Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death. This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed. Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly. Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.

In this study we explored the views of Mental Health professionals and general practitioners (GPs) regarding spiritual care and the effect of personal and cultural background on their views. Data were collected through anonymous questionnaires posted to hospital nursing and medical staff at Hollins Park Hospital, Warrington, UK, and to all GPs within the hospital catchments area. Forty-five percent of GPs, 33% of psychiatrists, and 76% of nursing staff ( p < 0.05) felt strongly that human beings are made up of spirit as well as body. More nurses felt that spiritual care is equally as important as other forms of care (52%) compared with psychiatrists (33%) and GPs (29%). A higher percentage of nursing than medical staff had previous training in this area and were more likely than medical staff to consider themselves appropriate to give spiritual advice. A total of 20% of GPs and 33% of psychiatric staff stated the need for training in this area and GPs especially felt they lacked time. Professionals' views are influenced by cultural and religious backgrounds, with significantly more non-UK born respondents feeling strongly that human beings all have a spiritual component. Many doctors do not consider spiritual care has a role for them to be involved in and many feel too pressured in daily life to take this on. Nurses are more inclined to take a holistic approach to care in this respect. Some people with mental health problems have spiritual care needs and we should be aware of this as an important facet to therapy.

Child bearing has been reported to be protective for women in terms of suicide risk. However, it is not clear whether the protective effect of having children diminishes in old age. A literature search has not found studies which examined childlessness as a possible risk factor in elderly suicide. In this study we attempt to explore whether childlessness has any significant association with elderly suicide and whether this differs between women and men. Data was extracted from the records of coroners' inquests into all unexpected deaths of persons aged 60 and over, in Cheshire, over a period of 13 years from 1989-2001. The study found no significant gender difference in childlessness in elderly suicide victims (P>.05). Significantly fewer widowed men who committed suicide were childless (OR 0.1, 95% CI 0.02-0.3 P<.001). A history of deliberate self-harm (DSH) and being previously known to services were found to be significantly lower in childless female victims compared to elderly mothers (OR 0.4, 95% CI 0.1-0.9 P<.05). Leaving suicide notes and the method of suicide did not appear to be significantly influenced by a childless status in either of the sexes (P>.05). The protective effect of having children appears to diminish in old age. Childless females appear to be at a higher risk of succeeding in their first suicide attempt and more importantly, can easily escape the attention of services.

In search of a good death Doctors need to know when and how to say die Editor-One of the main obstacles to the care of dying patients is the taboo against speaking or writing about impending death. Here are a few simple tests to see how you or your colleagues are doing. Try reading a selection of charts of patients who have died. Patients do "poorly," "fail to respond," or are "palliative," but I would wager that you will find few patients described as "dying" or "near death." Some dying patients even "demand" futile treatment such as cardiopulmonary resuscitation in the event of a "cardiopulmonary arrest," when asked to "consent" not to receive it. You should also see how often and how vigorously you avoid talking about death when speaking to a patient likely to die. I am always surprised at how difficult I find it to talk openly about death and dying, even when it clearly is necessary and appropriate and I have carefully thought out what I am going to say. If compassionate care of dying patients is to occur doctors need a structured and consistent approach to talking with patients about death and dying.

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