Firearm Suicides in the Elderly: A Narrative Review and Call for Action

Abstract

Firearm suicides are one of the leading causes of death for older Americans. The purpose of this review is to explore the risk factors associated with suicides in the elderly, provide an overview of the epidemiology of firearm-related suicides in older Americans, and explore methods of preventing firearm suicides in the elderly. The vast majority (70 %) of elderly suicides in the U.S were committed using a firearm. Elderly firearm suicides have increased by 49 % between 2010 and 2018, disproportionately affecting white males. Yearly firearm suicides in the elderly ranged from 4,276 in 2010 to 6,375 in 2018. In 2018, the rate of elderly male firearm suicides was 24.96/100,000 compared to a rate of 1.92/100,000 for elderly females, a rate ratio of 13 to 1 for males compared to females. The primary risk factors for elderly firearm suicides seem to be physical illnesses, mental illnesses, and social factors. Older Americans engage in suicidal behaviors with greater planning and lethality of intent than do young adults. Of all the strategies to prevent suicides with firearms, the most efficacious measures based on current research seem to be state firearm legislation and improving mental healthcare, but these effects are not specific to the elderly. Strengthening state firearm laws and improving mental healthcare for the elderly may have promise in preventing elderly firearm-related suicides. Additional implications for practice and research are discussed in this review.

Suicides Among Non-Elderly Adult Hispanics, 2010–2020

“…Our analysis shows that over the past decade, among Hispanic adults, firearms have surpassed all other means of suicide in males, and among females, they are now the second most common cause of suicidal deaths. This may reflect the growing trend of suicides with firearms across all racial and age groups [ 4 – 7 , 42 , 52 , 53 ]. Firearm access and ownership among Hispanics has also been increasing.…”

“…Second, our analysis is primarily descriptive using a cross-sectional design, limiting the ability to comment on causal factors associated with suicides. Third, WISQARS does not have key sociodemographic information such as marital status, education, income, immigration status, birth country, and others that could provide an opportunity for a more nuanced analysis [ 3 , 4 , 21 , 53 ]. Finally, a group of scholars has suggested that the recorded levels of Hispanic suicides may be lower than reality due to possible misclassification by approximately 17% [ 3 , 57 ].…”

Firearms: the leading cause of years of potential life lost

“… 8 These stress-inducing variables of life can accumulate, with many elderly adults reporting feelings of loneliness and isolation. 9 Loss of a job or retirement with subsequent reliance on social security income has been cited as a major stressor in older adults as the loss of financial resources causes individuals to perceive themselves as a burden to family members and society. 10 This is further compounded in individuals who identify themselves as their job, as the loss of their job further exacerbates lack of kinship and inclusion.…”

“…Studies have shown that major depressive disorders are present in approximately 50% of the suicide victims, and that financial, relationship, and other outside stressors are frequently present in these individuals 8. These stress-inducing variables of life can accumulate, with many elderly adults reporting feelings of loneliness and isolation 9. Loss of a job or retirement with subsequent reliance on social security income has been cited as a major stressor in older adults as the loss of financial resources causes individuals to perceive themselves as a burden to family members and society 10.…”

Worldwide suicide mortality trends by firearm (1990–2019): A joinpoint regression analysis

“…On the other hand, in developing countries (such as Venezuela, Lesotho, Central African Republic, Eswatini, Mozambique) where low mortality rates from suicide by firearm were recorded at the beginning of the observed period, significantly higher rates were recorded in 2019 for both sexes. Marked geographic variations in mortality rates of suicide by firearm could be explained by different prevalence of the main risk factors (such as some socio-demographic characteristics, firearms ownership and availability, large alcohol consumption, comorbidity, etc), and variations in suicide prevention [ 2 , 4 , 32 , 33 ]. Besides, it is always a question whether the differences in mortality of suicide by firearm are real or partialy reflect variations in data quality worldwide, in the process of registering causes of death or under-reporting [ 34 , 35 ].…”