Characteristics and Comorbid Symptoms of Older Adults Reporting Death Ideation

Abstract

Objective To determine whether death ideation in late life is associated with markers of elevated risk for suicide, or reflects normal psychological processes in later life. Design/Setting Population based cross sectional study in Gothenburg, Sweden. Participants The sample consists of 345 men and women aged 85 (born 1901-02) and living in Gothenburg, Sweden. Main Outcome Measures The Paykel Scale measured the most severe level of suicidality over an individual’s lifetime. Other key measures were severity of depression and anxiety and frequency of death/suicidal ideation over the previous month. Results Latent class analysis revealed distinct groups of older adults who reported recent death ideation. Recent death ideation did not occur apart from other risk factors for suicide; instead individuals reporting recent death ideation also reported either 1) recent high levels of depression and anxiety, or 2) more distant histories of serious suicidal ideation (indicative of worst point severity of suicidal ideation)—both of which elevate risk for eventual suicide. Conclusions Our results indicate a heterogeneous presentation of older adults who report death ideation, with some presenting with acute distress and suicidal thoughts, and others presenting with low distress but histories of serious suicidal ideation. The presence of death ideation is associated with markers of increased risk for suicide, including “worst point” active suicidal ideation.

Issues in research on aging and suicide

“…Rather, we suggest that more research is needed that examines the effectiveness of selective interventions that target groups at risk but well before the development of the acutely suicidal state, as intervening at this point in the trajectory toward suicide may be “too late” for some older adults. Some studies exist, including the Tele Help—Tele Check study described above, as well as a study we are conducting with our colleagues of the effectiveness of peer companionship for socially disconnected older adults (Van Orden et al, 2013), but more work is needed. Finally, all forms of intervention—universal, selective, and indicated—play an important role in suicide prevention in later life.…”

“…In one paper, we examined this question in a sample of 85 year olds from Sweden (Van Orden, Simning, Conwell, Skoog, & Waern, 2013). We found that the majority of older adults who endorsed passive suicide ideation within the last month also endorsed either active thoughts of killing themselves in their lifetimes or significant depressive or anxious symptomatology in the past month, indicating that passive suicide ideation was closely linked with indicators of suicide risk.…”

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

“…The trends for death by suicide in older populations have not diminished over three decades [2], despite several years of research to better understand the predictors and precursors of late life suicide, as well as intervention research demonstrating the positive effects of depression intervention on reductions in suicidal ideation[3-5] . It is well known that 90% of older people who take their lives suffered from a psychiatric disorder[6] with depressive disorders being the most common psychiatric diagnoses of elderly suicide victims[7]. Furthermore, late life suicidal ideation is a risk factor for suicide [4, 8, 9], and executive dysfunction[10, 11], in particular impulsivity [12-14], and impairments in risk-sensitive decision making[14, 15] are associated with greater suicidal ideation in older adults.…”

Stability of Genetic and Environmental Contributions to Anxiety Symptoms in Older Adulthood

“…Late-life anxiety symptoms have been linked with many adverse outcomes such as death ideation (Van Orden et al 2013), nursing home placement (Gibbons et al 2002), poor cognitive performance (Beaudreau et al 2013), functional impairment (Brenes et al 2008; Porensky et al 2009), and poor general health (Losada et al 2014). …”