Suicide prevention in older people
Scope of the guidance
The personal review and associated RCGP Factsheets give tips on
recognising suicidal tendencies in older people and responding
effectively to those at-risk.
Sources
Beeston, D. Older people and suicide. West Midlands:
Staffordshire University Centre for Ageing and Mental Health,
2006.
www.westmidlands.csip.org.uk/silo/files/suicide-in-elders-report.doc
RCGP Fact Sheet
www.westmidlands.csip.org.uk/primary-care/primary-care/-gp-fact-sheet-suicide-prevention-in-elders.html
Key points
1. Background
- In the UK about 500 people over 65 years old
commit suicide each year; the figure may be higher as deaths in
some older people who have committed suicide may have been put down
to pre-existing physical illness.
- People over the age of 65 years old are more
successful than any other age group at taking their own lives.
About one in two attempted suicides by those aged 65 years and over
result in death in the European population compared to one in
fifteen attempts by the general population.
- Almost two-thirds of adults who take their
own life have been in touch with a GP or primary care professional
in the month before their death.
- The strongest predictor of eventual suicide
for an older person is a past attempt/s.
- Around three quarters of over 65 years olds
who commit suicide have a diagnosable mental disorder at the time
of their death.
- Older people who commit suicide are less
likely to act impulsively as younger people, and more likely to use
lethal means (eg hanging, jumping).
2. Behavioural clues that older person is contemplating
suicide
- Previous failed suicide attempt
- Hoarding medication
- Making or suddenly changing a will
- Sudden interest in giving things away and
starting to put affairs in order
- Consulting GP with vague non-specific
complaints
- Self neglect
- Agitation
3. Verbal clues that older person is contemplating
suicide
- Maybe directly expressing the wish to die or
take their life, to you as their GP or close relatives and
friends.
- Indirect talk, such as referring to the
future as if they will not be around to see or participate in
things.
4. Situational and symptomatic clues
that older person is contemplating suicide
- Life event: eg death of spouse/partner or
close friend, retirement, moving house, diagnosis of a serious
illness
- Depression or other mood disorder
- Sudden recovery from a deep depression
- Sleep disturbance and changes in eating
habits
- Withdrawing from company and social
networks
5. Interventions
- Identify depression in older people. Administer a simple
screening tool to identify depression (eg PHQ9) in an older person
with any of the verbal, behavioural or situational clues listed
above.
- Signpost lonely older people to clubs, activities,
opportunities and support.
- Some older people with mild form of depression respond well to
exercise activities or guided self-help programmes.
- Brief cognitive behavioural therapy or counselling may help in
mild depression.
- Antidepressant therapies may be useful when simpler methods
have failed to produce an adequate response.
Practical
tips for the busy GP >>
EGP 1. May 2008