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Suicide Prevention and Treatment in Older Adults

In the past decade, specific treatments have been shown to reduce suicidal behavior in a variety of psychiatric conditions, from bipolar disorder to schizophrenia.

Published October 1, 2001

By Fred Moreno, Jill Stolarik, and Jennifer Tang
Academy Contributors

Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention

Older adults continue to be the highest risk group for suicide in the United States. Thanks to great advances in the psychopharmacologic treatment and psychotherapy of major psychiatric disorders, however, suicide rates have fallen in recent years. However, as demographers predict that the U.S. is set to experience a growing population of older people, some experts believe that treatment and prevention must take a broader approach, addressing recognition and effective intervention at the earliest possible points in the causal sequence that leads to suicide in an older person.

In “Suicide in Elders,” a report published in The Clinical Science of Suicide Prevention (Volume 932 of the Annals of the New York Academy of Sciences), authors Yeates Conwell and Paul R. Duberstein of the University of Rochester Medical Center, Center for the Study and Prevention of Suicide, discuss suicide prevention and treatment for older adults. One of their observations is that suicide prevention should be a national priority, given that an unprecedented number of baby boomers (those born between 1946 and 1964) will soon be entering the ranks of an age group that has had historically higher rates of suicide than the rest of the population.

The report cites past data from the Centers for Disease Control and Prevention. The 10-year period, 1980–1990, was the first decade since the 1940s that the suicide rate for older residents rose instead of declined. This trend has recently reversed itself—though it is not clear how future projections will hold. White men over the age of 50 still have the highest rate of suicide—comprising 10% of the population, they are responsible for 33% of the suicides.

The Baby Boom Cohort

Conwell believes that because of the size of the baby boom cohort, its historically higher risk for suicide at all ages, and the added risk associated with entering later life, “both the rate and absolute number of suicides may rise dramatically in coming decades. We must be prepared with preventive strategies. We believe that recognition and effective treatment of depressive illness in older adults is at the top of the list.”

One way to further reduce suicide rates is to reach out to an older population that is less likely to seek help, according to Annals co-editor Herbert Hendin, who is medical director of the American Foundation for Suicide Prevention. “It is a misconception that older adults are less responsive to psychotherapy and medication,” he said. “Most older adults who receive treatment respond very well.”

Annals co-editor J. John Mann of the New York State Psychiatric Institute agrees. “Most patients who commit suicide have not received adequate treatment,” he said. “For example, 60% of suicides occur in the context of a mood disorder and yet only about 12% of those suicides received a minimally effective dose of an antidepressant. Most depressed patients in the United States are not receiving adequate doses of antidepressants, even if they have a history of a prior suicide attempt, an indicator of higher risk for suicide.”

Suicide Attempts by the Elderly More Lethal than in Other Age Groups

Suicidal behavior among older people is more lethal than that in other age groups. While there may be as many as 200 suicide attempts for each completed suicide among adolescents and young adults, among older people there may be only four attempts per completed suicide. Older adults are more physically vulnerable than younger people; therefore, any self-injurious act is more likely to result in death. Secondly, older adults are more likely to live alone. Also, older adults are less likely to warn others of their suicidal intentions, and use more potentially lethal methods, such as firearms.

Suicide risk factors for older adults include: psychiatric and physical illnesses; functional impairment; social isolation; and specific personality traits such as neuroticism, timidity, hostility, and a rigid, fiercely independent lifestyle with low openness to experience.

According to Duberstein, openness to experience is one personality trait that may serve to decrease suicide risk in people who have other risk factors. “People who are open and show a higher willingness to experience new things have a greater will to live,” he said. “In contrast, people who are low in openness are less likely to see that they have multiple options. For them, suicide may be the only way out of their current predicament.”

In the past decade, specific treatments have been shown to reduce suicidal behavior in a variety of psychiatric conditions: bipolar disorder, schizophrenia, and borderline personality disorder.

Experts predict that we should be able to learn how effective our treatments of depression are in preventing suicide and in what way they need to be supplemented by treatments aimed at regulating associated affects and other behaviors that complicate depressive disorders

Also read: The New Wave of AI in Healthcare


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