Assessment and treatment of suicidal behaviour in later life

Abstract

Older adults have high rates of suicide worldwide. In many industrialized nations, the ratio of non-lethal suicidal behaviour to deaths by suicide for adults aged 65 or older is less than 4:1, compared with approximately 20:1 for the general population. Older adults may be more likely than younger adults to die by suicide because they are less likely to receive mental health treatment, including psychotherapy. This chapter reviews the known risk factors for death by suicide, and discusses assessment and treatment considerations for at-risk individuals. Recommendations are offered for improving risk assessment, treatment, and prevention initiatives. Before proceeding, we offer four caveats. First, generalizations about suicide among 'older people' should be made with caution. The age at which one is considered to be 'older' varies across cultures and from one era to the next. Secondly, it is often assumed that suicidal ideation is rare in the absence of a diagnosable mental disorder, but the conceptualization and measurement of mental disorders in individuals with chronic physical illness (e.g., congestive heart failure), neurodegenerative diseases (e.g., Parkinson's disease), and acute life-threatening illness (e.g., cancer) remain ambiguous, and ethical debates exist as to when and how to intervene in these diverse contexts. This chapter rests on the assumption that thoughts of suicide and a wish for hastened death are appropriate targets for intervention even in the absence of a major mental disorder. Thirdly, risk factors may be context-specific. Risk factors that appear to be robust in some clinical, sociocultural, and historical contexts might be associated with lower risk in other settings and contexts. Finally, the risk factors for non-lethal suicidal behaviour and death by suicide might differ, with corresponding implications for treatment and prevention. Not surprisingly, more studies have been published on suicidal behaviour than on death by suicide. This chapter focuses principally on death by suicide. (PsycINFO Database Record (c) 2015 APA, all rights reserved). (chapter)