Suicide and the Elderly

Suicide in older adults is a salient concern for geriatric public mental health care in the United States and around the world. The U.S. population age 65 years and older has the highest suicide rates of any age group despite clinical advances in risk factor assessment and intervention strategies targeting older adults at high risk. In 2002, the suicide rate for older adults was 15.6 per 100,000 compared with 11.0 per 100,000 for the entire population, and although older adults comprised only 12.3 % of the population, they accounted for 17.5% (5,548 persons) of all completed suicides (31,635 persons).

A greater degree of premeditation and lethality are observed in the population age 65 years and older. The high mortality in large part reflects access to firearms; more than 70% of elder suicides involve firearms, compared with 57% for the general population. Older adults average 4 attempts for every completed suicide, in contrast to 100 to 200 attempts for every completed suicide in younger age groups. Careful planning, increased vulnerability, decreased reserve capacity to recover, and relative social isolation also contribute to increased lethality in the aged. Older persons are less likely to be discovered after a suicide attempt, and they are less communicative about their suicidal ideation than are younger persons.

Suicide rates in the United States increase dramatically after 65 years of age, due largely to a sharp rise in rates for older men, particularly older White men, who commit more than 80% of all suicides. The rates for older White men are more than five times higher than those for younger and middle-aged adults, and the rates increase every 5 years after 65 years of age. Suicide rates also vary by gender, race, and ethnicity. In 2002, the age-adjusted suicide rate for men age 65 years and older (32.8 per 100,000) was nearly three times higher than the national rate, whereas the rate for older women (4.1 per 100,000) was less than half the national rate. White persons age 65 years and older had a higher suicide rate (16.7 per 100,000) than did Black older adults (5.3 per 100,000). The rate for Asian or Pacific Islander older adults (10.4 per 100,000) were higher than that for Native American Indian or Alaska Natives (4.5 per 100,000), and non-Hispanic or Latino older adults had a higher rate (15.8 per 100,000) than did Hispanics or Latinos (8.8 per 100,000).

Elder suicide is also a global geriatric mental health challenge. Extrapolating from 2002 data, the World Health Organization estimated that approximately 1.53 million people will die by suicide in 2020 and that the rates will be higher for the older population than for other age groups. An analysis of elder (age 65 years and older) suicide rates in 2003 among the 30 countries in the Organization for Economic Co-operation and Development (OECD) revealed that Korea had the highest rate (71 per 100,000) and that Luxemburg ranked second highest (53 per 100,000). Proportionally more Asian countries experienced an increase in elder suicide rates compared with countries in Europe, and the rates are predicted to continue to increase.

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