The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

18
Prevention and Treatment
of Suicidality in Older Adults

Diego De Leo and Urška Arnautovska


Introduction

Old age is characterized by various physical, psychological, social, and behavioral changes, which have both negative and positive consequences. From a psychological perspective, as explained by Erikson in his psychosocial theory of human development (1982), older adults usually either resolve this last stage of their life by acquiring a feeling of integrity or fail to resolve it, resulting in a sense of despair. If, when looking back, they cannot find enough positive achievements, they are likely to feel that their life has become meaningless and not worth living. This chapter focuses on older adults whose psychological state makes them particularly vulnerable to suicidal behavior.


Peculiarities of Suicidal Behavior in Older Age

Older adults differ from members of other age groups on a variety of biological, psychological, and social characteristics. Suicidal behavior (employed to include selfharm, attempted suicide, and suicide) among older adults presents with certain peculiarities. For example, suicide in old age is often considered to be the result of a rational decision. This is especially the case in the suicide of a dependent and frail male whose death closely follows that of a spouse. Suicide can also be seen as a “legitimate exit” from life when loss of dignity, change in social role, and increased emotional isolation are experienced. In contrast, there is substantial evidence that among older adults suicidal behavior is influenced by the presence of psychiatric disorders, especially when mood alterations are present (Conwell et al., 2000; De Leo, Draper, Snowdon, & Kölves, 2013b; Fiske, Wetherell, & Gatz, 2009). Contrary to “ageistic” perspectives, depression is not a normal feature of aging (Rabheru, 2004), nor is it a natural response to deterioration of physical conditions or social or financial difficulties, which can be particularly common in older age. Confusing depression with sadness may dangerously lower the level of vigilance shown to patients and amplify the widespread problem of underrecognizing and undertreating depression in older adults (De Leo & Diekstra, 1990). Prevention, identification, and treatment of depression in old age may not only counteract suicidal ideation, but it might also reduce general mortality risk (Capurso et al., 2007).

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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