Late-life suicide prevention strategies: current status and future directions

Abstract

Late life suicide prevention differs from suicide prevention for other age groups: first, the number of older adults worldwide is on the rise; second, late-life suicide receives much less attention in all societal spheres, from the media, to federal funding agencies, to healthcare initiatives. Recent findings indicate an association between internalized ageist stereotypes and reduced will to live. Recent research also addresses the role of cognitive control as a contributor to risk and as an intervention target (e.g., through psychotherapies such as problem solving therapy) as well as firearm safety as a promising, though a politicized and challenging strategy to implement. Another strategy that may prove feasible is an approach on upstream prevention strategies in healthcare. One strategy we believe holds great promise is the promotion of high quality geriatric medicine. Geriatricians are trained to work with patients to prioritize the promotion of physical and cognitive functioning (rather than solely absence of disease) and to focus on well-being as a goal. Thus, geriatricians routinely target numerous late-life suicide risk factors-physical illness, functioning, pain, and (dis)satisfaction with life. However, efficacious strategies will not prevent suicide deaths if they are not implemented-addressing ageism as a universal prevention strategy is essential.

The relationship between age and suicidal thoughts and attempted suicide among prisoners

“…For instance, suicide in later life has been linked to personality traits that reflect a lack of flexibility (see Conwell et al, 2002;Fiske & O'Riley, 2016), social disconnectedness (Duberstein et al, 2004, b;Fässberg et al, 2012), physical health problems Erlangsen, Vach, & Jeune, 2005;Fässberg et al, 2016;Lutz et al, 2016), disabilities in basic activities of daily living (Conwell et al, 2010;Dennis et al, 2009;Fässberg et al, 2016), and sleep patterns (Bernert, Turvey, Conwell, & Joiner, 2014;Nadorff, Fiske, Sperry, Petts, & Gregg, 2013;Ross, Bernstein, Trent, Henderson, & Paganini-Hill, 1990). With respect to psychopathology, it has been suggested that affective psychiatric illnesses, such as depression, are common in suicide among older adults (Conwell et al, 2002;Conwell, Olsen, Caine, & Flannery, 1991;Van Orden & Deming, 2018), and that depression is more common among older suicide victims as compared to younger counterparts (see Conwell et al, 2002). Relatedly, a series of studies have shown that depression is the most commonly reported mental health problem among older prisoners (see Stoliker & Galli, 2019), which might suggest a point of therapeutic intervention for this population.…”

“…Given that researchers have signified there are important differences in suicidal thoughts and behavior later as compared to earlier in the lifespan (Fiske & O'Riley, 2016;O'Riley et al, 2014; see also Lutz et al, 2016;Stanley et al, 2016;Van Orden & Conwell, 2016;Van Orden & Deming, 2018), it is imperative that studies on prisoner suicidality extend beyond merely assigning age as a control or descriptive measure (e.g., see Barry et al, 2017). As such, the primary aim of this study was to elucidate the relationship between age and suicidal thoughts and attempts among prisoners, with particular focus on factors that may explain age-based variation in suicidality.…”

“…Indeed, in the United States, older prisoners exhibit the highest rates of suicide in correctional systems (Barry, Wakefield, Trestman, & Conwell, 2017;Carson & Cowhig, 2020;Noonan, Rohloff, & Ginder, 2015). Despite that suicide in later life has become a major public health issue, there has been limited scholarly and public attention devoted to suicidality among older adults (Lutz et al, 2016;Van Orden & Deming, 2018). Much less is known about the nature of suicidal thoughts and attempts among older prisoners (see Barry et al, 2017), especially with respect to how older prisoners compare to younger counterparts.…”

“…It has been suggested that late-life suicidal ideation and behavior differs in important ways from suicidal ideation and behavior earlier in the lifespan (Fiske & O'Riley, 2016;O'Riley, Van Orden, & Conwell, 2014; see also Lutz et al, 2016;Stanley et al, 2016;Van Orden & Conwell, 2016;Van Orden & Deming, 2018), which necessitates the consideration of age-focused analyses on suicide. With the global trend towards an aging population, it is expected that numbers of suicide will increase (Lutz et al, 2016) and suicide in later life will be an increasing problem (Van Orden & Deming, 2018).…”

“…It has been suggested that late-life suicidal ideation and behavior differs in important ways from suicidal ideation and behavior earlier in the lifespan (Fiske & O'Riley, 2016;O'Riley, Van Orden, & Conwell, 2014; see also Lutz et al, 2016;Stanley et al, 2016;Van Orden & Conwell, 2016;Van Orden & Deming, 2018), which necessitates the consideration of age-focused analyses on suicide. With the global trend towards an aging population, it is expected that numbers of suicide will increase (Lutz et al, 2016) and suicide in later life will be an increasing problem (Van Orden & Deming, 2018). In the same way, population aging is taking place within prison systems in high-income countries (see Barry et al, 2017;Blowers & Blevins, 2015;Kakoullis, Le Mesurier, & Kingston, 2010;Opitz-Welke et al, 2019;Stoliker & Galli, 2019) and, therefore, it is expected that these facilities will face increasing challenges surrounding suicidal thoughts and behavior among the older inmate population (Barry et al, 2017).…”