Older men die by suicide at steep rates. Here’s how the VA is trying to change that

Los Angeles Times 

By Emily Alpert Reyes

June 5, 2024 

It was a Friday morning and George McCune had roused himself to make the 2.4-mile trip from his Northridge home to the Veterans Affairs campus in North Hills.

The 77-year-old was greeted there that March day by the usual crew training for the Golden Age Games: There was Roger, 82, who had piled up medals in javelin, discus and shot put. Bob, who had just gotten his cochlear implant. Becky, 71, bent on defeating her “nemesis” — a guy just six days her junior — in pingpong.

McCune can be reclusive, he said. He has grappled with post-traumatic stress disorder, he said, although he was never able to get formally diagnosed. Silent meditation is more of his usual speed than socializing.

Yet McCune routinely joins his teammates in the gym and on the track. He has yet to attend the Golden Age Games, a national competition for veterans 55 and older, but trains five days a week with the Greater Los Angeles team. That Friday, he had circled the track for 46 minutes, a goal he chose for the year of his birth.

And “more than the physical stuff is the mental stuff,” he said, “of getting me to interact with people.”

This might not be what you envision as “mental health” care, let alone “suicide prevention.” But at the VA, getting older veterans such as McCune together to hit the track is part of a broader push to improve their lives — and possibly even to save them. 

Older men in the United States have been at growing risk. When suicides reached a historic high for the country in 2022, the sobering numbers were being driven up by their deaths. The starkest statistics were for men past their 75th birthdays, who were dying by suicide at more than twice the rate of men younger than 25.

The problem is “not new but it is overlooked — regularly overlooked,” said Thomas Joiner, a Florida State University psychologist who studies suicide and has written about the mental health of older men.

The grim pattern has persisted for years and is totally different from that among U.S. women, for whom suicide rates rise in middle age and then fall. Across the lifespan, men are much more likely than women to die by suicide, even though depression is much more common among women. 

In Los Angeles County, the medical examiner tallied more than 300 such deaths in five years among men 75 and older — more than six times the number among women of the same ages, according to a Times analysis of the county figures. 

Researchers have faulted a host of forces for the steeper rate of suicide as men reach their 70s and 80s. Joiner said men tend to suffer from worsening loneliness over the course of their lives in a way that differs from women, with “friendship networks falling apart over the decades.” Women seem to be better at maintaining ties after school or work stop giving them a source of peers, he said.

That isolation both whittles down the chances that someone will recognize men are in trouble before a suicide attempt, and makes it less likely that they will be quickly rescued if they attempt to end their lives, said Dr. Yeates Conwell, professor of psychiatry at the University of Rochester Medical Center. Their physical frailty as older adults also jeopardizes their chances of recovering from a suicide attempt.

Diseases and other ailments such as hearing loss can also worsen mental health as men age. And then there are the dangers of guns, which older men are more likely to own — and which make suicide attempts more deadly. In L.A. County, roughly two-thirds of suicide deaths among elderly men in recent years involved guns, far more than among older women, according to a Times analysis of county medical examiner data.

Despite the troubling pattern, “we don’t screen for suicide risk very well, and we especially don’t do it with older adults,” said Richard Frank, director of the Center on Health Policy at the Brookings Institution. Suicide risk screenings in emergency rooms are done less often with seniors, he said, with “a big drop-off after age 60.”

And for older adults, the criteria for a mental health diagnosis often miss people in need, Frank said. “They are hurting psychologically in ways that are not cleanly captured by our diagnostic approach to mental illness.” 

In general, “our understanding of how to intervene is just emerging” in the last decade and a half, said Mike Hogan, a former New York state commissioner of mental health. Many suicide prevention theories revolve around “if we can protect people against the vulnerabilities that lead to it — so-called ‘upstream’ prevention.”

“That turns out to be very hard to do,” Hogan said. Suicide prevention strategies have also focused on limiting access to “lethal means,” such as installing barriers on tall structures, but Hogan said that has also been difficult when it comes to guns. Then there are targeted efforts to ask people whether they are at risk.

An effective approach is “basically asking people if they’re having those thoughts and — if they are — to then helping them” take steps to ensure safety, Hogan said. Yet such methods are “not yet in widespread use.”

Too often, medical providers “feel very uncomfortable asking” whether people have suicidal thoughts, said Julie Goldstein Grumet, director of the Zero Suicide Instituteat the Education Development Center, which helps health systems adopt practices to prevent suicide. With older patients, physicians may think “this is just sort of a natural consequence of aging. ... It doesn’t have to be. You don’t have to feel more sad as you age.”

Among the health systems that have grappled with the crisis is the Veterans Health Administration, which falls under the VA. Suicide has been an urgent issue for the health system in light of the alarming numbers among U.S. veterans, who have lost their lives to suicide at higher rates than the broader population.

