Virtually anyone has experienced the trance of accompanying someone to the ER, sitting in the waiting room and, suddenly, hearing the phrase: “Family of…”. A shotgun comes to see what has happened and how our relative is. What happens here is more shocking: the doctor asks about someone's family and no one answers, because no one has accompanied him.. This is the reality denounced by social workers and psychologists in our country: the percentage of people living alone has increased worryingly in the last 30 years. And loneliness, along with other circumstances typical of the elderly, such as chronic illness, dementia, depression, and the weariness of living, produce an explosive cocktail that sometimes ends in suicide.. The longest-lived people in our country are the group that commits suicide the most in Spain. In 2021, “999 suicides were registered in people over 70 years of age, one in four”, of which “519 were over 80 years of age”, according to data from the Spanish Foundation for Suicide Prevention (FSME).

It is not strange either to find a death by suicide in someone over 100 years of age. A scenario in which isolation and comorbidity prevail, and which is difficult to understand if one does not take into account that the causes are usually “silent”, that the elderly “have difficulties expressing themselves, and divide the world into what to do and what not to do, regardless of the emotion they feel”. This is how Enrique Galindo, psychologist and author of Stop suffering or stop living together with Francisco José Celada Cajal (Oberon Libros) explains it: “There is a progressive increase, the older, the more suicide. And detecting the risk is complex. Added to loneliness are own stressors, sensory losses, difficult living conditions, but vulnerability, hopelessness, lack of self-esteem, the feeling of uselessness prevail…”.

“The rates of the oldest can be 100 times higher”, confirm from the Spanish Federation for Suicide Prevention: “From 0.2 deaths per 100,000 inhabitants in those under 15 years of age to almost 20 in those over 79 years. This is so because there is also a very significant difference in the relationship between suicide attempts and deaths. If, in general, one death is usually registered for every 20 attempts, in the youngest this relationship can be 200 to 1, while in the very old it is estimated that there are 3-4 attempts for each suicide. The causes of this are that the attempts in the elderly are more planned, with less rescuability, more silent and with a more lethal method”, explains Andoni Ansean, president of the federation.

In addition, there is the weariness of living, which has been gaining importance in psychological research.. This same week, a report prepared by Dutch specialists -geriatricians, psychologists, social workers- published an exhaustive report on the state of the art, and their approaches are especially noteworthy given that the Netherlands is one of the most advanced countries in the study of how to reduce the exhaustion of existing, personal abandonment and, as Laura Ponce de León, professor of Social Work at UNED and researcher at the Cemtro de Investigaciones Sociológicas (CIS) specializing in older adults, says, “the fact that there are people who, in the absence of meaningful relationships, he lets go.

The Dutch report shows that even in the elderly who do not have serious illnesses, the fatigue of living is palpable, “and that the keys are loneliness, chronic pain, difficulties in expressing oneself, existential exhaustion and the fear of becoming a completely dependent being. In this sense, it is clarifying to look at the analysis of the type of families in Spain, where only one person lives in three out of four households. One-person houses that were 10.8% in 1990 and, according to data from 2019, more than 25%.

Ponce de León knows this because his most recent publication is about it: “The profile is that of a widow or single woman, over 65 years of age. How do we compensate for the experience of aging? With support from social services, yes, home help and telecare, but the most important thing is the blood family if they have one, relatives or people in a similar situation.. The family makes water in Spain. I know of cases of neighbors who denounce the suicide attempts of a person who lives alone on their doorstep and who has no one, absolutely no one.. Because in their situation, feeling that if they needed it, someone could help them is essential, that they accompany them to a medical test, that they visit them in the hospital…. In short, having a quality of life that protects against suicide attempts.”

That “having someone” is truly crucial, and the pandemic has increased a situation that already existed. According to data from the National Institute of Statistics (INE), in Spain 4,003 people have died by suicide in 2021. These are data collected by the Complutense University of Madrid, specifically by the Mental Health Network Biomedical Research Center (CIBERSAM), in collaboration with the Hospital del Mar in Barcelona, which analyzed the time frame 2000-2021. Alejandro de la Torre, one of its researchers, then stated the “growing trend in mortality from suicide since 2018”, crystallized in 2021 with an annual growth of 6%.. And it was also noted that “the rate was higher in people close to 64 years of age”. And 31% of those who died by suicide in 2021 were over 65 years of age.

