Article 40: Guidelines for Suicide Prevention and Sexual Health in the Elderly

7. Suicide in the elderly

Suicide in the elderly is an extreme outcome of psychological disorder in the elderly and a comprehensive reflection of the aging problems existing in a society. It should be given sufficient attention and prevention.

The main causes of suicide in the elderly

(1) Life has lost its purpose and hope.

(2) Poverty

(3) Abuse by children

(4) Suffering from chronic illness

(5) Geriatric depression

Prevention and control of suicide among the elderly

Suicide among the elderly is effectively preventable, not only through external intervention but also through self-help through psychological adjustment.

(1) Improve the psychological environment of the elderly

To prevent serious psychological disorders in the elderly, it is necessary to meet their reasonable personal needs and enhance their willingness to live an active life.

Elderly people have a variety of needs, the most prominent of which are health and longevity, safety, and social interaction. However, many elderly people do not have these needs fully met, leading to feelings of worry, anxiety, loneliness, and isolation. Many elderly people, despite their advanced age, still have unfulfilled ambitions and wish to contribute their remaining energy to do things they find meaningful. Therefore, it is essential to strengthen the emotional support provided by children to their elderly parents, continuously enrich their spiritual lives, and encourage their active participation in social life to meet their needs for self-actualization. Furthermore, it is crucial to vigorously promote respect and care for the elderly throughout society and cultivate this as a social norm.

(2) Crisis Intervention

American scholar Colin proposed that the direct goals of crisis intervention should be: a. to alleviate current dangers, such as anxiety, confusion, and despair; b. to restore the connection between the suicidal person and their relatives and friends; c. to help the suicidal person understand what they should do; d. to help the suicidal person explore the root causes of suicide; e. to help the suicidal person establish new attitudes and behavioral patterns and master effective coping skills.

Crisis intervention for suicide among the elderly should focus on providing comfort, concrete assistance in daily life, and resolving practical difficulties. Simply making empty promises is ineffective for worldly-wise seniors.

(3) Self-rescue

Since most suicides occur while the victim is of sound mind, self-help is of paramount importance in suicide prevention.

a. Adjusting one's mindset. This includes self-deprecation, self-persuasion, not having excessively high expectations for anything, not pursuing perfection, facing reality, and being content with what one has.

b. Emotional release. For example, one can confide in relatives, neighbors, and friends about their inner distress and resentment, or hide away in a place where no one is around to have a good cry or shout, etc.

c. Emotional transfer. Specific methods include:

Distract yourself. If you can only stay at home, you should create a daily routine and try to stick to it. Physical activities such as doing laundry, grocery shopping, cooking, and taking walks outdoors can greatly help heal psychological trauma. In addition, playing cards, chess, listening to music, watching TV, or reading can also have a certain protective effect on your mind.

Help others with what you can. For example, look after their belongings, offer advice, or come up with solutions. This can make you feel valued and help you regain self-confidence.

Seek a different environment. If your physical and financial situation allows, you can take a trip (including local and out-of-town travel) to change your living environment and lifestyle, thereby relieving your depression and troubles.

8. Facing Death

Attitudes towards death among the elderly are influenced by a variety of factors, such as age, physical health, personality traits, psychological maturity, adaptability, life experiences, satisfaction with one's life, religious beliefs, social status, economic situation, and the attitudes of influential figures towards death. Based on relevant research, attitudes towards death among the elderly can be broadly categorized into five types:

(1) Fear type

(2) Liberation type

(3) Acceptance

(4) The type who are ready to die

(5) Indifferent or confused type

How should older adults approach death?

(1) View death positively.

It is not only important to recognize the inevitability of death, but more importantly, to fully understand its value. From a scientific perspective, death is the meaningful continuity that gives meaning to the cycle of life; it is necessary for humanity's existence as a whole. As Goethe said, "Death is nature's scheme to protect more life." From a religious perspective, death is a liberation, the beginning of rebirth, reincarnation, ascension to heaven and paradise, and so on. In short, regardless of one's perspective or the rationale behind viewing death, as long as this understanding helps one fully recognize and comprehend its value, it can alleviate or even eliminate, to some extent, the fear of death in daily life and the pain, sorrow, and despair before death.

