Case-control study of suicide attempts in the elderly

Suicide and dementia: A systematic review and meta-analysis of prevalence and risk factors

Dementia is a global health concern with increasing numbers of people living long enough to develop dementia. People with dementia (PwD) may be particularly vulnerable to suicidality. However, suicide in PwD has not been thoroughly explored. The objective of this review was to determine the prevalence and risk factors of suicide in PwD. Five databases were searched from inception to July 2023. Peer-reviewed publications reporting prevalence, risk factors or quantitative summary data for suicide outcomes in PwD were included. Random effects models were used to calculate the pooled prevalence and effect sizes. 54 studies met inclusion criteria. In PwD, the point prevalence of suicidal ideation was 10 % (95 %CI=6 %;16 %), 2-year period prevalence of suicide attempts was 0.8 % (95 %CI=0.3 %;2 %), 10-year period prevalence of suicide attempts was 8.7 % (95 %CI=6.0 %%;12.7 %) and the incidence of death by suicide 0.1 % (95 %CI=0.1 %;0.2 %). Compared to not having dementia, a diagnosis of dementia increased risk of suicidal ideation (OR=1.62[95 %CI=1.17;2.24]) but not risk of suicide attempt (OR=1.77 [95 %CI=0.85;3.69]) or death by suicide (OR=1.30 [95 %CI=0.81;2.10]). People with moderate dementia had significantly increased risk of suicidal ideation than those with mild dementia (OR=1.59[95 %CI=1.11;2.28]), younger PwD were at increased risk of dying by suicide (OR=2.82[95 %CI=2.16;3.68]) and men with dementia were more likely to attempt (OR=1.28[95 %CI=1.25;1.31]) and die by suicide (OR=2.88[95 %CI=1.54;5.39]) than women with dementia. This review emphasises the need for mental health support and suicide prevention in dementia care, emphasising tailored approaches based on age, symptoms, and being male.

Understanding complex causes of suicidal behaviour among graduates in Bangladesh

This study utilizes both fieldwork and desk-based discourse analysis of newspaper reports to investigate the concerning number of suicides among graduates in Bangladesh. According to some reports, a majority of suicide cases involve young adults who are either currently studying at university or have recently completed their degree (between the ages of 20 and 32). This research contends that patriarchal social expectations in Bangladesh place significant pressure on young adults to secure well-paying jobs to support their families and uphold their family's status, which can have a negative impact on their mental health. Furthermore, this article identifies additional risk factors that contribute to the high suicide rates among graduates in Bangladesh. These factors include unemployment, poverty, relationship problems, drug addiction, political marginalization, and the stigma of shame, all of which can cause low self-esteem and suicidal thoughts. Moreover, the research suggests that families in Bangladesh have not been providing adequate support to their young members when facing challenges in life. On the contrary, families have added to the pressure on young adults, which can be attributed to joiner's theory of the effect of industrialization on family norms and values.

Mild cognitive impairment is associated with passive suicidal ideation in older adults: A population-based study

OBJECTIVE

To investigate the association between MCI and passive/active suicidal ideation in a population-based sample of older adults.

METHOD

The sample included 916 participants without dementia acquired from the two population-based studies Prospective Population Study of Women (PPSW) and the H70-study. Cognitive status was assessed using a comprehensive neuropsychiatric examination and classified according to the Winblad et al. criteria: 182 participants were classified as cognitively intact, 448 had cognitive impairment but did not fulfill MCI criteria and 286 were diagnosed with MCI. Passive/active suicidal ideation was assessed using the Paykel questions.

RESULTS

Passive or active suicidal ideation (any level) was reported by 16.0% of those with MCI and 1.1% of those who were cognitively intact. MCI was associated with past year life-weariness (OR 18.32, 95% CI 2.44-137.75) and death wishes (OR 5.30, 95% CI 1.19-23.64) in regression models adjusted for covariates including major depression. Lifetime suicidal ideation was reported more frequently in MCI (35.7%) than in cognitively intact participants (14.8%). MCI was associated with lifetime life-weariness (OR 2.90, 95% CI 1.67-5.05). Among individuals with MCI, impairments in memory and visuospatial ability were associated with both past year and lifetime life-weariness.

CONCLUSION

Our findings suggest reports of past year as well as lifetime passive suicidal ideation to be more frequent among individuals with MCI compared to those cognitively intact, indicating that individuals with MCI may constitute a high-risk group for suicidal behavior.

Suicide Attempt Aftercare in Geriatric Patients: A Pilot Project

Hospitalized patients after suicide attempts gave informed consent to a postvention project after discharge. A continuous caregiver contacted the subjects monthly by phone for a period of 1 year. In case of significant worsening and reoccurrence of suicidal ideations, immediate re-admission was possible. Ten subjects 65 years and older and hospitalized because of suicide attempts were included. The sample was presumed to be at high risk for repeated suicides because of somatic comorbidities and social isolation. Affective state was monitored using the PHQ-9. At the end, the social situation was assessed using the MILVA inventory. Of 16 patients screened for participation only 10 gave informed consent. Six subjects completed the study per protocol. Three subjects died (one suicide, two deaths by natural causes) and one dropped out for other reasons. At the end of the study, all completers appreciated the continuous guidance. While the affective state remained relatively stable in most subjects during the observed period, activities and social isolation could not be modified. Only one patient was readmitted during the project. Phone contacts proved to be feasible in the follow-up after suicide attempts especially in old age, because of the limited mobility of this vulnerable population.

