Protective factors against suicide among older adults

A systematic review of psychosocial protective factors against suicide and suicidality among older adults

by Myung Ki, Sylvie Lapierre, Boeun Gim, Minji Hwang, Minku Kang, Luc Dargis, Myoungjee Jung, Emily Jiali Koh and Brian Mishara

Published 2 February 2024

What's the issue?

Suicide prevention for older people in Australia is a priority area. Statistics released annually by the Australian Bureau of Statistics show that males aged over 85 years have the highest suicide rate of all age groups (32.7 deaths per 100,000 persons in 2022). This is considerably higher than the suicide rate for all males, which was 18.8 per 100,000 persons.

Understanding perceptions of death, suicide and suicidal ideation in older adults is paramount to prevention. For older adults, research suggests that talking about death can sometimes be part of accepting the aging process. For this reason, it can be challenging to determine if an older person is experiencing suicidal thoughts, or is just processing the aging process and inevitable end of life that comes with being human. Furthermore, suicidal thinking is difficult to define, and no universal scale exists.

Older adults can be placed at an increased risk of suicide due to a range of factors including isolation, a changing sense of purpose and identity, experiencing grief from the loss of loved ones, and the effects of ageism. Research shows that older people who experience ageism have a higher rate of active suicidal thoughts.¹

Research also suggests that suicide may be considered by older people as a way to face hardships and challenges associated with older age.²

What was done?

Researchers from South Korea and Canada conducted a systematic review of the literature with the aim of synthesising knowledge on protective factors in older adults, and identified what factors are associated with reduced suicide risk k in older adults.

The researchers conducted the review in two steps:

• The first step was to select protective factors against suicide in older adults. Protective factors were selected through a scoping review of key terms from studies focusing in this area.
• Once the list of protective factors had been established, the researchers searched the literature to determine the strength of relationship between the protective factors and preventing suicide in older adults.

There was no exclusion of peer-reviewed research based on language of publication, year and country. Research that was excluded included case studies and other literature that did not provide information about the strength of a relationship between a protective factor and suicide.

The researchers categorised the search results by population group, study design, research measures, and suicidal thinking outcomes. Further distinction was made by the researchers around passive active suicidal thinking. Literature results that included statements such as ‘would be better off dead’, ‘rather be dead’, ‘wish to be dead’ or ‘tired of living’ was classified as passive suicide thinking. Research that featured terms such as ‘ending one’s life’, ‘killing oneself’ or ‘taking one’s life’ were classified as active suicidal thinking.

Additionally, each study was scored on strength of evidence from poor to good.

What was found?

From the search results, 70 studies were included in the literature review.

Thirteen protective factors were identified in the literature, including:

The majority of studies included in the review used representative samples. Most studies were conducted in Asia (n = 38) and North America (n = 14), while some were conducted in Europe (n = 4), Oceania (n = 7), and the Middle East (n = 6), but only one in Africa, and one in South America.

The research results showed that:

• Purpose in life was found to have a protective effect against suicidal thoughts.
• Purpose in life gave people a greater sense of control which lowered the risk of suicide.
• Older people who felt their lives were meaningful were less likely to have any type of suicidal thoughts.
• A sense of belonging was linked to lower levels of suicidal thoughts.
• Feelings of hopelessness were linked to suicidal thoughts.
• Older adults with adaptive coping strategies tended to exhibit less suicidal thoughts. Adaptive coping strategies include things like religious coping and positive reframing.
• Problem-focused coping such as altering the circumstance that caused distress did not have a great link with suicidal thoughts for older adults, meaning this may be less relevant for older adults compared to other age groups.
• High levels of perceived control were linked to lower levels of passive suicidal thoughts.
• Good levels of resilience showed a significant protective association against suicidal thoughts.
• Levels of social support showed inconsistent results as a protective factor against suicidal thoughts. This may be because relying on support of others can diminish older adults’ sense of competence and increase feelings of burdensomeness.
• One study showed that of types of social participation, religious participation was linked to lower levels of suicidal thoughts, but other types of social participation such as meeting with friends or playing instruments did not protect.

The researchers also state the main limitation for the review was the identification of protective factors was difficult as there is strong overlap between many interpersonal factors and social constructs. The review was also unable to capture the presence of protective factors in older adults who had attempted or died by suicide.

Why are findings important?

Suicide rates in older adults in Australia are higher than any other age group. By strengthening protective factors we can support a reduction in suicide risk. The protective factors for older adults are similar to other age groups across the lifespan, however having a purpose in life and levels of resilience were found to have the highest impact on preventing suicidal thoughts. These findings suggest potential value in including both purpose-in-life and resiliency when developing interventions for vulnerable older adults.³

The researchers also suggest variables such as character strengths (perseverance, creativity, gratitude, hope, humour, bravery, zest) might be considered as protective factors that can contribute to resilience. The researchers encourage future research to explore protective factors to suicide across all age groups when examining prevention approaches, acknowledging that suicide research often focuses on deficits when exploring risk.