The crossroads of mental health

In this sense, in addition to loneliness as a great factor, the psycho-emotional and mental health of the elderly is key. And also the combination of this with deterioration of aging such as the beginnings of dementia or neurological disorders such as Alzheimer's. Ponce de León says that this is where one should influence, and explains the cycle of growing older: loneliness, dependency (physical and mental deterioration), need for personal contact (physical and mental). “Not forgetting dementias, often linked to depression.”

From the FSME, in addition, they convey concern about the possible consequences derived from the new euthanasia law. “We still don't know how it can influence the deaths of the very old or their suicides.. It could happen that the existence of this assisted death increases the premature deaths of the elderly: How many deaths by euthanasia could have been deaths by suicide in the absence of this law? But the opposite effect can also occur: could suicides decrease knowing that the right to euthanasia can be exercised? In all cases, from the Spanish Foundation for the Prevention of Suicide we have to remember that, like suicides, euthanasias are also preventable. Or, put another way: do we do everything possible to prevent deaths by suicide (or euthanasia) before they occur or do we assume that death is the only solution to the problems that person suffers?

There is also no specific plan on national suicide, although the psychologist Enrique Galindo points out that “almost all the autonomous communities have prevention plans and strategies”. “In all of them there are lines of action for elderly and frail people, and even local programs, support, volunteers, pets, orchard rental…. Mental health unit centers, supervised housing and others managed by associations, which are gaining more prominence every day given their closeness to individuals”.

But specialists insist that more than social networks and telehelp, the issue should be tackled from the fight against loneliness, taking into account that “everyone needs physical contact”. And “teach the population to eliminate the myths or false beliefs about suicide,” Galindo proposes, “as if whoever says it doesn't do it, they only do it to attract attention, only crazy people commit suicide or if they talk about it subject is encouraged to do so. Talking is the first step. You have to keep in mind that talking saves lives and silence kills.”

Galindo, who believes that we can all contribute to the fight against suicide because it is ultimately simple and pure help to others, thinks that “nobody wants to die but to stop suffering”. And that in our elders it is a problem that they have difficulties to express what they feel and, above all, “to find meaning in life at that stage, in which one falls more into despair.”

“They are older, but they are not stupid or crazy. We must activate programs that aim to alleviate loneliness, with friendship groups, outings, visits with other voluntary elderly people, clubs, associations, studies at their level…”. And, from health professionals, to internalize that the elderly, when they go to see them, “tell what is expected of them, that they express pain or physical symptoms, while they are ignored if they speak of sadness, anxiety, fear of death or wishes to die, treating them in those cases with antidepressants or anxiolytics”.

And he concludes: “The alarm signals that indicate a high risk of suicide escape us: making a will is normal, saying goodbye to loved ones is normal, talking about death is normal, hoarding medicines is normal; that often walk to the railway, in a population with several suicides for this reason, perhaps it is not so normal and you have to listen to them, even what they do not say. Not everything is solved by medicalizing emotions, but by listening and promoting leisure activities and a sense of life”.

April 14, 2003 is an important date in the history of science.. That day a little over 20 years ago the end of the Human Genome Project was announced: the essential sequence of our DNA had been deciphered after many years of effort.

However, this 'map', which cost 3,000 million dollars and which began to be used as a reference of the human genome, was not complete.. It had gaps in several genetic regions and was based primarily on the DNA of a few individuals of European origin.. And although in these two decades there have been technological advances that have allowed these gaps to be 'mapped' – the complete sequence was obtained in 2022 – and to make the process cheaper, a more global and diverse reference was still missing.

From now on, thanks to an international consortium funded by the US National Human Genome Research Institute, this resource – a reference pangenome – will be available.

