, withdrawing or detaching, saying things such as “I should die”, or stopping eating. Even psychiatrists may not always pick these signals up immediately because subjective distress and functional impairment can be expressed through behaviour rather than a clear verbal disclosure.

Watch out for persistent sadness or anxiety; agitation or irritability; mood swings; changes in sleep; neglect of personal care or food; disruption of routine; loss of interest in enjoyable activities; social withdrawal; increased substance use.

How important are physical illnesses such as diabetes, hypertension, cancer and persistent pain?

Physical disease is common in old age, and depression — a major suicide risk factor — is two to three times more common in people with chronic physical illness. Depression rates are roughly 15-35% in diabetes, 20-40% in cancer, 20-30% in hypertension, and 30-35% after stroke.

Older patients also take multiple medications, some of which can have psychiatric side effects. Yet depression and anxiety are frequently missed because symptoms are attributed to ageing or physical illness. Chronic illness can restrict mobility, independence and daily functioning; physical and psychological burdens can reinforce each other.

Why can someone who appears composed, accomplished, and reassuring to family still be in serious distress?

Psychiatric illness is not visible in the way a broken wrist is. Someone with mild or moderate psychiatric problems can appear “alright” during brief interactions. But sustained contact may reveal changes in personal, social and daily functioning — persistent crying, irritability, withdrawal, or unusual behaviour. This is particularly relevant to high-achieving older adults. Professional identity provides status, structure, friendships and usefulness. Retirement can remove much of that architecture, while physical decline can add dependence.

What can be done before a crisis becomes acute?

Intervention has to operate at several levels. Physical disease and chronic pain need proper management; depression and cognitive decline need to be detected rather than normalised as ageing.

For families, prevention is less dramatic but more continuous: maintain a structured routine; encourage daily activity such as walking, stretching, light yoga or breathing exercises suited to physical ability; preserve pleasurable activities; and build regular social contact. Family and friends should periodically ask how an older person is doing physically, mentally, and socially. Community groups can restore connection.

But retirement itself should be planned, not endured. Put your eggs in many baskets, learn to take a back seat from your current profile and nurture your other passions. For example, I know I have a couple of years left, so I have decided to write books, do some public-speaking at forums, (and) develop a new skill beyond my current job. Cultivate new interests, even friendships. Join peer hobby groups and build social connectedness with new companionships that are beyond familial judgment. The point is to ensure that one role does not carry the entire weight of your identity.