The Association of Physical and Mental Illness and Self-Harm Resulting in Hospitalization: A Population-Based Study of Older Adults in South Korea

Self-harm injury among older adults is a pressing problem that demands social attention in South Korea. This study sought to identify the association between physical and mental illness and hospitalization following self-harm injuries, compared to non-self-harm injuries, among older adults living in Korea. We analyzed individuals aged 65 and older who were admitted to hospitals either for self-harm or non-self-harm from a population-based survey of the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS). A logistic regression analysis was performed. Compared with non-self-harm-related hospitalization, self-harm hospitalization was associated with higher odds of depression, other disorders of the nervous system, malignancies, alcohol misuse and dependence, and drug-related dependence. Dementia, anxiety disorder, diabetes, arthritis, cerebral palsy, and other paralytic syndromes had a lower likelihood of leading to self-harm than non-self-harm hospitalization. The findings of this study can inform medical professionals to identify older adults with a heightened risk of self-harming behavior leading to hospitalization.

Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia

IMPORTANCE

Little is known about the association between mild cognitive impairment (MCI) and suicide. Most studies have focused on dementia and suicidal behavior, with inconsistent results.

OBJECTIVES

To examine the association between diagnoses of MCI and dementia and suicide attempt and explore potential psychiatric moderators and to assess whether the association differs based on recency of diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide cohort study integrated 5 national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services and included all VA medical centers in the US. US veterans 50 years or older with MCI diagnoses at baseline (October 1, 2011, to September 30, 2013) or earlier (October 1, 2007, to September 30, 2011) were propensity matched 1:3 with (1) patients with dementia diagnoses and (2) patients without either diagnosis based on demographic characteristics and the Charlson Comorbidity Index. Diagnoses of MCI or dementia were defined as recent if there were no diagnosis codes before baseline. Data were analyzed from March 16, 2020, to January 15, 2021.

MAIN OUTCOMES AND MEASURES

Information on suicide attempts through December 31, 2016, provided by the National Suicide Prevention Applications Network (nonfatal) and Mortality Data Repository (fatal).

RESULTS

The study population of 147 595 participants included 21 085 patients with MCI, 63 255 with dementia, and 63 255 in the propensity-matched comparison group. Participants had a mean (SD) age of 74.7 (10.3) years, 143 353 (97.1%) were men, 4242 (2.9%) were women, and 127 065 (86.1%) were non-Hispanic White. A total of 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) attempted suicide during follow-up, compared with 253 patients without MCI or dementia (0.4%). Exploratory analyses revealed that no psychiatric comorbidity moderated the association between MCI or dementia and suicide attempt. After adjustment for demographic details and medical and psychiatric comorbidities, risk of suicide attempt was consistently highest for patients with a recent MCI or dementia diagnosis, with adjusted hazard ratios (HRs) of 1.73 (95% CI, 1.34-2.22; P < .001) for recent MCI and 1.44 (95% CI, 1.17-1.77; P = .001) for recent dementia. Risk associated with prior diagnosis was not significant (HR for prior MCI, 1.03 [95% CI, 0.78-1.36; P = .84]; HR for prior dementia, 1.14 [95% CI, 0.95-1.36; P = .15]).

CONCLUSIONS AND RELEVANCE

This study found that older adults with recent MCI or dementia diagnoses were at increased risk of attempting suicide. These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.

Self-harm in older adults: systematic review

BACKGROUND

Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.AimTo systematically review characteristics of self-harm in older adults.

METHODS

A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings.

RESULTS

A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations.

CONCLUSIONS

Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.Declaration of interestNone.

Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings

OBJECTIVE

The study investigated the prevalence of depressive and anxiety disorders and suicide risk in geriatric outpatients in tertiary care hospitals.

MATERIALS AND METHODS

An observational, cross-sectional study was conducted with 803 participants aged 60 and above attending geriatric outpatient clinics in tertiary care hospitals in Thailand. Participants were assessed using DSM-IV-TR criteria to calculate the prevalence of deressive and anxiety disorders, and their suicide risk. Montreal Cognitive Assessment (MoCA), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support, Core Symptom Index (CSI), 15-item Geriatric Depression Scale (GDS-15), Neuroticism Inventory (NI) and the Revised Experience of Close Relationships Questionnaire (ECR-R) were administered. Quality of life was assessed using the EuroQoL (EQ-5D).

RESULTS

The prevalence rate for depressive disorders was 23.7%, anxiety disorders was 6.4%, and current suicide risk was 20.4%. PSS, MSPSS, GDS, CSI, and NI scores were significantly higher in all clinical disorders and a suicide group compared with nonclinical subjects. MoCA and ECR-R did not differentiate between clinical disorder and nonclinical samples. Comparing all four outcomes, the EQ-5D differed most in the mixed depressive-anxiety disorder and nonclinical groups (t = 12.20, p < .001).

