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. Ceropsychology 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.

Future orientation moderates the relationship between functional status and suicide ideation in depressed adults

“…In a study of suicide deaths in older adults, Waern et al [1999] found that 38% expressed thoughts of suicide to a clinician, but 8% denied having suicidal thoughts even when asked directly. Although past history of suicidal behavior is an important risk marker for suicide [Heisel and Duberstein, 2005], those who have never previously engaged in suicidal behavior nonetheless account for 58% [Rubenowitz et al, 2001] to 75% [Phillips et al, 2003] of deaths by suicide in older age. Although our data suggest that there is a relationship between FO and suicide ideation, the implications of FO for lethal and nonlethal self-harm are unknown.…”

Effect of Community-based Intervention Using Depression Screening on Elderly Suicide Risk: A Meta-analysis of the Evidence from Japan

“…Recent qualitative reviews have suggested an association between community-based depression screening (CDS) and reduced suicide risk for older adults (Blow et al 2006;Grek et al 2006;Heisel and Duberstein 2005;Dombrovski and Szanto 2005;Mann et al 2005). To our knowledge, there are no large intervention studies using CDS for elderly suicide prevention, nor systematic reviews that provide a quantitative synthesis of studies regarding the effectiveness of CDS on the suicide risk.…”

Suicide and its Prevention among Older Adults

“…Age, sex, and race are consistent risk indices: older white men are overrepresented among suicides (15,16). Late-life suicide rates have declined steadily since the 1930s, except for a temporary increase in the 1980s (7).…”

“…Late-life suicide risk is associated with suicidal ideation and behaviour, mental illness, personality vulnerability, medical illness and physical impairment, losses and poor social supports, and functional limitation (15,16). Resiliency factors include integration in social networks and clubs, religious practice, having a hobby, and perceiving that life is meaningful and worth living.…”