Yet that isn’t the case for the oldest male veterans, according to Veterans Affairs figures. In 2021, elderly male veterans had lower rates of suicide, as calculated by the veterans system, than the figures reported by the National Center for Health Statisticsfor men ages 75 and older. And there was a promising downturn in their suicide rate between 2020 and 2021, especially among those who had recently used the health system.

Matthew Miller, director of the VA’s national suicide prevention program, said the agency has worked to weave risk assessment for suicide into its pain, sleep and oncology clinics, mindful that older patients may be at higher risk after getting troubling news about their health, especially if a gun is in reach. It has also done media outreach to urge older veterans to securely store firearms and medications.

The VA has also placed mental health professionals in the same facilities where veterans get day-to-day care. Roughly three-fourths of older adults who die by suicide have seen a primary care physician in the year before their death, researchers have found — a much higher percentage than had received mental health care — which has led to an increased focus on routine care as a route to thwart suicide.

At the West Los Angeles VA Medical Center, Dr. Lucinda Leung said a patient might come in complaining of sleep problems. “Most of my patients don’t say, ‘I’m depressed. Please refer me to a psychiatrist,’” she said. (Older men are less likely than older women to state that they are lonely when asked directly, even in cases when indirect questions suggest similar levels of loneliness, researchers in Britain have found.)

But careful questioning might make clear that PTSD and nightmares are keeping that patient awake, Leung said. If that happens, she can walk the person down the hall to meet Dr. Suzie S. Chen, a clinical psychologist who can assess that patient the same day. 

“Many of my patients are reluctant to speak to a mental health specialist or even admit to having psychological symptoms,” Leung said. Being able to immediately connect someone to mental health care on the same site helps it become “normalized.”

Chen agreed. “We’re not scary people — and mental health treatment doesn’t have to be a scary thing.”

Then there are programs that might not look, at first glance, like mental health care. Inside her office on the Sepulveda Ambulatory Care Center campus, Paige Velasquez turned to the camera on her computer, greeted the familiar faces signing on, and guided a virtual group through a series of exercises.

“Let’s lean to the left. You should feel a nice stretch through this whole right side of your body now,” Velasquez instructed from behind her desk. “You guys feeling that today?”

As the group took a break from the exercises, she asked, “It’s Friday — anybody have plans for the weekend?”

“Yeah — to make it to Monday,” one veteran quipped.

The virtual groups meet Monday through Friday, connecting seniors who might be unable to make it to the San Fernando Valley campus for an exercise class. Velasquez, a recreation therapist, said that beyond the physical benefits, the regular meetings can ease isolation for older veterans.

Behind the computer screen or in person, recreation is a kind of “back door therapy,” Velasquez said. People think, “I’m golfing. That’s not therapy. Horseback riding — that’s not therapy. We’re just having fun.”

“You are! But fun is therapeutic.”

Hogan said the “surprising power” of such interventions is that “if people feel like they have meaning and purpose, and they’re connected to other people, it is extraordinarily less likely that they’ll die by suicide.”

When Roger Reitan retired, he found himself asking, “What am I going to do with myself?” The Granada Hills resident had served in the Navy, then worked as an accountant for more than two decades, commuting to downtown Los Angeles. Friendships seemed to wither after his accounting career ended, he said.

“I lost track of everybody,” Reitan said.

But now, “some of my best friends are right here.” The 82-year-old said he had competed for more than two decades in the Golden Age Games, proudly rattling off the many sports he had mastered.

The Los Angeles team has been preparing for the August games, which will be held this year in Salt Lake City. Nearly two dozen of its athletes are planning to attend. Ray Emmons, 76, said in March that when he first went last year — and won a bronze medal in pingpong — he was enthralled to watch blind veterans playing bocce ball.

“I just said, ‘This is for me,’” Emmons said. 

But Velasquez said that for the veterans she coaches, the Golden Age Games is not just “something to look forward to once a year. It’s every week — training, seeing your friends, and making that connection.” 

“That impacts mental health tremendously,” she said. “I’ve seen it.”

Pasqual Ramirez, 77, said in March that training with the team had helped him lose weight. He stopped relying on insulin. Beyond the physical changes, joining the group “made me realize that maybe I could live longer.”

“I used to be angry at the world,” Ramirez said. “In a way I felt let down.” 

There were times in his life when he didn’t admit to having served in Vietnam, after protests broke out over the war, he said. His wife tells him he still has nightmares, although he doesn’t remember them.

What helped ease that anger was “this,” he said, gesturing around an echoing gym where his teammates were playing pingpong. “The camaraderie with people that went through similar situations.”