Suicide and Its Prevention among Older Adults

Article excerpt

Objective: To review the research on the epidemiology, risk and resiliency, assessment, treatment, and prevention of late-life suicide.

Method: I reviewed mortality statistics. I searched MEDLINE and PsycINFO databases for research on suicide risk and resiliency and for randomized controlled trials with suicidal outcomes. I also reviewed mental health outreach and suicide prevention initiatives.

Results: Approximately 12/100 000 individuals aged 65 years or over die by suicide in Canada annually. Suicide is most prevalent among older white men; risk is associated with suicidal ideation or behaviour, mental illness, personality vulnerability, medical illness, losses and poor social supports, functional impairment, and low resiliency. Novel measures to assess late-life suicide features are under development. Few randomized treatment trials exist with at-risk older adults.

Conclusions: Research is needed on risk and resiliency and clinical assessment and interventions for at-risk older adults. Collaborative outreach strategies might aid suicide prevention.

(Can J Psychiatry 2006;51:143-154)

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

* Assessment of risk and resiliency and use of standardized measures, if implemented, might improve suicide risk detection.

* Combining antidepressants and interpersonal psychotherapy may help resolve suicide ideation.

* Mental health providers are encouraged to collaborate with older patients' primary care providers, social service workers, and family and other gatekeepers and to employ mental health outreach efforts.

Limitations

* Risk-factor research has been limited by the statistical rarity of suicide, by the use of diverse inclusion criteria for age, by uncontrolled studies or use of varied control groups, and by little research on resiliency factors.

* Few older adult suicide assessment instruments and evidence-based interventions exist.

* This review is limited to English-language publications.

Key Words: suicide, suicide ideation, suicidal behaviour, geriatrics, older adults

Adults aged 65 years or over have high rates of suicide worldwide (1). Approximately 1.3 die by suicide in Canada every day (2). Older adults have long had high suicide rates (3-7); however, programmatic study of geriatric suicide is relatively recent. The prevalence of late-life suicides may increase as the baby boom cohort reaches retirement age (8), given this population's high suicide rates (9,10) and because they are moving into a phase of life in which rates are high. However, baby boomers' strength in getting health care needs met (11) may help to stem that tide. Geriatric suicidology is in a relatively early phase of development, with limited information available on risk detection and treatment implementation. The aging of the North American population necessitates greater understanding of late-life suicide risk, resiliency, and detection and intervention options. Before reviewing the literature on suicide among older adults, I briefly address pertinent definitions and methodological issues.

Definition of Terms

Knowledge regarding suicide among older adults has been limited by imprecise use of terms. In this article, I employ O'Carroll and colleagues' definitions of suicide ideation, suicidal behaviour, and suicide (12); I avoid moral-evaluative or pseudolegalistic terms (13) and use the term "older adult" to refer to individuals aged 65 years or over.

Methodological Issues

Despite high rates among older adults, suicide is a low-base-rate occurrence, limiting research and hindering risk detection. The 1997 suicide rate for adults aged 65 years or over in Canada was 12.4 per 100 000 population members (2), or 1 suicidal death for every 8065 individuals. Epidemiologic data typically derive from national mortality data or population polls. …