The new 'map', which is presented as a first draft, includes the complete genetic sequence of 47 individuals of different origins, which provides detailed information on 94 genomes because each individual carries two copies of 'inherited' genes in their DNA. of his father and mother. The objective of the project is to continue adding data to the 'map', which is why it is expected that by mid-2024 it will include genetic information from 350 people of diverse ethnic ancestry.

“Until now, the reference used by the scientific community was incomplete and lacked diversity,” Benedict Paten, associate director of the University of California's Santa Cruz Genomics Institute and one of the project leaders, told a news conference.. This new resource, on the other hand, provides a more complete image and will allow for more accurate analyzes when characterizing the genetic variability of the human population, whatever its origin, he highlighted.

In fact, the new pangenome has already brought to light more than 100 million new bases -each one of the letters that make up the genome-, and has uncovered new alleles in structurally complex regions of the genome that until now were not included in the genome. reference. Details of the research are published in four articles in the latest issue of the journals Nature and Nature Biotechnology.

Using state-of-the-art computational techniques, the researchers have been able to build a resource that, instead of being unique and linear, as was the GRCh38 reference used up to now, provides different versions of the same sequence at the same time, which provides researchers with a greater range of options for their analyzes. A team from the Barcelona Supercomputing Center (BSC) led by Santiago Marco-Sola has participated in the project.

What does the new pangenome mean for research?

“Until now we have been content with a single genome sequence that was once arbitrarily decided to be the reference sequence, made up of bits of sequence from a handful of people of mainly European descent.. And while this has been very useful, it also has many limitations,” says Jorge Ferrer, a researcher at the Barcelona Center for Genomic Regulation (CRG).. “For example, surprising as it may seem, each of us may be missing or left over with a few very large chunks of the genome.. If the piece of genome chosen to be the reference is from someone who does not have that piece (or has it sufficiently altered), the reference map we currently use would not work for a person who has a mutation that affects that part,” he clarifies.. To further complicate matters, he continues, “the genome can vary enormously in different parts of the world.. And if the reference map is made with European variants, it is less useful for interpreting the genome of a person from Cameroon or China.”

The current work, says Ferrer, “is the first step to solve these problems”. “They have created a complex system that allows one person's genomic sequence to be matched against all of these possible human sequences, rather than just one sequence, and the consortium plans to develop this strategy against the sequence of many more individuals.”

A resource for medicine

For José Manuel Castro Tubío, leader of the Genomes and Disease Research Group at the Center for Research in Molecular Medicine and Chronic Diseases (CIMUS) in Santiago, this new resource will help, first of all, to “better understand our identity, to know what makes us genetically different from each other”. And the fact of “knowing what makes us different, what sequences of genetic material make us different, will allow us to know things about our evolution and it will also allow us to know things about the genetic diseases that affect us”.

“Genetic variability is associated with biological traits and also with the predisposition to develop diseases,” he explains.. “These new genomes that are now being published will make it possible to discover many variants that we still don't know what they are associated with.”

“All the people who are sequencing genomes right now are going to be able to compare the sequences with these reference genomes that are very well characterized.. And that will give us much more information than what we have been able to obtain up to now with the reference human genome that was obtained in the early 2000s”, underlines the researcher, who points out that the new resource represents “a more quantitative than qualitative leap”. .

“In the last 20 years there have been great technological advances that have made it possible to go from a single incomplete reference genome to 47 complete genomes with a very good level of sequencing precision,” he points out.. And this has been possible thanks to second and third generation sequencing technologies that have previously allowed, for example, very long DNA readings.

In the reference genome that existed until now, there were large knowledge gaps. “There were sequences that could not be assembled,” explains Tubío. “But the development of third-generation sequencing technology has made it possible to get very long sequencing reads, which allow us to bypass these complex regions and reconstruct the complete architecture of chromosomes.. Last year the first complete genome was published for the first time thanks to these advances and continuing with this work, this pangenome is now being presented”, the researcher underlines.

Although the new reference presented is still a first draft and only represents a still small number of individuals, it contains information that will be very useful to advance biomedical research, concludes the researcher.