(2) Make full psychological preparations for death.

Elderly people generally sense that their time is limited. At this point, they should plan their remaining time and make appropriate arrangements for their funeral. Only in this way can they completely let go of their mental burdens, live a fulfilling and meaningful life, and face death calmly.

(3) Treat illness correctly

Positive mental activity is beneficial for improving the body's immune defense capabilities, helping to heal and alleviate illness. Therefore, elderly people should learn to adapt to their patient role as soon as possible after becoming ill, focusing on treatment and recuperation, and especially actively cooperating with doctors' treatment. Of course, more and more people today believe that if they are suffering from a terminal illness or their disease is causing them unbearable pain, then choosing "euthanasia" is not necessarily a bad thing.

In addition to the three points mentioned above, for the elderly to face death correctly and calmly complete the last stage of their lives, they also need psychological qualities such as a mature personality, good adaptability, strong will, and stable emotions. Therefore, even the elderly should continuously strengthen their self-cultivation.

Sexual psychological health care

1. Male sexual psychology

The pursuit of sex education: Because male sexual development occurs later than females of the same age, the development of sexual awareness also occurs later. When the first ejaculation and the appearance of physical characteristics of both sexes occur, a series of complex and subtle psychological changes occur. Generally speaking, they lack sufficient mental preparation for these changes, and therefore find it difficult to adapt, often experiencing anxiety and unease. During this period, they are very eager to learn about sex, especially paying close attention to the gaze of the opposite sex. Unlike women, they rarely obtain sex education from parents or teachers, but mostly satisfy their need for sex education through newspapers and medical books. This is related to the tendency of adolescent males to become withdrawn.

Attraction to the opposite sex: At the onset of puberty, males' pursuit of the opposite sex is not very obvious; they may even show aversion and distance. They value friendships with their male peers. After entering the period of closer contact with the opposite sex, they develop an emotional need to be close to them. They are generally curious about women and want to understand them, both physically and psychologically. They are particularly attracted to beautiful girls, and those with outstanding academic performance often attract their attention. They want to showcase their talents in front of women to attract their attention. Especially in front of women they like, they work particularly hard, hoping to become heroes and objects of admiration in their eyes.

Sexual Desire: Because male sexual awareness develops differently from females, once a desire to approach the opposite sex arises, and interest and interaction with a specific target develops, sexual desire often emerges. Therefore, men tend to be more proactive in heterosexual relationships. Generally, the development from initial approach to romantic love is first explicitly expressed by the man. Male sexual maturity occurs later than female sexual maturity, but the development is more rapid, quickly entering a period of heightened sexual desire, characterized by increased sexual arousal and libido. The ability to rationally overcome sexual desire during adolescence is also a marker of male sexual psychological maturity. The task of parents, schools, and society is to "prepare their reasoning as soon as their sexual instincts awaken."

2. Female sexual psychology

According to a survey by sex psychology experts, most married women desire to share a sexual relationship with their husbands, but are too ashamed to talk about it. The main characteristics of women's sexual psychology are manifested in the following aspects:

(1) For women, sex life, as a part of married life, must be accompanied by good emotions. Good emotions and feelings are the prerequisite for a woman's fulfilling sex life. The husband's usual attitude and behavior towards his wife will greatly affect her reaction to sex life.

(2) Women, like men, have the same worries and anxieties about whether they can achieve orgasm during sex. Studies have shown that about 60% of married women have experienced orgasm during sex, but many women find it difficult to achieve satisfaction because they are too serious about sex.

(3) The tenderness and caresses after sexual intercourse are absolutely essential for women's sexual satisfaction. Many married women complain: "After sex, I sometimes feel very lonely. He doesn't even say a word and just falls asleep." Wives who continue to receive caresses and attention from their husbands after sex feel genuine satisfaction and happiness from their sex life.

(4) Women also need intimacy and caressing that are not for the purpose of sexual intercourse. They need to communicate their feelings and express their feelings to each other through language, caressing and affectionate gestures.

