Suicide

Risk Factors for Suicide in Late Life, Age >65 years:

• Male
• Chronic or terminal illness
• Social isolation
• Financial strain
• Bereavement
• Depression
• Alcohol or drug abuse
• History of prior suicide attempts
• Family history of suicide
• Preoccupied with suicidal talk and plans

Older adults, particularly those with chronic conditions, have nearly twice the rate of suicide of any other age groups. About 40% of all suicides occur in people age 60 and older and the majority are white males. After age 75 the suicide rate of white males is 3 times the national average and by age 80 it rises to 6 times the average. The numbers are probably under-reported since there may be "silent suicides" (i.e., medication overdoses, "accidents"). Elderly people who do not comply with life-saving medical treatment (e.g., such as insulin for diabetes) or who stop eating may be indirectly attempting to commit suicide.

Older adults are more successful than younger adults in committing suicide because they use more lethal methods. Most attempted suicides in older males are successful and four out of five involve guns. "Double suicides" involving spouses occur more frequently among the older population. The majority of older adults who commit suicide are depressed, although not necessarily in pain or medically ill (Clark, 1992).

Many studies show that 70% of suicidal individuals have seen a physician within the month before the suicide attempt (AARP, 1994). However, suicidal intent is often missed by health care providers. Clinicians often discount patients' suicide messages or assume that death wishes are a normal part of growing old. Frequently overlooked risk factors such as failure to adapt to multiple stressors or many physical complaints without organic cause may indicate suicide or depression among elderly clients. Behavioral clues of suicidal intent in younger adults such as putting personal affairs in order, giving away personal items, and making will and funeral plans are often signs of good judgement in an older adults.

Suicide prevention requires early detection of suicidal intent and lowering risk by treating physical and psychiatric disorders, reducing social isolation, improving resources, enhancing self esteem, and helping elderly patients find meaning or satisfaction in life. Although controversy exists about elderly patients' motivation to seek help, most people tell other friends and health professionals about their suicidal ideas before they attempt suicide. All references to suicide should be seriously evaluated.

Statements such as "I want to die; I don't want to live" or "I'd be better off dead" are red flags to danger that need to be discussed during an evaluation for suicide risk. Evaluation of suicide risk includes asking about details of a person's plan (e.g., what would you do? how? and when?). A person with a suicide plan or thoughts of suicide should be referred to a mental health professional for evaluation; if the suicide plan is lethal and immediate (e.g., I'll shoot myself with a gun tonight and I have the gun and bullets ), they should be taken for evaluation right away.