Older men and suicide

0:00David Conn:How to Live to 100, or Die Trying, is brought to you by Genical.

0:09David Conn:A while back, I spent a few days doing what we in the media call a ride-along. Back in the day, we did it with cops reporting on crime. This time, I went with physicians working for an organization called House Calls. They do medical checks on much older people who aren't able to leave home. After visiting apartments in Toronto, I noticed a theme. A lot of these people live alone and spend 12 or 15 hours a day in a chair. If a government-paid personal support worker didn't show up to help them out of the chair and into bed, they'd stay there until the next day. In Ontario, we call this aging in place.

0:51David Conn:But in practice, it looks a lot more like aging in isolation. Obviously, this is not the life that anyone envisions. It sounds like a nightmare, really. But as a journalist, it made me wonder if, well, some older adults living in isolation might choose a way out. So I asked the Office of the Ontario Coroner for data on suicides among older people, and they sent me data for a 10-year period ending in 2022, and it exposed a detail that we don't discuss enough. Suicide among older men. According to the coroner, the suicide rate among men aged 80 and older is almost the same as men in their 50s who have the highest rates of suicide.

1:36David Conn:And the suicide rates of these much older men are almost six times higher than the women of the same age. It gives data on how they died, but not why. Those reasons are complex. There is a lot to unpack here. First, we know from researchers at Women's Age Lab that Canada is facing an epidemic of loneliness and isolation among older people, which can lead to chronic health conditions and premature death, not to mention a strain on health and social systems. Though they may seem similar, loneliness and isolation are in fact two separate conditions, and we will discuss those in just a moment during our conversation with Dr.

2:19David Conn:David Kahn, a psychiatrist from Baycrest. But first, let's talk about older men, much older men. They grew up in a time when maleness was focused mostly on what was perceived as strength and stoicism. They didn't learn to easily share their feelings and many felt it was downright unmasculine to do so. Later, their wives mostly organized social events and if the wife died first, a lot of husbands disappeared into the house. Compared to many older women, men don't get out much, nor do they have a lot of male friends. So women, who do report high levels of loneliness, will actually go out and talk to other women while many men, especially widowers, often refuse to essentially leave the living room couch.

3:09David Conn:The men I interviewed for this podcast say it is easy to spend every day inside, following a routine that might start with a coffee and end watching a hockey game. The next day is the same, even if the TV shows change. And then, over time, the curtains on their front windows close.

3:41David Conn:From the Toronto Star, this is How to Live to 100 or Die Trying. And I'm your host, Moira Welsh.

4:01David Conn:Research makes clear that the choice of suicide is not entirely related to isolation. A 2017 paper published in the Cambridge University Press said there needs to be more research focused on suicide among different ages of older people because the oldest old, as the researchers call it, 85 plus, have different risks than those in their 60s. Among the oldest, feeling like a burden, physical decline, bereavement over losses of a spouse and friends, all leads to a stark choice. The study looked at men in Australia, which is also the country where an organization called Men's Sheds was founded to help older men deal with loneliness and isolation.

4:48David Conn:Men's sheds has since spread internationally. The shed can be literal, meaning men get together and do woodwork or fix things, tasks that don't necessarily require conversation, but enable them to do things, to work, to provide for others. In Ontario, men's sheds are popular in the Ottawa region, and in Toronto, where the possibility for a literal shed is a bit trickier men meet regularly for coffee, just to chat. The first man I met was Alan Marison. He and his wife were married for decades. They didn't have kids. They had long careers in business. And after retiring, their lives revolved around each other.

5:31David Conn:It was a lovely relationship. We played a lot of golf together. We had no children. And so we just basically did everything together. and I tried to keep her out golfing as long as I could. And finally, at the end of 2015, I realized that she just couldn't go on anymore. And so I took a year off from the club and I resigned her membership and stayed home and looked after her. But unfortunately, with the Alzheimer's, she declined fairly rapidly. And it became apparent around the summer of 2016 that she needed to, she was going to need more care than what I could provide. And so we placed her in long-term care.

