Suicide in the elderly

Abstract

In the vast majority of countries the suicide rate of elderly persons (referring to those aged 65 years and above) is significantly higher than in younger age groups. In the US, by age 80 the suicide rate ranges from 3/100 000 among African American women to 60/100 000 among Caucasian men. Although in all age groups men have higher suicide rates than women, the difference is the most striking in older men living in industrialized countries. In the US the elderly have the highest suicide rate of all age groups, with men accounting for 81% of completed suicides in late-life. It seems that certain life events such as widowhood pose a higher risk for suicide on men than women. It is also possible that the aging process has different effects among men than women and/or elderly women may possess distinct protective factors that could explain the dramatic gender difference. The clinical profile of depressed elderly suicide victims suggests that, if treated for depression, these patients would have had a favorable prognosis. In older people suicidal ideation, suicide attempt, and completed suicide occur most frequently in the context of major depression. Studies have observed that depression in elderly suicide victims is more often without comorbid substance abuse or personality disorders than in younger age groups. Furthermore, while the elderly carry out high lethality attempts, the time to intervene may be longer as the elderly are less impulsive, contemplating suicide for months. Psychological autopsy studies may overestimate the number of elderly suicides that occur in the first episode of late onset depression. It is possible that in a subgroup of suicidal elderly men previous depressive episodes may have been undetected. The detection of suicide in the elderly (especially in men) is more challenging, as they are less likely to communicate their depressed mood and overt suicide intent and are often present with symptoms of masked depression. Although 50% of elderly suicide victims visited their GP the month before their death, more than half of the visits were exclusively for physical complaints. Following an overview of epidemiology and risk factors, we report data on the development and preliminary testing of the Yale Evaluation of Elderly Suicidality Scale and summarize interventions that can be effective in treating suicidal elderly. Finally, we briefly describe two prevention and treatment studies that are currently underway in primary care settings. The aim of these studies is to determine whether the improved detection of depression, improved compliance, and state of-art pharmacotherapy and/or psychotherapy will reduce the prevalence of depressive symptoms, hopelessness and suicidal ideation. These studies aim to investigate whether all the above decrease the rate of suicide attempts and lethal suicide in older adults.