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Cited by 565Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGrief, Bereavement, and Mental Health

Suicide in older adults

Open access
Conwell, Yeates, Van Orden, Kimberly, Caine, Eric D.·2011·Psychiatric Clinics of North America
DOI 10.1016/j.psc.2011.02.002PMC PMC3107573
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Abstract

This article makes the case that late-life suicide is a cause for great concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large. It reviews the evidence for factors that place older adults at risk for suicide, or protect them from it. The authors introduce the notion that suicide preventive interventions target individuals or groups at different levels of risk at different points on the developmental trajectory toward death by suicide, offering examples and recommending their strategic, combined application to create an effective, community-level response to the mounting problem of suicide in older adults.

Integrity signals

Registry

Crossref · 10.1016/j.psc.2011.02.002

Cites

70 of 70 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 87 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    For both black and white women, suicide rates rise through midlife and fall thereafter.

    “For both black and white women, rates rise through midlife and fall thereafter; black men experience two peaks of risk, one in young adulthood and the second in old age.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Reductions in suicide rates among youth, young adults, and those over age 65 largely accounted for the US decrease.

    “Reductions in rates among youth, young adults, and those over age 65 largely accounted for the decrease.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Black men experience two peaks of suicide risk, one in young adulthood and another in old age.

    “For both black and white women, rates rise through midlife and fall thereafter; black men experience two peaks of risk, one in young adulthood and the second in old age.”
    Quote in the paperNot a substantial claim
  • Interpretationreasoning

    Longitudinal cohort studies with enough suicides for meaningful analyses are unfeasible because suicide is a relatively rare event.

    “Longitudinal cohort studies in which sufficient numbers die by suicide to allow meaningful analyses are unfeasible because suicide is a relatively rare event.”
    Quote in the paperSubstantial claim
  • Interpretationnone given

    Risk factors taken individually give weak guidance for suicide prevention because their ability to predict individual suicide deaths is poor.

    “Taken individually, however, risk factors offer relatively weak guidance for implementation of successful suicide prevention initiatives because, at the individual level, their ability to predict who will die by suicide is so poor.”
    Quote in the paperSubstantial claim
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Findingnone given

    Since 1986, US older adult suicide rates dropped by over 35 percent, while rates among ages 35 to 64 rose by almost 20 percent over the last 8 years.

    “since 1986 rates have dropped among older adults in the United States by over 35 percent, even as suicide rates have risen by almost 20 percent over the last 8 years among those ages 35 to 64.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The overall US suicide rate fell slowly but steadily from 1985 through 2000, after which it began to rise marginally.

    “the overall rate of suicide fell slowly but steadily from 1985 through 2000, after which it has begun to rise again marginally (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Centers for Disease Control and Prevention

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    White men have higher suicide rates at every point in the life course, peaking in the oldest age group at over 45 per 100,000 per year, over four times the overall age-adjusted US rate of 11.5 per 100,000 per year.

    “Most striking is the higher rate at every point in the life course for white men, rising to a peak in the oldest age group of over 45 per 100,000 per year, over 4 times the nation's overall age adjusted rate of 11.5 per 100,000 per year (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Centers for Disease Control and Prevention

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In most countries that report suicide statistics to the World Health Organization, suicide rates rise with age for both men and women and peak in old, old age.

    “In most countries throughout the world that report such statistics to the World Health Organization, suicide rates tend to rise as a function of age for both men and women to a peak in old, old age (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] World Health Organization—Mental Health

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    As the baby boom cohort enters older adulthood in large numbers, suicide rates in men and women are anticipated to rise again, producing substantial increases in the absolute numbers of older adult suicides.

    “we anticipate that the rate of suicide in men and women will rise again, resulting in substantial increases in the absolute numbers of senior citizens dying by their own hands.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Birth cohorts carry a characteristic propensity to suicide as they age.
    • Rests on an assumption: The baby boom cohort has had relatively higher suicide rates at any given age than earlier or subsequent birth cohorts.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    It remains unclear how applicable lessons from suicidal ideation and attempts in later life are to completed suicide.

    “It remains unclear how applicable lessons learned from the study of suicidal ideation and attempts in later life are to the understanding of completed suicide.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    The leading edge of the baby boom cohort will reach age 65 in 2011, fueling rapid growth over the next 20 years in the older adult population.

    “As well, the leading edge of the baby boom cohort will reach age 65 in 2011, fueling rapid growth over the next 20 years in the total size of the older adult population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Serious relationship and financial problems distinguished older adult suicides and near fatal suicide attempters from controls in New Zealand, findings replicated in Sweden.

