Suicide in Later Life

Abstract

Suicide in later life is a significant public health problem around the world—a problem that will increase in magnitude in the coming years with the impact of population aging. Adults age 70 and older have higher suicide rates than younger groups worldwide in both lower-income and higher-income countries. While suicide rates tend to increase with age, suicide in later life is not an expected or normative response to stressors that accompany the aging process. Instead, a constellation of risk factors places an older adult at elevated risk for suicide. These factors can be remembered as the Five D’s: psychiatric illness (primarily depression); functional impairment (also called disability, often associated with dependency on others); physical illness (particularly multiple comorbid diseases); social disconnectedness (including social isolation, loneliness, family conflict, and feeling like a burden); and access to lethal (deadly) means. The greatest risk occurs when multiple domains of risk converge in a given individual. Approaches to prevention can address the Five D’s. Given that older adults are reluctant to seek out mental healthcare and that standard primary care practice cannot easily provide it, models of primary care-based integrated care management for mental disorders, including in older adulthood, have been developed, rigorously tested, and widely disseminated. These models play an important role in suicide prevention by integrating treatment for physical and mental illness. Upstream, selective prevention strategies that target disconnectedness—such as engaging older adults as volunteers—may serve to reduce disconnectedness and thereby reduce suicide risk. Universal prevention strategies that involve growing the geriatric workforce may address disability by increasing older adults’ access to medical and social service providers with expertise in improving physical, cognitive, and social functioning, as well as improving quality of life. Addressing ageism and building age-friendly communities that use strategies to integrate older adults into society and promote social participation hold promise as universal prevention strategies. Ultimately, effective suicide prevention strategies for older adults must focus on improving quality of life as well as preventing suicide: strategies such as psychotherapy and medication for psychiatric disorders must be supplemented by prevention strategies for older adults give at all ages in addition to treating psychiatric disorders and suicidal thoughts is needed to address the problem of suicide in later life.

Suicide and Lewy body dementia: Report of a Lewy body dementia association working group

“…In addition to older age and male gender, risk factors for suicide in older adults can be framed as the “5 Ds”: disease (medical illness, pain, and multi‐morbidity), depression (and other common mental disorders of later life), disability (functional impairments and dependency), social disconnectedness (e.g., isolation, loneliness, and feeling like a burden), and access to deadly means 33–36 . Given the paucity of literature regarding suicide in LBD, the working group examined factors in these domains associated with a risk of suicide in (1) PD and (2) dementia populations.…”

Capitalizing on psychosocial strengths in aging

“…Older adults are more likely to use lethal means and less likely to be discovered. As one example, in the U.S., most older people who die by suicide use a firearm (Van Orden et al, 2019); thus, an openness/willingness to use safe storage methods (e.g., locked safe, bullets stored separately) or willingness to have another person keep the firearm during times of stress are likely protective against a lethal suicide attempt. Research investigating psychosocial, social, and environmental predictors of willingness for means safety could be useful in assessing potential strengths to be capitalized on or targets for intervention to enhance protection against suicide.…”

Lifespan development and suicide in later life

“…Decades of research worldwide have yielded reliable insights into factors associated with suicide in later life. Encompassing constructs in multiple domains, they can be usefully framed as the “5Ds” (Van Orden etal ., 2019). The first is access to deadly means .…”

“…The remaining four Ds are depression , disease, disability , and disconnectedness . While other mental disorders are also present in older people who die by suicide, major and minor affective disorders have been found through psychological autopsy studies in up to 87% (Van Orden etal ., 2019). Disease and disability refer to medical illnesses and their functional impact that, although so common as to be the rule in later life, are known to elevate risk approximately twofold.…”

“…Suicide rates rise with age across the life course for both men and women in most countries that report mortality statistics to the World Health Organization (Van Orden etal ., 2019). Furthermore, older adults are the most rapidly growing segment of the population worldwide.…”