The elderly man was depressed, and with good reason.
At age 72, his wife had left him and was telling him he should stop seeing her friends and going to her church.
"A lot of how he identified himself was through her," said Errika Hill, a clinical social worker with CHI Memorial's Community Health Centers. "He had a great, great amount of depression over that, having to figure out who he was again without her.
"He was high risk for suicide," she said. "At that point, we had to pull our crisis unit in, and they admitted him to one of our geriatric units."
He was eventually referred to a psychiatrist and appears to be doing well.
"He comes back and tells me everything is OK. He had a good talk with counseling," Hill said. "Sometimes people just need to do some talk therapy, to get their feelings out."
But many others are not so fortunate.
Despite improvements in overall health care, the rate of suicide has increased 24 percent in the U.S. since 1999, according to a study released Thursday by the federal Centers for Disease Control and Prevention.
The numbers are sobering:
- Although the overall number is still small, the number of teenage girls aged 10-14 committing suicide shot up 200 percent.
- The number of women killing themselves increased by 45 percent, compared to 16 percent for men, although women are still far less likely to commit suicide than men.
- The suicide rate increased by about 1 percent each year from 1999 until 2006, but then doubled, growing by about 2 percent annually at a time roughly corresponding to the Great Recession. The biggest increase in suicide among males was in the 45- to 60-year-old age group, the one some researchers say was most affected by the economic downturn.
"The suicide rate in older adults has been an issue for a long time," said Dr. Warren Taylor, a psychiatry professor at Vanderbilt University's School of Medicine. "With the wave of Baby Boomers aging, it is becoming a significant issue."
The suicide rate itself in Tennessee has stayed relatively steady over the past 10 years, according to the Tennessee Department of Health. But as the large baby boomer generation has moved into old age, the raw number of deaths has increased, from 851 in 2005 to 945 in 2014.
What is striking is the gap between men and women, and between whites and blacks. In 2014, the last year for which statistics are available, 5.8 women out of 100,000 committed suicide, according to the CDC, but the figure for men was 20.7 out of 100,000 - more than three times higher.
Experts say that is because while women are more likely to attempt suicide, they tend to choose less lethal means of killing themselves.
"They are overdosing," said Dr. Paul Hill, a geriatric psychiatrist at the University of Tennessee Medical School. "But they won't kill themselves unless they have a sophisticated knowledge of pharmacology."
Men, on the other hand, choose methods that don't offer any opportunities for second thoughts. "Older men don't mess around," Hill said. "They will slash their wrists, hang themselves or shoot themselves."
But race also is important. Whites are three times more likely to commit suicide than blacks.
Experts say there is a strong correlation between suicides in older white males and what happened to many of them during the Great Recession. The suicide rate for middle-aged white men has risen by 40 percent since 1999, and spiked higher starting in 2006, as the housing and financial crisis began.
A study last year in the American Journal of Preventive Medicine noted 27 percent of all men in the 50-64 age group reported a decline in salary during the Recession. Psychiatrists say a decline in status, such as losing a job, is a prime motivation for suicide. But it also can be triggered by a voluntary change in status, such as retirement.
"People ask, 'What do I do with myself?' especially if they have had a busy career and haven't had time to build other interests around them," Taylor said. "Or if they had to sacrifice their family for work and now the ties are not as strong and they wake up and say, 'What do I have?'"
While suicide is treated as a mental illness, it is often prompted by very real concerns - the loss of a partner or friends, increased social isolation, and personal medical problems including a loss of mobility or mental capability.
For some, suicide can seem to be a rational solution to the problems they face, Taylor said.
"I think when we see suicide in older adults, there is a huge element of fear, especially with medical problems, that their quality of life will go down," he said. "I will lose my mind, or I will become immobile and nonfunctional."
As doctors have managed to cure many of the diseases that killed off previous generations before they reached old age, more seniors are facing the prospect of losing mental function due to dementia, which many people find unacceptable.
"If you are headed down the pathway for Alzheimer's, there is nothing I can do for you today that will change that trajectory," Taylor said. "So if people are making a conscious decision to kill themselves because of that, is that a psychiatric illness?"
The most obvious sign of possible suicide is depression. Too often that leads to a withdrawal from social contacts, which causes more depression, and even more withdrawal. "It's an insidious pain," Dr. Taylor said. "No one wakes up and has a light come on and says 'You're depressed.' It slowly sneaks into your life until a threshold is crossed, and people think this is just how life is and they forget how it used to be."
Combining depression with alcohol or drugs can be a deadly combination. Alcohol lowers inhibitions, UT's Hill said. "You might be more likely to do something on an impulse. Old folks are prone to impulse, to an impulse decision that leads to serious consequences."
Hill emphasized the need for seniors to avoid isolation. "If you find yourself alone in the world, whether you are single, widowed, or divorced, you need to be open-minded and willing to reconnect with people again," he said.
"Suicide in the elderly is just heart-breaking for the family and survivors," Hill said. "It adds a sad note to the very end of their life."
Contact staff writer Steve Johnson, sjohnson@timesfreepress.com, 423-757-6673, on Twitter @stevejohnsonTFP, or on Facebook, at www.facebook.com/noogahealth.