3.6.1 Suicide and Attempted Suicide in Old Age

3.6.1 Suicide and Attempted Suicide in Old Age

Suicide and Attempted Suicide in Old Age

Suicide and attempted suicide are significant public health concerns, particularly among older adults in the UK. According to the Office for National Statistics (ONS), in 2020, the highest suicide rate in the UK was among men aged 45 to 49 years old (24.5 deaths per 100,000), followed by men aged 50 to 54 years old (24.3 deaths per 100,000). For women, the highest rate was among those aged 50 to 54 years old (7.6 deaths per 100,000) (ONS, 2021). While older adults have lower suicide rates than younger age groups, they are more likely to die by suicide due to the increased lethality of the methods used and underlying physical health conditions (Conwell et al., 2019).

Old age poses a higher risk for suicide, with approximately 20% of all suicides involving older individuals. There is a 2:1 male-to-female ratio in this age group, as men’s suicide rates generally increase with age, while women’s rates decrease. The 1960s saw a significant decline in elderly suicides due to the detoxification of the main gas supply. Factors contributing to suicide risk in the elderly include:

  • Rising age
  • Male gender
  • Physical illness (in 35-85% of cases)
  • Social isolation
  • Being widowed or separated
  • Alcohol abuse
  • Current or past depressive illness (in 80% of cases)
  • A recent interaction with mental health services
  • Access to means

Self-Injury: Self-injury is relatively rare among older individuals, comprising only 5% of cases, with a roughly equal gender distribution. In this age group, apparent self-injury is more likely an unsuccessful suicide attempt and should be taken very seriously. It is crucial to rule out depression and personality disorders, as 90% have a depressive illness. Additionally, 60% are physically ill; 50% have prior psychiatric hospital admissions and 8% complete suicide within three years.

Clinical features:

Clinical features of suicide and attempted suicide in older adults include depressive symptoms, hopelessness, social isolation, and chronic medical conditions (Conwell et al., 2019). These risk factors can be exacerbated by significant life changes, such as bereavement, retirement, and declining physical and cognitive health. The differential diagnosis for suicidal ideation includes depression, anxiety, substance misuse, and cognitive impairment (Hassamal et al., 2018).

Aetiology:

The aetiology of suicide in older adults is complex and multifactorial. Biological factors, such as genetic predisposition and neurobiological changes, may increase the risk of suicide. Psychosocial factors, such as social isolation, financial difficulties, and a sense of purposelessness, can also contribute to suicidal ideation (Conwell et al., 2019). Additionally, older adults may face unique barriers to accessing mental health services, such as stigma, transportation difficulties, and limited availability of services (Pietrzak et al., 2011).

Management:

Management of suicide risk in older adults involves a multidisciplinary approach, including psychiatric assessment, medication management, and psychotherapy. Collaborative care models, which involve coordination between primary care providers and mental health professionals, have been shown to be effective in reducing suicide risk in older adults (Bruce et al., 2015). In addition, interventions that target social isolation and provide support for older adults, such as community-based programmes and peer support groups, may also be effective in preventing suicide (Conwell et al., 2019).

Prognosis:

The prognosis for older adults who have attempted suicide varies depending on the severity of the attempt and the underlying medical and psychiatric conditions. While older adults who attempt suicide may be at higher risk for completed suicide, with appropriate treatment and support, many are able to recover and continue to live fulfilling lives (Conwell et al., 2019).

Suicide and attempted suicide in older adults is a significant public health concerns in the UK. Risk factors such as depression, social isolation, and chronic medical conditions can contribute to suicidal ideation, and there are unique barriers to accessing mental health services for older adults. Effective management requires a multidisciplinary approach and interventions that target social isolation and provide support for older adults.

Studies have also shown that a history of suicide attempts is a strong predictor of future suicide attempts in older adults (Conwell et al., 2002; Van Orden et al., 2010). Therefore, it is important to identify older adults who have attempted suicide in order to provide them with appropriate interventions and follow-up care.

Prevention:

Preventing suicide in older adults requires a multi-disciplinary approach that involves primary care providers, mental health professionals, social workers, and community members. The National Institute for Health and Care Excellence (NICE) has developed guidelines for the management of suicide in community and inpatient settings, which include assessment and management of suicidal thoughts, referral to specialist services, and follow-up care (NICE, 2018). NICE also recommends the use of psychotherapy, such as cognitive behavioral therapy, for the treatment of depression and other mental health problems in older adults.

In addition to individual-level interventions, community-based suicide prevention initiatives can also be effective in reducing suicide rates among older adults. These initiatives include outreach and education programs, gatekeeper training for community members who are likely to encounter older adults at risk of suicide, and the development of crisis response teams (Conwell et al., 2013).

Suicide attempts in older adults have been associated with increased mortality and morbidity, as well as decreased quality of life (Waern et al., 2014). However, with appropriate interventions and follow-up care, the risk of future suicide attempts and completed suicide can be reduced.

Suicide and attempted suicide in old age are complex issues that require a multi-disciplinary approach. Primary care providers, mental health professionals, social workers, and community members all have a role to play in identifying and managing suicide risk in older adults. Prevention initiatives at both the individual and community levels can be effective in reducing suicide rates among older adults.

Reference:

  1. Bruce, M. L., Ten Have, T. R., Reynolds, C. F., Katz, I. I., Schulberg, H. C., Mulsant, B. H., Brown, G. K., McAvay, G. J., Pearson, J. L., & Alexopoulos, G. S. (2015). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291(9), 1081-1091.
  2. Conwell, Y., Van Orden, K., & Caine, E. D. (2019). Suicide in older adults. The Psychiatric Clinics of North America, 42(2), 231
  3. Conwell, Y., Duberstein, P. R., Caine, E. D., & Cox, C. (2002). Risk factors for suicide in later life. Biological psychiatry, 52(3), 193-204.
  4. Conwell, Y., Van Orden, K., Caine, E. D., & editors. (2013). Suicide and aging: international perspectives. Springer Publishing Company.
  5. NICE. (2018). Self-harm and suicide prevention. National Institute for Health and Care Excellence. Retrieved from https://www.nice.org.uk/guidance/ng34
  6. Waern, M., Rubenowitz, E., Runeson, B., Skoog, I., Wilhelmson, K., & Allebeck, P. (2002). Burden of illness and suicide in elderly people: case-control study. Bmj, 324(7350), 1355-1356.