Suicide behavior in older adults

The largest number of suicides occurs in middle-aged adults and teenager suicide deaths capture the bulk of media attention. However, older adults have higher rates of suicide than younger age groups in most countries that report mortality data to the World Health Organization, with those 85-90 years old constituting the age group with the highest rates. In this descriptive overview we make the case that late life suicide is a cause for enormous concern that warrants ongoing attention from professionals, policy makers, researchers, and society at large. We review the evidence for factors that place older adults at risk for suicide, or protect them from it. Taken individually, however, risk factors offer relatively weak guidance for implementation of successful suicide prevention initiatives because, at the individual level, their ability to predict who will die by suicide is so poor. We argue then from a public health perspective for understanding suicide as a developmental process to which risk and protective factors contribute in defining a trajectory to suicide over time. The “cause” of suicide in later life must be understood as a complex combination of interactive effects. Demographic characteristics associated with elevated risk for suicide. These include older age, male gender, and white race. Unmarried conjugal status confers risk for suicide as well. Personality traits also may play an important role. The majority of older adults who attempt or die by suicide suffer from depression with clear implications for the design of prevention strategies. Depression alone does not account for all cases of suicidal behavior. Other risk factors for suicide in older adults include history of serious suicidal ideation, stressful life events (bereavement and family discord may lead to isolation), substance abuse. Physical illness and functional impairment are common in late life and may lead to loss of autonomy, isolation, pain, increased burden on social networks, and the development of depression. Older adults who die by suicide often consult their physicians within weeks of their death. Physical ailments are often the focus of these visits, and mental distress and suicidal feelings are often unaddressed. Social ties and their disruption are significantly and independently associated with risk for suicide in later life, relationships between which may be moderated by a rigid, anxious, and obsessional personality style. Social support variables may act both as risk enhancers and buffers. Factors in each of these domains interact within an older individual to determine his/her level of risk at any particular point in time. Acknowledging the complexity biopsychosocial nature of suicidal behavior among elderly, we provide an organizational model on which to base its мultilevel prevention program (i.e. sites outside the rigid matrix of psychiatric care where older adults can best be detected and сomprehensive target treatment and support made to correct for the better their unavoidable suicidal scenario). Additional research is needed to define more precisely the interactions between emotional, physical, and social factors that determine risk for suicide among elderly.