    “Serious relationship and financial problems distinguished older adult suicides and near fatal suicide attempters from controls in New Zealand (20), findings replicated by Rubenowitz and colleagues in Sweden (16).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] Beautrais, 2002, A case–control study of suicide and attempted suicide in older adults, Suicide Life Threat Behav source

      Not checked in the free run.

    • cites [16] Rubenowitz, 2001, Life events and psychosocial factors in elderly suicides—a case–control study, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Harwood and colleagues compared completed suicides with controls who died of natural causes in hospital, whereas other listed studies used living community controls.

    “Harwood and colleagues compared completed suicides with controls who died of natural causes in hospital (12), whereas the other listed studies used living community controls.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Harwood, 2001, Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case–control study, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Specific factors in psychiatric illness, social connectedness, physical illness, and functional capacity appear to influence suicide risk in older adults.

    “Results indicate that specific factors in domains of psychiatric illness, social connectedness of the older person with his or her family, friends, and community, physical illness and functional capacity appear to influence risk for suicide.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The cognitive mechanisms underlying relationships between cognitive control, problem solving, and suicidal behavior remain obscure.

    “The cognitive mechanisms underlying relationships between cognitive control, problem solving, and suicidal behavior remain obscure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Patients with three physical illnesses had approximately a threefold increase in estimated relative risk for suicide compared with those with no diagnosis, and those with seven or more illnesses had approximately nine times greater risk.

    “They found that patients with three physical illnesses had approximately a threefold increase in estimated relative risk for suicide compared with subjects who had no diagnosis, whereas older adults who had seven or more illnesses had approximately nine times greater risk for suicide.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Juurlink, 2004, Medical illness and the risk of suicide in the elderly, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Psychiatric illness is present in 71% to 97% of older adult suicides, with affective disorder being the most common.

    “Psychiatric illness is present in from 71% to 97% of suicides, with affective disorder being the most common.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premiseown data

    The highest odds ratios for suicide in older adults were observed for mood disorders, with lower and more mixed results for substance abuse and dependence, schizophrenia, and anxiety disorders.

    “The highest ORs were observed for mood disorders, with lower ORs and generally more mixed results in those studies that examined substance abuse and dependence, schizophrenia, anxiety disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Li and Conwell found that men with severe and uncontrolled pain were at especially high risk for self injury ideation, whereas no such association was observed in women.

    “Li and Conwell found that men with severe and uncontrolled pain were at especially high risk for self injury ideation, whereas no such association was observed in women (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Li, 2010, Pain and self-injury ideation in elderly men and women receiving home care, J Am Geriatr Soc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Keilp and colleagues found that adult suicide attempters performed poorly on frontal executive tasks relative to controls, similar to King and colleagues' observation in older adult attempters.

    “Keilp and colleagues found that adult suicide attempters performed poorly on frontal executive tasks relative to controls (33), a similar observation to one made by King and colleagues in older adult attempters (34).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Keilp, 2001, Neuropsychological dysfunction in depressed suicide attempters, Am J Psychiatry source

      Not checked in the free run.

    • cites [34] King, 2000, A neuropsychological comparison of depressed suicide attempters and nonattempters, J Neuropsychiatry Clin Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Dombrovski and colleagues' finding of deficits in depressed attempters supports the notion that late life suicidal behavior is in some instances associated with impaired decision-making based on impaired ability to access and use prior experience, which may relate to underlying age-related ventral prefrontal pathology.

    “Their finding of deficits in depressed attempters supports the notion that late life suicidal behavior is in some instances associated with impaired decision-making based on impaired ability to access and use prior experience, which in turn may be related to underlying age-related ventral prefrontal pathology (36).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Arango, 1997, Postmortem findings in suicide victims. Implications for in vivo imaging studies, Ann N Y Acad Sci source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Harwood and colleagues reported that dementia or delirium was significantly less common in suicides than controls.

    “Harwood et al reported, for example, that the diagnosis of dementia or delirium was significantly less common in suicides than controls”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Harwood, 2001, Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case–control study, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    In the struggle with acute and chronic medical illnesses and functional decline, some older persons become socially disconnected.

    “In the struggle with acute and chronic medical illnesses and functional decline, some become socially disconnected.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Relative suicide risk increases among those who are less resilient and develop early symptoms of psychiatric illness.

    “Relative risk increases among those who are less resilient and develop early symptoms of psychiatric illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Spirituality and religiousness have been cited as protective factors against the development of depression and suicidality, a relationship that might be understood as a function of connectedness at a spiritual or instrumental level.

    “Spirituality and religiousness have been cited as protective factors against the development of the depression and suicidality (19, 45), a relationship that might also be understood as a function of connectedness at a spiritual or instrumental level”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Duberstein, 2004, Poor social integration and suicide: fact or artifact? A case–control study, Psychol Med source

      Not checked in the free run.