6:19David Conn:She never forgot who I was, even though she had Alzheimer's, right up to the very last day that I was in visiting her. She always knew who I was. He knew that one day it could come, but when she died, the loss was devastating. the day it really hit me was the day after the celebration of life i got up that morning and suddenly realized that my god she's gone and what do i do now i felt like a ship without a rudder nothing to sort of guide me along and everybody was telling me oh you got to get back into your regular routine and i thought well my regular routine is gone because she's not here and And I quickly realized that I needed help.

7:09David Conn:Alan went for bereavement counseling. It was helpful. But Alan recognized that he was growing detached, isolated. We had lots of friends, but they were all married friends. But once she was gone, of course, everybody says, oh, you know, well, we got to have lunch. Well, we'd have one lunch and that was it. And then when I went to the bereavement counselor, she asked me how many single men friends I had. And I had one. And he lived way out in Mississauga. And if we were lucky, we saw each other maybe three times a year. And that's just about when the Men's Shed at Better Living was starting. Men's Sheds was designed to help older men avoid isolation by offering programs or tasks such as woodworking that appeal to guys, something that ultimately gives a sense of purpose, of providing.

8:04David Conn:At the Seattle Conference of the Gerontological Society of America, I ran into an academic named Melanie Hines from the University of Northern Iowa. She was presenting a synopsis of her early research on men's sheds in the U.S. It found that making friends was top of the list among reasons for joining. So was learning new skills and finding purpose from teaching others new skills. The Shedders, as the Ontario organization calls its members, work with men who are reluctant to reach out for help. The man who leads Ontario's chapter, John Peters, said in the last few years, Ontario has tripled its Men Sheds groups to about 20.

8:48David Conn:Some are still new, and others are well into it. Once they come out, it's a win-win, helping others, and at the same time gaining a sense of purpose, of productivity that is vital. When I first went in, I didn't talk very much, very quiet. Gradually, I began to open up and talk a little bit more. And I really enjoyed it. We used to meet every other Thursdays of every month. Most of us are over the age of 80. There's a few a bit younger. You could tell that the men at the Don Mills coffee table once had substantial careers. They spoke with confidence, and in many ways, you can see that the golf, the retirement, it wasn't enough.

9:36David Conn:So that is why they were intrigued when a PhD named Elan D 'Anjou, a University of Toronto lecturer in education studies at the Mississauga campus, reached out with a question. Could your members come and talk about managing isolation to international students who were having a hard time being away from home? The men said yes. It turned into hours of conversation, all of which inspired a podcast created by the students, an intergenerational exchange of ideas. The next question that I have is, what financial mistakes did you make and what lessons did they teach you throughout your life? any any biggest mistake that is to rely on my on the bank and rely on financial advice from advisors right because i'm a physician and what happens when patients come to me i give them the best advice that i can and what happens i assume that the same thing applies to other people that if i go to my banker they'll give me the best the best into my best interest right They have the bank's best interest.

10:45David Conn:Realize that your banker is not your friend. That's the sad reality of it. Your banker is the main interest of the banker or anybody working in the bank or any organization is for that organization. Yeah. Right? I will give you just a practical example. This mentoring of international students, it turns into something unexpected, which is usually the case when younger and older demographics mix. It can offer rich connections, benefiting both sides. I found it quite exhilarating talking to young people, because thinking back, most of my talking now is with older people and old guys. And it was great to be able to sit and talk with some young people.

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12:03PhD candidate at B.C.'s Simon Fraser University:Always read and follow the label. Genical makes me feel so good.

12:18David Conn:When we spoke last fall, Erin O'Day was a PhD candidate at Simon Fraser University in British Columbia. and by now, she no doubt has her doctorate, focused on research into activities that benefit the lives of older people, based on a concept called generativity. The definition of generativity is the concern in establishing and guiding the next generation. That's kind of the basic definition. And it first emerged as part of one of many life stages of human development by psychologist Eric Erickson. So when it was first conceived, it was thought to be the main kind of crisis to be resolved in middle adulthood, somewhere like age 45 to 60, where adults at this age had to grapple with, am I going to be generative or am I going to remain stagnant, more self-interested?

