Suicide in the elderly

The elderly have some of the highest rates of suicide in the population.

Males aged 75 and over have the highest rates of suicide in nearly all industrialised countries, and among many of these nations suicide rates increases with age (1).Note though many countries have recorded a decline in rates among the elderly in recent years (1)

• in England and Wales between 1983 and 1995, suicide rates for men reduced by between 30 and 40% in the age groups 55–64, 65–74 and 75–84
• rates for the most elderly men (males over 85 years) during between 1983 and 1995 remained fairly static, this group still having the highest rates of any group
• in contrast, the 25- to 34-year-old male group exhibited a 30% increase in suicide rate between 1983 and 1995; this group are becoming the group with the second highest rate, while the 15- to 24-year-old male group demonstrated a 55% increase between 1983 and 1995.

Female suicide rates have shown a similar overall decrease, reducing by between 45 and 60% during the years 1983–1995 in the 45–84 age group.

• elderly women, however, retain the highest rates throughout the life span (1)
• ratio of male to female elderly suicide deaths remains approximately 3:1

These trends in suicide rates are probably due to:

• improved detection of those at risk
• aggressive treatment of mental illness in the elderly

The problem of suicide in the elderly is potentially more amenable to intervention because the elderly are more likely than the young to seek professional help.

Cross-cultural differences clearly influence suicide rates.

• for example, in the UK, rates in elderly first-generation immigrants from the Indian subcontinent are low in comparison with the indigenous elderly population
• note that nationwide analysis may also obscure local variations, as demonstrated in a recent study from a deprived inner-city area where rates among young White men exceeded those among elderly men (2)
• in the USA, the highest suicide rates occur among elderly White men; note that rates among Black men are higher in younger age groups.

Attempted suicide should always be taken seriously in the elderly and is most likely to represent a failed suicide bid rather than parasuicide (1).

• associated with high rates of depression (up to 90%), with major depression accounting for over 50% and physical illness being a significant contributor in around 60–70% of cases
• attempts in the elderly are a much stronger predictor of subsequent completed suicide compared with attempts in younger people, with a ratio of attempts to completion estimated to be around 4:1 compared with between 8 and 200:1 for young people who attempt suicide
• the profile of elderly people who attempt suicide (more so than in other age groups) resembles that of those who complete, and suicidal intent scores are reported to be at their highest

Reference:

1. Cattell H. Suicide in the elderly. Advances in Psychiatric Treatment (2000) 6: 102-8.
2. Br J Psychiatry 1997 Nov;171:463-7 Related Articles, Links