Skip to main content

Advertisement

Log in

Suicides in Late Life

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Charles ST, Carstensen LL. Social and emotional aging. Annu Rev Psychol. 2010;61:383–409.

    Article  PubMed  Google Scholar 

  2. World Health Organization. Suicide rates (per 100,000), by country, year, and gender. 2003. Available at http://www.who.int/mental_health/prevention/suicide/suiciderates/en/. Accessed February 2006.

  3. Heron MP, Hoyert DL, Murphy SL, Jiaquan X, Kochanek KD, Tejada-Vera B. Deaths: final data for 2006. Natl Vital Stat Rep. 2009;57:1–135.

    PubMed  Google Scholar 

  4. Conwell Y, Van Orden K, Caine E. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2) in press.

  5. Phillips JA, Robin AV, Nugent CN, Idler EL. Understanding recent changes in suicide rates among the middle-aged: period or cohort effects? Public Health Rep. 2010;125:680–8.

    PubMed  Google Scholar 

  6. Mann JJ, Oquendo M, Underwood MD, Arango V. The neurobiology of suicide risk: a review for the clinician. J Clin Psychiatry. 1999;60 Suppl 2:7–11.

    PubMed  Google Scholar 

  7. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54.

    Article  PubMed  Google Scholar 

  8. Duberstein PR, Conwell Y, Caine ED. Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study. Psychiatr Interpers Biol Process. 1994;57:213–24.

    CAS  Google Scholar 

  9. Rubenowitz E, Waern M, Wilhelmson K, Allebeck P. Life events and psychosocial factors in elderly suicides–a case-control study. Psychol Med. 2001;31:1193–202.

    Article  PubMed  CAS  Google Scholar 

  10. Karvonen K, Hakko H, Koponen H, Meyer-Rochow VB, Rasanen P. Suicides among older persons in Finland and time since hospitalization discharge. Psychiatr Serv. 2009;60:390–3.

    Article  PubMed  Google Scholar 

  11. Holland JM, Schutte KK, Brennan PL, Moos RH. The structure of late-life depressive symptoms across a 20-year span: a taxometric investigation. Psychol Aging. 2010;25:142–56.

    Article  PubMed  Google Scholar 

  12. Miret M, Nuevo R, Morant C, et al. Differences between younger and older adults in the structure of suicidal intent and its correlates. Am J Geriatr Psychiatry 2010;18(9):837–47.

    Google Scholar 

  13. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159:909–16.

    Article  PubMed  Google Scholar 

  14. Conwell Y, Lyness JM, Duberstein P, et al. Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc. 2000;48:23–9.

    PubMed  CAS  Google Scholar 

  15. Cheng S-TPD, Yu, Lee, et al. The Geriatric Depression Scale as a screening tool for depression and suicide ideation: a replication and extension. Am J Geriatr Psychiatry. 2010;18:256–65.

    Article  PubMed  Google Scholar 

  16. • Heisel MJ, Duberstein PR, Lyness JM, Feldman MD. Screening for suicide ideation among older primary care patients. J Am Board Fam Med. 2010;23:260–9. This article describes the accuracy of the GDS in detecting the presence of suicidal ideation among older adults in primary care. Given that most older adults who die by suicide are seen in primary care, yet universal screening is not recommended by the US Preventive Task Force due to insufficient data on the efficacy of screening tools (see Liu et al. [17]), this article addresses a topic of great importance for late-life suicide prevention.

    Article  PubMed  Google Scholar 

  17. Liu IC, Chiu CH. Case-control study of suicide attempts in the elderly. Int Psychogeriatr. 2009;21:896–902.

    Article  PubMed  Google Scholar 

  18. US Preventive Services Task Force. Screening for Suicide Risk: Recommendation and Rationale. May 2004 [cited Retrieved August 30, 2010; Available at http://www.uspreventiveservicestaskforce.org/3rduspstf/suicide/suiciderr.htm].

  19. Haw C, Harwood D, Hawton K. Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr. 2009;21:440–53.

    Article  PubMed  Google Scholar 

  20. Carlsten A, Waern M. Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly? BMC Geriatr. 2009;9:20.

    Article  PubMed  Google Scholar 

  21. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316.

    Article  PubMed  Google Scholar 

  22. Waern M, Runeson BS, Allebeck P, et al. Mental disorder in elderly suicides: a case-control study. Am J Psychiatry. 2002;159:450–5.

    Article  PubMed  Google Scholar 

  23. Conwell Y, Rotenberg M, Caine ED. Completed suicide at age 50 and over. J Am Geriatr Soc. 1990;38:640–4.

    PubMed  CAS  Google Scholar 

  24. Turvey CL, Conwell Y, Jones MP, et al. Risk factors for late-life suicide: a prospective community-based study. Am J Geriatr Psychiatry Special Issue: Suicidal behaviors in older adults. 2002;10:398–406.

    Google Scholar 

  25. Kjolseth I, Ekeberg O, Steihaug S. “Why do they become vulnerable when faced with the challenges of old age?” Elderly people who committed suicide, described by those who knew them. Int Psychogeriatr. 2009;21:903–12.

    Article  PubMed  Google Scholar 

  26. Wiktorsson S, Runeson B, Skoog I, Ostling S, Waern M. Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. Am J Geriatr Psychiatry. 2010;18:57–67.

    Article  PubMed  Google Scholar 

  27. Harrison KE, Dombrovski AY, Morse JQ, et al. Alone? Perceived social support and chronic interpersonal difficulties in suicidal elders. Int Psychogeriatr. 2010:22(3):445–54.