    • cites [45] Dervic, 2004, Religious affiliation and suicide attempt, Am J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Differences in suicide risk by gender and race/ethnicity with aging might be understood in part by stronger ties to supportive others that women and some minority communities have capacity to establish relative to men and white race groups in general.

    “differences in suicide risk as a function of gender and race/ethnicity with aging might be understood in part by the stronger ties to supportive others that woman and some minority communities have capacity to establish relative to men and white race groups in general (46).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Goldsmith, 2002

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The Interpersonal Theory of Suicide proposes that thwarted belongingness and perceived burdensomeness are two proximal causes of the desire for suicide, with a particularly dangerous level of suicidal desire resulting from their simultaneous presence.

    “It proposes that there are two proximal causes of the desire for suicide -- thwarted belongingness and perceived burdensomeness -- with a particularly dangerous level of suicidal desire resulting from the simultaneous presence of both factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Van Orden, 2010, The interpersonal theory of suicide, Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Knowledge of factors that increase or decrease suicide risk in older adults is necessary but not sufficient for effective design of preventive interventions.

    “Knowledge of factors that increase or decrease risk for suicide in older adults is necessary but not sufficient for the effective design of preventive interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Psychological autopsy studies have shown that older adult suicides were significantly less likely to have had a confidante, more likely to live alone, and less likely to participate in community activities, be active in organizations, or have a hobby.

    “PA studies have shown that older adult suicides were significantly less likely to have had a confidante (41), more likely to live alone than their peers in the community (7), and less likely to participate in community activities (19), be active in organizations, or have a hobby (16).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [41] Miller, 1977, A psychological autopsy of a geriatric suicide, J Geriatr Psychiatry

      Not checked in the free run.

    • cites [7] Barraclough, 1971, Suicide in the elderly: recent developments in psychogeriatrics, Br J Psychiatry

      Not checked in the free run.

    • cites [19] Duberstein, 2004, Poor social integration and suicide: fact or artifact? A case–control study, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Suicidal elders have been characterized as timid and seclusive, hostile, rigid, and with an independent style.

    “Suicidal elders have been characterized as timid and seclusive (47), hostile, rigid and with an independent style (47, 48).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [47] Batchelor, 1953, Attempted suicide in old age, BMJ source

      Not checked in the free run.

    • cites [48] Clark, 1993, Narcissistic crises of aging and suicidal despair, Suicide Life Threat Behav source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Interpersonal Theory proposes that risk factors for suicide, including psychiatric illness, elevate risk by causing or exacerbating thwarted belongingness, perceived burdensomeness, and/or acquired capability.

    “The Interpersonal Theory proposes that risk factors for suicide, including psychiatric illness, elevate risk for suicide by causing or exacerbating thwarted belongingness, perceived burdensomeness and/or acquired capability.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Van Orden, 2010, The interpersonal theory of suicide, Psychol Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    Duberstein and colleagues hypothesize that older adults low in Openness to Experience are at risk for suicide because they are less well equipped socially and psychologically to manage aging, and less likely to be recognized as distressed and needing intervention.

    “Duberstein and colleagues hypothesize that older adults low in OTE are at risk for suicide because they are less well equipped socially and psychologically to manage the challenges of aging, and less likely to be recognized as being in distress and need of intervention (51)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Duberstein, 2001, Are closed-minded people more open to the idea of killing themselves?, Suicide Life Threat Behav source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Widespread use of risk and protective factors would produce many false positives leading to unnecessary, intrusive, expensive interventions, and many false negatives leaving at-risk elders undetected.

    “The large number of “false positives” that resulted from their widespread use would lead to unnecessary, intrusive, and expensive interventions for those who did not need them, while many “false negatives” results would leave at-risk elders undetected and unprotected.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Some older adults become more frankly depressed and hopeless, and the most vulnerable enter the peri-suicidal state.

    “Some become more frankly depressed and hopeless, the most vulnerable of whom enter the peri-suicidal”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    On a foundation of personality characteristics, neurobiological factors, and cultural context, each older person encounters stressful events.

    “On a foundation of personality characteristics, individual neurobiological factors, and cultural context, each older person encounters stressful events.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Interventions to prevent the development of the suicidal state are especially critical in older adults.

    “the implications are clear: interventions to prevent the development of the suicidal state are especially critical in this age group.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Suicidal processes unfold over time, with risks accumulating through progressively more proximal risk factors and/or loss of protective buffers.

  • May combine two claims.

    Premisecitation

    In Oyama's meta-analysis of five quasi-experimental studies in Japanese rural regions with high suicide rates (greater than 160 per 100,000), overall risk was significantly reduced in men and women when follow-up was conducted by a psychiatrist, but only in women when follow-up was conducted by general practitioners.