13:11David Conn:And the main question here was, can I make my life count once we've accumulated more wisdom and experience and may have a better idea of how we want to leave the world behind and help others? The sort of primary activity when it was first proposed was parenthood. It's now understood as more of a process and impulse that can occur at many stages in the life course, but primarily in later life. It's now applied to more activities like caregiving, producing art, volunteering, teaching, mentoring, any kind of activity that's associated with maintenance of the world. Erin's research into volunteering found that late-life generativity among men is influenced by factors from earlier years, such as adversity, resilience, family, and culture.

14:06David Conn:This concept of giving back, the value of generativity for individuals offering and receiving, makes so much sense. But in many ways, society ignores the value of older people. Instead, it stresses the youth culture, the hustle over those it sees as less productive, which in turn makes us view older people as less valuable. Generativity, then, is a lifeline, particularly for men. Men have very unique challenges when it comes to aging. They typically have shorter life expectancies. They're more affected by things like life transitions, like widowhood, retirement. And often this is because compared to women, men have smaller social networks.

14:50David Conn:And with the social networks they do have, which tend to be smaller, they tend to be less emotionally invested and involved with those members of their social networks. So any kind of opportunity to increase one's social network, just to build those connections and potentially reduce feelings of loneliness and isolation as a result can be really beneficial to older men. So things that can get them out of their homes, feeling productive, especially in retirement and experiences of widowhood and things like that. And the feeling that they're able to contribute to others and broader society can be really beneficial.

15:31David Conn:Not all, but many men like a good task. Maybe not if their spouse assigns it, but they like to feel useful. We all do, of course, but men seem primed to be providers, fixing things, making stuff work. This expression of the practical is often what feeds their emotional needs. I mean, when we talk about caregiving and generativity, it's known that men typically want to provide more instrumental forms of care. So things where they're really like taking on a task. So as opposed to kind of like social emotional support, they're doing things like helping with finances or, you know, helping make accommodations to one's home or driving, things like that.

16:15David Conn:And I think generativity or any kind of generative activity, whether it's volunteering or just helping, you know, they provide the opportunity for older men to do these things, to share their skills with others, to encourage creativity, to increase social connections, build positive relationships with others, all of which, again, are working towards increasing their social network. But also, again, I think, like you said, kind of satisfying this need or desire to provide and be useful and work, really. Sometimes people want to be helpful but don't always know where or how to begin. Here's Erin sharing some of her research findings.

16:57David Conn:With volunteering in general, something I've learned is it can be hard for people to know that there's a volunteering opportunity out there that they can contribute to. they need to be asked. I've, for example, interviewed several older people who work with causes within the Jewish community in Vancouver through the Jewish Community Center, and oftentimes their volunteer roles began because they were attending this community center just as, you know, participants doing exercise, things like that. And, you know, the people that ran volunteer initiatives there saw who they were and their potential and asked them if they would be interested.

17:37David Conn:And I don't think without that reaching out, they maybe would have been inclined to start on their own. Really, the impetus for people to start volunteering is being asked. The men I've interviewed have spoke about the ways in which their volunteer roles have given them the opportunity to get out of the house, keep busy, give their lives meaning. I had a man who I interviewed in my research who ran a weekly card game for older adult participants at a local community center. And it attracted many older men who spent a lot of their time alone at home. And it helped create ties, you know, in one instance, provided the kind of support needed when one of the men didn't show up to the meeting and he became very concerned and was actually able to locate him and determine that he needed medical attention.

18:24David Conn:Something like that would not have happened if this volunteer initiative wasn't in place and this two-way relationship wasn't created. We'll be right back. Hi, it's the makers of Genicol. Your knee's called again. They're suffering. Please give them a relief with Genicol Anti-Inflammatory. It contains aminolacollagen, biopurine, and turmeric, which is traditionally used in herbal medicine as an anti-inflammatory to help relieve joint pain. You'll find Genicol Anti-Inflammatory in pharmacies and online. And a coupon is waiting for you at Genicol.ca. Give it a try. This product may not be right for you.

19:00David Conn:Always read and follow the label.

19:01PhD candidate at B.C.'s Simon Fraser University:Jennifer Kohn makes me feel so good.

19:15Dr.

19:16David Conn:David Kohn is a geriatric psychiatrist at Baycrest with academic interests in late-life mood disorders and nursing home psychiatry. With his leadership, the first-of-their-kind clinical guidelines surrounding social isolation and loneliness in older adults were developed and released by the Canadian Coalition for Seniors Mental Health. Let's begin with his explanation on the difference between isolation and loneliness.