    Google Scholar 

  28. Golden J, Conroy RM, Bruce I, et al. Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriatr Psychiatry. 2009;24:694–700.

    Article  PubMed  Google Scholar 

  29. Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004;164:1179–84.

    Article  PubMed  Google Scholar 

  30. Bergman Levy T, Barak Y, Sigler M, Aizenberg D. Suicide attempts and burden of physical illness among depressed elderly inpatients. Arch Gerontol Geriatr. 2010;52:115–7.

    Article  PubMed  Google Scholar 

  31. Sirey JA, Bruce ML, Carpenter M, et al. Depressive symptoms and suicidal ideation among older adults receiving home delivered meals. Int J Geriatr Psychiatry. 2008;23:1306–11.

    Article  PubMed  Google Scholar 

  32. Li LW, Conwell Y. Pain and self-injury ideation in elderly men and women receiving home care. J Am Geriatr Soc. 2010;58:2160–5.

    Article  PubMed  Google Scholar 

  33. Conwell Y, Duberstein PR, Hirsch JK, Conner KR, Eberly S, Caine ED. Health status and suicide in the second half of life. Int J Geriatr Psychiatry 2010;25(4):371–9.

    Google Scholar 

  34. Tsoh J, Chiu HF, Duberstein PR, et al. Attempted suicide in elderly Chinese persons: a multi-group, controlled study. Am J Geriatr Psychiatry. 2005;13:562–71.

    PubMed  Google Scholar 

  35. Kjolseth I, Ekeberg O, Steihaug S. Why suicide? Elderly people who committed suicide and their experience of life in the period before their death. Int Psychogeriatr. 2010;22:209–18.

    Article  PubMed  Google Scholar 

  36. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2010;25:843–9.

    Article  PubMed  Google Scholar 

  37. Lund R, Nilsson CJ, Avlund K. Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women. Age Ageing. 2010;39:319–26.

    Article  PubMed  Google Scholar 

  38. Dombrovski AY, Clark L, Siegle GJ, et al. Reward/punishment reversal learning in older suicide attempters. Am J Psychiatry. 2010;167:699–707.

    Article  PubMed  Google Scholar 

  39. Gibbs LM, Dombrovski AY, Morse J, Siegle GJ, Houck PR, Szanto K. When the solution is part of the problem: problem solving in elderly suicide attempters. Int J Geriatr Psychiatry. 2009;24:1396–404.

    Article  PubMed  Google Scholar 

  40. Hwang JP, Lee TW, Tsai SJ, et al. Cortical and subcortical abnormalities in late-onset depression with history of suicide attempts investigated with MRI and voxel-based morphometry. J Geriatr Psychiatry Neurol. 2010;23:171–84.

    Article  PubMed  Google Scholar 

  41. Marty MA, Segal DL, Coolidge FL. Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults. Aging Ment Health. 2010;14:1015–23.

    Article  PubMed  Google Scholar 

  42. Edelstein BA, Heisel MJ, McKee DR, et al. Development and psychometric evaluation of the reasons for living–older adults scale: a suicide risk assessment inventory. Gerontologist. 2009;49:736–45.

    Article  PubMed  Google Scholar 

  43. Yur’yev A, Leppik L, Tooding LM, et al. Social inclusion affects elderly suicide mortality. Int Psychogeriatr. 2010;22:1337–43.

    Article  PubMed  Google Scholar 

  44. • Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner Jr TE. The Interpersonal Theory of Suicide. Psychol Rev. 2010;117:575–600. This theoretical paper describes the Interpersonal Theory of Suicide in detail, including rationale for its hypotheses and empiric studies investigating these hypotheses.

    Article  PubMed  Google Scholar 

  45. World Health Organization. Primary prevention of mental, neurological and psychosocial disorders. Geneva: World Health Organization; 1998.

    Google Scholar 

  46. Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE. Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008;76:72–83.

    Article  PubMed  Google Scholar 

  47. De Leo D, Dello Buono M, Dwyer J. Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. Br J Psychiatry. 2002;181:226–9.

    Article  PubMed  Google Scholar 

  48. Oyama H, Sakashita T, Ono Y, Goto M, Fujita M, Koida J. Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan. Community Ment Health J. 2008;44:311–20.

    Article  PubMed  Google Scholar 

  49. • Alexopoulos GS, Reynolds CF, III, Bruce ML, et al. Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry 2009. doi:10.1176/appi.ajp.2009.08121779. This article describes 2-year outcomes of a collaborative care model designed to reduce suicidal ideation among older adults and represents one of the largest and most well-designed clinical trials for the prevention of late-life suicidality.

  50. Heisel MJ, Duberstein P, Talbot NL, King DK, Tu X. Adapting interpersonal psychotherapy for older adults at risk for suicide: preliminary findings. Prof Psychol Res Pract. 2009;40:156–64.

    Article  Google Scholar 

  51. Chan SS, Leung VP, Tsoh J, et al. Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong Chinese community. Am J Geriatr Psychiatry 2011;19(2):185–96.

    Google Scholar 

  52. Joiner TE, Van Orden KA, Witte TK, Rudd MD. The Interpersonal Theory of Suicide: guidance for working with suicidal clients. Washington: American Psychological Association; 2009.

    Book  Google Scholar 

Download references

Acknowledgment

This work was supported in part by grant no. T32MH20061 from the National Institute of Mental Health.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yeates Conwell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van Orden, K., Conwell, Y. Suicides in Late Life. Curr Psychiatry Rep 13, 234–241 (2011). https://doi.org/10.1007/s11920-011-0193-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-011-0193-3

Keywords

Navigation