In the United States, as in many countries of the world, older adults are at greater risk for suicide than other age groups. This article provides an overview of suicide in later life and a foundation on which to base decisions about the design and implementation of preventive interventions. Ultimately, implementation of effective suicide prevention strategies and reduction of selfinflicted deaths by older people will depend on information obtained at each of four stages of the preventive intervention research cycle, depicted in Fig. 1. First is the definition of the scope of the problem: rates of suicide in the older population and their patterns over time and space. Second is the characterization of suicide in older adults, with particular reference to risk and protective factors. These in turn suggest potential pathogenic mechanisms and indicate where one can obtain the most efficient access to older adults at risk, or who may be targets of preventive interventions. With this information, those interventions can be designed and preliminary testing conducted for their refinement before they are implemented on a larger scale. With effective surveillance tools established to evaluate the impact of the intervention, the cycle then starts afresh.This article first considers special challenges to suicide prevention in older adults, and then reviews the information available to inform each of these steps in the late-life suicide preventive intervention research cycle.
CHALLENGES TO LATE-LIFE SUICIDE PREVENTIONDeveloping suicide prevention strategies in older adults is particularly challenging because of a range of factors at the individual, provider, systems, and even social/cultural levels. To the extent that suicide prevention relies on timely and effective detection and treatment of mental disorders, older adults face multiple barriers to the acquisition of care [1]. At the service system level, discriminatory barriers still exist in access to mental health care. Medicare recipients are required to pay 50% of charges for mental health services, rather than a 20% copay for physical health conditions. Older adults tend not to use mental health services, but rather seek care from primary care providers. Affective syndromes may be milder in older adults, expressed as physical symptoms [2]. Their presentations are further complicated by comorbid medical illness and the multiple medications prescribed to treat them. Older adults are reluctant to talk about emotional problems and are less likely to report depression and suicidal ideation to others [3,4]. Although doctors see many older people in a typical primary care practice, they often lack specialized training in geriatric care, the information and decision support needed to optimize quality of care, and the time necessary to diagnose affective disorders and assess suicide risk among so many competing demands [5,6] Consequently, fewer than half of older people with clinically significant mood disorders are diagnosed with depression in primary care, and of those, a m...