The overall global suicide rates for each of the eight five-year age-bands are sufficiently large for them to constitute a public health concern. This is especially important given the ongoing rise in the elderly population size and the paucity of data on risk and protective factors for suicide in the five-year age-bands after the age of 60 years.

Suicide rates were sufficiently large amongst centenarians for there to constitute a public health concern given the anticipated rise in the centenarian population and the paucity of data on risk and protective factors for suicide in this age group.

The elderly population size is increasing worldwide due to prolonged life expectancy and falling birth rates. Traditionally, suicide rates increase with age. For example, a recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007a). Thus, suicides in the elderly are an important public health concern. While much is known about proximal (individual level) risk and protective factors for elderly suicides (e.g. Conwell et al., 1991; Cattell and Jolley, 1995; Harwood et al., 2001), less is known about more distal (societal or population level) risk and protective factors (Rehkopf and Buka, 2006). Moreover, detailed knowledge of these distal factors may have greater public health relevance for the development of comprehensive prevention strategies (Knox et al., 2004).

The findings may be due to methodological flaws. However, if they are genuine, then the following approaches require consideration to further reduce suicide rates: (1) development of strategies to ensure continued prescription of psychotropic drugs at the current level; (2) development of strategies to improve non-pharmacological measures, including improved mental health services provision for older people, improved assessment of suicide risk, increased availability of psychosocial interventions and restricting the availability of methods of suicide; and (3) development of strategies to implement improvement in distal risk (e.g. societal socio-economic status) and protective (e.g. societal educational attainment) factors for suicide at a societal level.

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Two important aspects of the epidemiology of suicides in the elderly people can potentially be applied to dementia. The first is the well-established observation of the independent effects of age, birth cohort membership, and the period on the risk of suicide in the elderly people (Murphy et al., 1986; Surtees and Duffy, 1989; Snowdon and Hunt, 2002). The second is the recently developed concept of the epidemiological transition hypothesis of suicide in the elderly people (Shah and Bhat, 2009; Shah, 2010; Shah et al., 2008). These epidemiological aspects, in addition to the theoretical aspects, may also have clinical and public health implications for dementia.

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