Marital sexual mental health

A harmonious and fulfilling sex life for couples depends on many factors, one of the most important being maintaining good marital psychological health. Therefore, understanding and mastering knowledge about marital psychological health and taking good care of one's sexual well-being is essential for improving the quality of marital sex life and promoting harmony and fulfillment. So, how can couples maintain good marital psychological health?

In sexual life, it is important to maintain psychological equality between husband and wife.

Due to the influence and pressure of outdated social customs and ideas, women often find themselves in a passive and negative state in their sexual lives. When a woman, especially a bride, displays unusual initiative and enthusiasm during sex, it often arouses suspicion in her husband, who may even label her as promiscuous or "fickle," subjecting her to discrimination, scorn, and punishment. Therefore, most women experience sexual repression to varying degrees. This hinders female sexual arousal and also affects male sexual pleasure to some extent, eventually leading to disharmony in marital sex lives. Couples should establish equal sexual attitudes; wives have the right to enjoy sexual pleasure, and husbands should respect their wives' sexual needs. In sexual life, both partners are equal subjects; there is no question of one dominating the other.

It is important to cultivate a good marital relationship in daily life.

A harmonious sex life begins with a strong foundation of marital affection. Generally speaking, aside from those with physical ailments, disharmonious sex lives are often directly related to factors such as marital discord, poor coordination, and low tolerance for occasional sexual incongruities. Couples with a harmonious relationship are more likely to use sexual contact techniques such as hugging, kissing, and caressing to enhance sexual arousal during intercourse. They are also more likely to openly communicate their sexual needs and feelings during intercourse, and through concerted effort, share the experience of orgasm in synchronized excitement.

Expectations for a harmonious and fulfilling sex life should not be too high.

Both theory and experience have proven that couples should not set their expectations for a harmonious sex life too high. Excessive expectations for sexual pleasure can easily lead to three negative consequences: First, it increases psychological pressure on both partners, potentially triggering sexual dysfunction, especially in men, such as erectile dysfunction and premature ejaculation. Second, even if intercourse is successful, the resulting satisfaction will be reduced. Third, unexpected problems that disrupt or hinder sexual activity can lead to intense disappointment and profound psychological distress, potentially sowing the seeds for future psychogenic sexual dysfunction. Such situations are all too common.

The point here, that we shouldn't have overly high expectations for a harmonious sex life, is not to oppose couples' desire and pursuit of such a relationship, but simply to emphasize that these expectations should be moderate. As for what constitutes a moderate expectation, that varies from person to person; there is no single standard, and each couple needs to gradually explore and understand this through their own sexual experiences.

Maintaining the right attitude when encountering difficulties or obstacles in sexual life.

It's inevitable that difficulties or obstacles will arise in marital sexual life, and the reasons for this are varied. Both partners should have the following correct understanding and attitude towards this:

Sexual intercourse is not just a matter for one spouse, but a sexual activity involving both partners. If difficulties or obstacles arise during intercourse, neither should blame or criticize the other. The less understanding and comforting the other is, the more serious the situation will become. Especially for the spouse who appears to bear little or no responsibility, their appropriate and correct attitude towards the issue will directly influence, and even determine, the success of resolving the problem.

Couples should face reality, share hardships, and jointly explore the various reasons for the problems. They should actively, patiently, and persistently seek solutions, and if necessary, seek help from sexologists and clinicians.

The environment for sexual activity should be suitable.

While sexual intercourse is legal for couples, a suitable environment is essential; otherwise, it can easily lead to sexual psychological barriers and reduce the quality of their sex life. Of course, every couple's adaptability to their sexual environment varies. However, generally speaking, couples should create a conducive environment for sex in the following ways: the room should not be too large; bedding should be clean and chosen in their favorite colors and styles; lighting should be soft, and artificial light or candlelight can be used to create a romantic atmosphere; and quiet should be maintained to avoid noise interference. In addition, paying attention to hygiene and keeping the body clean also helps improve the quality of sex life.