A recently published paper by Professor Emeritus Diego De Leo from Griffith University has drawn attention to some of the issues surrounding the high rates of suicide in older adults. The perspective paper, published in online research journal, Nature Aging, brings together a collection of research into suicide in older persons and proposes a multi-faceted approach to suicide prevention in this age group.
Suicide in older persons is most predominant in men; in Australia men over 85 years have the highest age specific suicide rate of any age/gender group (36.2 per 100,000), but accounts for the smallest proportion of male suicides (3.1%).1
Further, suicide death rates in older adults are likely to be underestimated. It can be challenging to determine whether causes of death such as falls, or taking too much or not enough of prescribed medications, are a deliberate act. Professor De Leo also highlighted unreported cases of ‘silent suicide’, such as those due to voluntarily stopping eating and drinking (VSED), which are generally not registered as suicide cases.
Older age can often be accompanied by factors that increase a person’s risk of suicide, including loneliness, feelings of abandonment and loss of meaning for life. However, the paper warns against overly simplistic views of suicide in older persons; often suicide in older age is presumed to be a rational act and rightful choice because of some of the negative situations that can present as we get older. For example, frailty, physical illness, loss of autonomy and dependency, and loss of a partner and friends are thought to inevitably be characterised by severe depression, however, this view reflects prejudices about the value of life in older age.
In the paper, Professor De Leo argues that while depression is a known major risk factor for suicidal behaviour (including in older age) it can often be used as the ‘scapegoat’ for any suicidal behaviour, minimising the complexity of an older person’s problems.
“In old age, people tend to be more often viewed with this way of thinking, which reflects anti-aging attitudes that are still widespread, even among doctors themselves,” said Professor De Leo.
From the normalisation of depression, to the reluctance to intervene clinically, ageism limits the care provided to older adults. In a media release from Griffith University, Professor De Leo said, “Ageism is currently a powerful barrier to the proper care of older adults. We need to fight it much more aggressively than what we are currently doing.”
In order to prevent suicide in older adults, Professor De Leo suggests targeting the social determinants of health, as well as combating stigma and discrimination. He argues that suicide prevention interventions for older persons needs to be expanded, and more attention directed to mitigating risk factors of suicide, for example, financial insecurity or loneliness, and strengthening protective factors, such as supporting quality social interactions. Professor De Leo proposes an integration of social prescriptions with pharmacotherapy for older adults, however, this type of intervention will require more research effort to understand and implement.
“Successful aging requires promoting a culture of resilience and adaptation to the different stages of life as well as to the changes that come with advancing age,” said Professor De Leo.
This in turn provides examples for younger people to live a meaningful life and maintain connection to the community.
Australian Bureau of Statistics [Internet]. Australia: 2021. Causes of Death, Australia; 29 September 2021 [cited 18 May 2022]. Available from: https://www.abs.gov.au/statist...