19:44PhD candidate at B.C.'s Simon Fraser University:So social isolation and loneliness are certainly a critical part of it, but there are other aspects we must talk about in relation to men and the much higher rate of death by suicide among men. But in terms of social isolation versus loneliness, we tend to talk about them as though they're the same thing. And as you say, they're not the same thing. So social isolation is objective. So it's a measurable deficiency in the number of contacts or connections that you have with other people. It could be friends, family, the community as a whole. And you can actually measure it. You know, you could say, I have three contacts a week or less or more.

20:29PhD candidate at B.C.'s Simon Fraser University:So that's very measurable. Whereas loneliness is actually subjective. And it's very much a personal feeling. It's not a good feeling. It's a very, very unpleasant feeling that people have. And it's associated with social isolation. So if you're socially isolated, you're more likely to be lonely. But the two don't always go together. So for example, some people who have very few social contacts will actually tell you they're not lonely. They'll tell you that, you know, I've never really needed an awful lot of social contact. It's okay with me. I just don't need that much. and other people who might say, yeah, I actually see people a lot, but I'm still very lonely.

21:11PhD candidate at B.C.'s Simon Fraser University:And maybe that's a lifelong feeling. Maybe it's something to do with how they view themselves in relation to other people. Maybe they're socially anxious, perhaps. But regardless, the two things are very different. And I think that's important for us as health and social service providers, because if you don't actually ask someone if they're feeling lonely, you actually can't tell. You know, we kind of assume, well, if you're not getting out of the house much, you must be lonely. But in fact, it's very, very important for us to start asking people about loneliness.

21:45David Conn:Clearly, older men have a much different way of expressing their needs when they experience loneliness and isolation.

21:53PhD candidate at B.C.'s Simon Fraser University:One of the factors that seems to be really, really important is how males are socialized in relation to emotions. So in most cultures, men are kind of trained, you know, to be tough and not to show much in the way of emotions. And it can be, you know, the little guy who comes home from school and he's had an awful day and he starts crying. And his dad said, you know, come on, Joey, you've got to be a tough guy. You know, you can't cry like that. Or if he's upset about something, he'll tell his son, don't let the others see you crying. You know, that's a sign of weakness. So, you know, males are sort of trained that this is the way to be.

22:34PhD candidate at B.C.'s Simon Fraser University:And I suppose it goes back probably thousands of years that men are supposed to be these tough guys. And so they're reluctant often or not able even to show their emotions or share their emotions with others. And we do think that's an important factor because when someone goes through a difficult time in their life, as you mentioned, perhaps retirement or losing a spouse, it takes a long time to process those feelings and those emotions. And if you keep it all bottled up inside, then that can increase the likelihood of someone becoming seriously depressed. Another interesting thing is that men seem to experience depression in a different way than women.

23:12PhD candidate at B.C.'s Simon Fraser University:There's not a lot that's been written about this, but someone from Australia actually recently came up with a new rating scale. It's called the Male Depression Rating Scale. And it has a whole series of questions that are different from the usual rating scales that we use in mental health. So it includes things like, do you find yourself bottling up your emotions? Do you have trouble sharing your feelings? Have you become more irritable lately? Are you finding yourself needing to drink alcohol more often or look for drugs? Those kind of things that can often be a signal or a sign of depression.

23:51PhD candidate at B.C.'s Simon Fraser University:and they're different from the usual signs and symptoms, which are things like trouble sleeping, losing appetite, those kinds of things. And the other thing is sometimes people who don't show their emotions, they actually bring, the depression comes out in a physical way. So they have headaches or stomach aches. They don't feel well generally, but they're not in touch with their emotions. They can't really say, yes, I'm feeling terribly depressed. It's not in their vocabulary perhaps. Another thing is that, which goes along with this, is that men are less likely to reach out for help. They're less likely to tell a doctor or another health professional that they're having an emotional problem.

24:31PhD candidate at B.C.'s Simon Fraser University:And they're less likely then to be connected with, say, a mental health professional. And so untreated depression is much more likely in men than women.