SF Gate        http://www.sfgate.com/        Return to regular view
SAN FRANCISCO
Hot line a matter of life or death for the elderly
Focus on seniors makes crisis service only one of its kind
- Carolyn Said, Chronicle Staff Writer
Tuesday, June 21, 2005

Click to View

Kevin, a San Francisco man who suffers from severe depression, has a slender lifeline that brings him some solace. Every evening, he receives a call from the Friendship Line, a crisis and support line for seniors.

"I talk to Friendship Line each day about my frustrations and my argument with God," said Kevin, who asked not to use his last name and gave his age only as "senior citizen." The calls were particularly important to Kevin during the past year, which was filled with anguish, as his son died of a heroin overdose and a neuromuscular virus partly paralyzed his right arm.

"It's a consolation to me to share some of the stress and the anger and the frustration, all these toxic emotions, with someone so I can get clear of them," Kevin said.

Sponsored by San Francisco's Institute on Aging, the Friendship Line is unique among crisis telephone lines for its focus on seniors. It accepts incoming calls 24 hours a day and also makes regular calls to seniors who have requested the support.

Staffed by psychology graduate students and others from the community who volunteer their time, it receives about 1,500 calls a month and places about 1, 600 calls a month. Although it's intended to serve the Bay Area, the line is so rare a resource that about 30 percent of its calls come from outside the region.

"We need to encourage connections because that is what binds us to life," said Patrick Arbore, who founded the line in 1973 as a way to address the high suicide rate among seniors. He is now director of the Center for Elderly Suicide Prevention and Grief Related Services at the Institute on Aging. The center's $500,000 annual budget, which includes the Friendship Line, comes primarily from the state Department of Aging, as well as some foundation grants and an annual fund-raiser.

The calls are a way of saying, "We know you're here on the planet; you're important and we want to recognize your importance," he said. "It's hard to recognize and respond to older people who have depression. The worse thing to be in America today is old, poor, sick and alone. You really feel the impact of it."

Many of the calls are simple. Some people receive reminders to take medicine. Some people call just to say they're still here. Others need to vent.

"Friendship Line, this is Alicia," said Alicia Lawson, a doctoral candidate in psychology who was staffing the line one recent morning,

"What's going on?" She listened as the caller told her he was feeling very anxious before asking, "What would be helpful for you right now?" The caller said taking a shower or a walk often calmed him, and they agreed he would do so. "He knows how to soothe himself; I remind him he went through it before; the anxiety passes," Lawson said. "It helps him to self-regulate. The agreement is he can call one time per (four-hour) shift."

An outgoing call, focused on the senior's health.

"This is Alicia. How are you feeling? Not well? Have you checked your blood-sugar level? Have you eaten anything today? Do you want to tell me about what's going on? What are your plans for today? What is it like to talk about what's going on? That's OK -- sometimes you don't feel like talking. I hope you feel better, too. Bye-bye."

Gloria Cavanaugh, president of the American Society on Aging, a San Francisco nonprofit for professionals in the field, said the Friendship Line fills a vital need.

"Oftentimes, older adults are reluctant to acknowledge that they have any kind of mental health problems or substance-abuse problems," she said. "For them to know there are professionals who can deal with their issues is extremely helpful rather than having to approach people who primarily deal with other age groups."

It is both surprising and unfortunate that the model hasn't been replicated elsewhere, she said. "With changing demographics (as the population ages), I would hope that would change."

Older people have the highest suicide rates of any age group. There were 18 suicides for every 100,000 people age 85 and older in 2002. Among people age 65 and up, the suicide rate was 15.6 deaths per 100,000 population. By contrast, people ages 15 to 24 killed themselves at a rate of 9.9 suicides per 100,000 population.

Older people's suicide attempts lead to death much more frequently than do those of other age groups. Nationally, there are 25 attempts for every death by suicide; among the elderly there are four attempts for every suicide death. The overwhelming majority of elderly suicides stem from mental illness, often depression -- which means that they are preventable.

The reasons seniors have a higher incidence of suicide are both obvious and subtle.

Ageism makes many of them feel invisible, Arbore said. "It's very insidious. Just like it isn't easy to be black in America or be a woman in corporate America" it's hard to old in a culture so wrapped up in valuing youth.

Then there are the effects of aging itself. Older people often struggle with layers of losses: of their independence, their mobility, their senses of sight and hearing. They see death and dying among their peer groups and loved ones; their social isolation can increase as friends become ill or die.

But the medical establishment doesn't seem tuned in to the problem.

According to the National Strategy for Suicide Prevention, about three- quarters of all people over 65 who killed themselves had visited a doctor within the month before their act. A significant number of the visits were within the 24 hours before they committed suicide.

"There is a massive problem of elderly suicide that most people don't even know about," said San Francisco filmmaker Susan Stern, whose documentary about her 77-year-old father's suicide, "The Self-Made Man," will be shown on PBS next month. "Most of them are stoppable. We have a situation where primary case providers don't know how high risk these people are and aren't connecting with them."

"Doctors in their 7.5-minute clinical visits are not equipped for psychosocial" evaluations and treatments, Arbore said. Moreover, he said, many older people aren't good at communicating symptoms of psychological ailments like depression, instead focusing on physical problems.

Despite their high suicide rate, older people account for less than 2 percent of the calls to traditional crisis hot lines.

"Older people don't like to hear, 'Hello, Suicide Prevention,' so we say, 'Hello, Friendship Line,' " Arbore said.

"The population we work with is ambivalent about psychotherapy," said Tom Cicciarelli, the supervising psychologist at the Institute on Aging. "There's a generational difference. They didn't grow up with Oprah.

"Friendship Line is a way in that feels safe. Over time, some folks become comfortable with help and want psychotherapy."

Institute on Aging therapists make house calls for seniors who request in- person therapy. It has 140 patients receiving home therapy, and it also runs five counseling groups in nursing homes and assisted-living facilities. Therapy is done on a sliding-scale basis and often is covered by Medicare. For Kevin, the daily Friendship Line calls continue to be a bulwark.

"It's been a major stabilizer for me," he said. "Friendship Line has enabled me to be closer to people and feel more safe, and be discriminating about being vulnerable."

Friendship Line

You can contact the Friendship Line at (415) 752-3778 or (800) 971-0016.

The Institute on Aging offers a range of other services designed to support seniors who want to keep living at home. They include managed health care, home health care, care management, adult day care, money-management assistance, art programs, and elder abuse prevention. Senior information and advice is available by calling (415) 750-4111. The Institute on Aging is at (415) 750-4180 or http://www.ioaging.org/.

E-mail Carolyn Said at csaid@sfchronicle.com.

Page B - 1
URL: http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/06/21/BAGASDBOB41.DTL

©2005 San Francisco Chronicle