    “Overall, risk was significantly reduced in men and women when follow-up was conducted by a psychiatrist, but only in women when follow-up was conducted by general practitioners.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Oyama, 2008, Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan, Community Ment Health J source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The high proportions of female subjects in these trials leave open the question of how effective the interventions would be in reducing attempted and completed suicide among men, the group at greatest risk in later life.

    “the relatively high proportions of female subjects leaves open the question of how effective they would be in reducing attempted and completed suicide among those at greatest risk in later life, men.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The effect of collaborative care in reducing suicide among elderly men remains to be determined.

    “Collaborative care delivered by primary care providers informed by mental health expertise has shown promise as an indicated preventive intervention, although its effect in reducing suicide among elderly men remains to be determined.”
    Quote in the paperSubstantial claim
35 of 35

  • The paper relies on this without support.

    Birth cohorts carry a characteristic propensity to suicide as they age.

    “Birth cohorts tend to carry with them a characteristic propensity to suicide as they age.”

  • The paper relies on this without support.

    The baby boom cohort has had relatively higher suicide rates at any given age than earlier or subsequent birth cohorts.

    “The “baby boom” cohort, those born between 1946 and 1964, has had relatively higher suicide rates at any given age than earlier or subsequent birth cohorts.”

  • The paper relies on this without support.

    Risk states are dynamic and wax and wane over short periods of time.

    “risk states are dynamic -- they wax and wane over short periods of time.”

  • The paper relies on this without support.

    Identification of risk and protective factors can guide prevention efforts.

    “identification of risk and protective factors can guide our prevention efforts.”

  • The paper relies on this without support.

    Affective illness often goes undetected and inadequately treated in primary care settings.

    “However, affective illness often goes undetected and inadequately treated in primary care settings.”

  • The paper relies on this without support.

    The baby boom cohort has carried a greater propensity to suicide than earlier or later birth cohorts.

    “fueled by aging of the baby boom cohort that life-long has carried a greater propensity to suicide than earlier or later birth cohorts”

  • The paper relies on this without support.

    Depression is an important pathogenetic factor in late-life suicide.

    “The importance of depression as a pathogenetic factor in late life suicide makes its detection and effective treatment of paramount importance.”

  • The paper relies on this without support.

    Elderly men are by far the highest risk group for suicide in the U.S.

    “who are by far the highest risk group in the U.S.”

  • The paper relies on this without support.

    The older adult population is anticipated to increase rapidly.

    “Anticipated rapid increases in the size of the older adult population”

  • The paper relies on this without support.

    There are no randomized controlled trials of universal prevention of suicide.

    “Although there are no randomized controlled trials of universal prevention of suicide”

  • The paper relies on this without support.

    Examples of selective preventive interventions for suicide are rare.

    “Examples of selective preventive interventions for suicide are rare”

  • The paper relies on this without support.

    Suicidal processes unfold over time, with risks accumulating through progressively more proximal risk factors and/or loss of protective buffers.

    “Risks mount over time with the accumulation of progressively more proximal risk factors and/or the loss of protective buffers.”
12 of 12

Claims other papers make about this one

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Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Hawton, 1998, The psychological autopsy approach to studying suicide: a review of methodological issues, J Affect Disord, 50, 269
  2. Barraclough, 1971, Suicide in the elderly: recent developments in psychogeriatrics, Br J Psychiatry, 87

Cited by

Sorted by citations

Related

Authors
Conwell, Y., Van Orden, K., & Caine, E. D.
Affiliations
University of Rochester Medicine (US)
Corresponding author
Conwell, Yeates
ORCID
Venue
Psychiatric Clinics of North America
Publisher
Elsevier BV
Published
2011-06
Volume
34
Issue
2
Pages
451-468
ISSN
0193-953X (ISSN-L)
DOI
10.1016/j.psc.2011.02.002
PMC
PMC3107573
OpenAlex
W2087539512
Semantic Scholar
7cb87465569ae52771b5f449fa4313e9bfe8818f
Cited by
555
References
67
Citations by year
2026: 25 · 2025: 33 · 2024: 41 · 2023: 32 · 2022: 40 · 2021: 52 · 2020: 83 · 2019: 42 · 2018: 33 · 2017: 42 · 2016: 27 · 2015: 36 · 2014: 35 · 2013: 23 · 2012: 8
FWCI
3.23
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatric Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5t32mh020061-25)
  • National Institute of Mental Health (T32 MH20061, T32-MH020061)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Keywords
suicide, older adults, late-life suicide, suicide risk factors, suicide prevention, suicide prevention interventions, community response
MeSH terms
Suicide Prevention, Aged, Aging, Humans, Prognosis, Risk Factors, Social Support, Stress, Psychological, Suicide, Comorbidity

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