For five decades, the numbers of elderly Americans who took their own lives went steadily down. But suddenly, in the '80s, suicides among older people increased dramatically.
Nobody really knows why.
But all agree that the increase -- 21 percent over six years -- is large enough to be significant. Even before, suicide rates for the elderly were the highest in the nation, well above those for teen-agers and young adults.
"It is quite alarming that there is such an increase in the rate of elderly suicide," said Dr. Richard Sattin, a researcher at the federal Centers for Disease Control in Atlanta and co-author of a new study on the subject.
"It is all the more unsettling because conditions appear to be improving for the elderly generally. . . . Why is this happening now? We really don't know."
Those who study suicide trends almost universally predicted back in 1980 that the elderly suicide rate would continue to drop, as services for older people and an understanding of their problems increased in society.
For every 1 million people over age 65 that year, 178 killed themselves. By 1986, the number had jumped to 215.
"This increase in elderly suicide rates flies in the face of all the theories about why they went down before," said David C. Clark, a Chicago psychiatry professor and president of the American Association of Suicidology.
"These were reasonable theories -- that Social Security and Medicare and advocacy groups for the elderly all made life easier for older people and would reduce the suicide rate -- but now they appear to be wrong," he said.
Some have suggested that the unexpected increase is a part of the same phenomenon behind the dramatic sales of the best-selling suicide manual "Final Exit": that of elderly people, in deteriorating health, choosing to die.
Researchers like Sattin, however, are skeptical, and say the information collected does not support this theory.
What Sattin and his colleagues found and reported in last month's issue of the American Journal of Public Health is that white men were most responsible for the steep increase in elderly suicides; their rate went up 23 percent from 1980 to 1986. White men account for almost three-quarters of all the elderly suicides in the nation.
Elderly black men are far less likely to kill themselves, but the rate of increase for them was even greater -- up 42 percent from 1980 to 1986.
The rate for elderly women of either race, who attempt suicide more than men but accomplish it far less, went up 17 percent.
"Men use handguns much more, and that's why their ability to commit suicide is far higher," Sattin said. In 1986, two-thirds of all elderly suicides were committed with a firearm.
Sattin and his colleagues used suicide statistics up to 1986 in their just-released study because they believe more recent statistics are incomplete -- suicides initially are often reported as accidents. Figures from the National Center for Health Statistics show suicide among those 65 to 74 declined between 1986 and 1990, but rates rose for those over 75.
The large shifts in the elderly suicide rate have taken place over years when the national suicide rate has remained generally stable, though it has edged up recently. Researchers say that only suicide rates for the elderly and teen-agers have changed much over the last 50 years.
Although teen-age suicides generally receive the bulk of public attention, the nation's elderly have long been more likely than the young to kill themselves. For every teen-age suicide in 1970 per 100,000 people, for instance, there were three elderly suicides.
Since then the gap has narrowed, but the elderly rate still remains substantially higher.
Sattin and others have pointed to "increased social isolation" as a likely cause for the suicide-rate increase -- more older people are divorced, widowed or otherwise living alone. Divorce is a clear risk factor for elderly suicide, with the suicide rate for divorced men over 65 three times as great as for married men over 65.
Some remarkable new research into elderly suicide by the American Association of Suicidology, however, suggests that isolation itself is not the key determinant. Psychiatric disorder, says association president Clark, is the most important factor.
Using an unusual technique he calls a "psychological autopsy," Clark and his associates contact the families and friends of elderly men and women who take their lives, and question them about the mental, physical and emotional state of the person just before they died.
Their findings: Almost 80 percent of those committing suicides had symptoms of major or minor depression. Most of the rest suffered from acute alcoholism or drug dependency, usually to prescription drugs.
This was equally true for the married, divorced and widowed suicides, who were found equally likely to kill themselves.