Suicide Prevention in Older Adults

Abstract

Older adults have high rates of suicide in the United States and worldwide; rates vary markedly by gender, race, and ethnicity. Geropsychology practice guidelines (e.g., American Psychological Association [APA], 2004) indicate the need for assessment and treatment practices specific to older adults, as the phenomenology of mental disorders and psychotherapeutic change processes may shift across the lifespan. Inadequacies in the available knowledge base and in the education and training of clinicians have slowed progress in suicide research and hindered the development of a healthcare workforce that is deeply dedicated to suicide prevention. Inadequate knowledge stems from inattention to demographic differences, definitional imprecision and conceptual conflation, lack of research focus on older adults, and the exclusion of at-risk patients from clinical trials. The near absence of rigorous training and education in suicidology among clinical psychologists amplifies these problems. This article also reviews the empirical literature on suicide risk, noting in particular the roles of mood disorders, suicidal ideation and behavior, adjustment to life events, lack of social integration, personality traits, and access to lethal means. Suggestions are offered for improving risk assessment, the treatment of at-risk patients, and the development of prevention programs. Implications for training and education in clinical psychology are briefly discussed, and directions for future research are offered.

A Systematic Review of Elderly Suicide Prevention Programs

“…Strategies that enhance positive aging and quality of life by increasing empowerment, coping and adaptive behavior (Heisel & Duberstein, 2005), flexibility (Brandtstädter & Rothermund, 2002), social skills (Hinrichsen & Hernandez, 1993), self-esteem (Chatterton, Hall, & Tarrier, 2007), sense of belonging (McLaren, Gomez, Bailey, & Van Der Horst, 2007), reasons for living (Malone et al, 2000), hope (Snyder & Rand, 2004), meaning in life (Edwards & Holden, 2001; Heisel & Flett, 2004), religion or spirituality (Dervic et al, 2004), and even humor (Richman, 1993) could be innovative and promising ways to prevent suicide in older adults.…”

“…Yet, suicide in old age is a much neglected area. In fact, there is a lack of basic knowledge and training about elderly suicide among clinicians (Heisel & Duberstein, 2005), as well as in suicide prevention centers (Adamek & Kaplan, 1996). …”

Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings.

“…Existing clinical recommendations for managing suicide risk have largely drawn on practices not empirically tested with older adults (Joiner, Walker, Rudd, & Jobes, 1999; Kleespies, Deleppo, Gallagher, & Niles, 1999; Rudd, Joiner, Jobes, & King, 1999), necessitating population specific research. The extreme lethality of suicidal behavior among older adults and the increasing rates of suicide with advancing age necessitate preventive interventions targeting at-risk older adults, such as those expressing suicidal thoughts and desires (suicide ideation), preoccupation with death and/or wish to die (death ideation), and/or self-injurious behavior (Heisel & Duberstein, 2005). In one study, many older adults who died by suicide had expressed thoughts of suicide to a clinician (38%) or to a family member or acquaintance (73%) in the final year of life (Waern, Beskow, Runeson, & Skoog, 1999).…”

Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

“…Older adults have high rates of suicide [1,2], necessitating focused clinical risk assessment and intervention [3,4]. Older adults are amenable to and respond well to psychological interventions [5-8]; however, only one trial of psychotherapy to date has been conducted exclusively targeting suicidal older adults [9].…”