CONCLUSION

The present findings revealed a high prevalence of depression, anxiety and suicidality among elderly patients attending tertiary care hospitals. Perceived stress, perceived social support, and neuroticism scores were significantly higher in this group. Role of sociodemographic, clinical and psychosocial variables as risk factors for these clinical disorders should be further examined.

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

BACKGROUND

Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.

METHODS

A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.

RESULTS

SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.

CONCLUSION

To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

Nursing diagnosis for Risk of Suicide in elderly: integrative review

OBJECTIVE

To analyze the specialized literature regarding the risk factors in nursing diagnosis for suicide risks in elderly.

METHOD

This is an integrative literature review carried out during June 2015 in the following databases with no time limit: MEDLINE, PsycINFO and CINAHL.

RESULTS

A total of 80 full papers were analyzed. It was suggested the inclusion of 23 risk factors in NANDA-I taxonomy: apathy; unrest; low self esteem; carelessness with medication; Inability to ask for help; Inability to express feelings; suicidal plan; rigidity; functional disability; visual problems; sadness; hostility; anxiety; failure; frustration; unhappiness; dishonor; frequent visits to a physician with unclear symptoms; social deprivation; social devaluation; psychological violence; Interfamilial violence; and financial violence.

CONCLUSION

The risks for suicide presented in NANDA-I taxonomy need to be refined and adapted to the elderly reality. Furthermore, a review is also recommended for the risk factors not included in this classification.

Tentativas de suicídio entre pessoas idosas: revisão de literatura (2002/2013)

Foi realizada revisão da literatura sobre as principais questões associadas às tentativas de suicídio em pessoas idosas. O estudo abrangeu o período de 2002 a 2013, a partir das bases Medline, Lilacs, PubMed, PsychInfo, SciELO, Biblioteca Virtual em Violência e Saúde da Bireme e Biblioteca Virtual de Saúde Pública (BVS/SP). Foram selecionadas 105 referências e analisadas 75. Os estudos se ampliaram na América do Norte, Europa e Ásia, são raros na América Latina e inexistem na África. Predominam investigações epidemiológicas. Os principais fatores predisponentes são doenças graves e degenerativas, dependência física, distúrbios e sofrimentos mentais e depressão severa. A depressão é o mais relevante fator explicativo associado a sofrimento físico crônico, perdas, abandonos, solidão e conflitos familiares. Diferenças de gênero, etnia, avanço da idade, questões sociais e traços culturais foram encontrados. O tema em pauta é da mais alta relevância para o Sistema Único de Saúde, mas não tem sido abordado no Brasil nem na teoria e nem na prática. Que esta revisão seja base para estudos empíricos que favoreçam o apoio à saúde do idoso e promova um envelhecer saudável.

Reflections of older adults on the process preceding their suicide attempt: a qualitative approach

The study explores the reflections of older adults on the process preceding their suicide attempt. Data were gathered using in-depth interviews with eight older inpatients who had attempted suicide. Grounded theory methodology was used for data analysis. They described their life and the self as disrupted after experiencing a loss, loneliness, loss of control, and unwillingness to continue living the current life. The findings suggest that the concurrence of these constructs precedes a suicide attempt in later life.

The association between social relationships and self-harm: a case-control study in Taiwan

BACKGROUND

Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case-control study.

METHODS

The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models.

RESULTS

A total of 124 case-control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94).

CONCLUSIONS

More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere.

Literature-based recommendations for suicide assessment in the emergency department: a review

BACKGROUND

Suicidal ideation and attempted suicide are important presenting complaints in the Emergency Department (ED). The Joint Commission established a National Patient Safety Goal that requires screening for suicidal ideation to identify patients at risk for suicide.

OBJECTIVES

Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment.

METHODS

A review of literature was conducted using PubMed to determine important elements of suicide assessment in adults, ages 18 years and over, in the ED. Four typical ED cases are presented and the assessment of suicide risk in each case is discussed.

RESULTS

The goal of an ED evaluation is to appropriately determine which patients are at lowest suicide risk, and which patients are at higher or indeterminate risk such that psychiatry consultation is warranted while the patient is in the ED. Emergency clinicians should estimate this risk by taking into account baseline risk factors, such as previous suicide attempts, as well as acute risk factors, such as the presence of a suicide plan.

CONCLUSION

Although a brief screening of suicide risk in the ED does not have the sensitivity to accurately determine which patients are at highest risk of suicide after leaving the ED, patients at lowest risk may be identified. In these low-risk patients, psychiatric holds and real-time psychiatric consultation while in the ED may not be needed, facilitating more expeditious dispositions from the ED.

Prevalence and correlates of suicidal thought and self-destructive behavior among an elderly hospital population in Iran

BACKGROUND

Few studies have examined suicidal ideation and behavior in hospitalized physically ill elderly patients, a group potentially at high risk. Our aim was to investigate the prevalence and risk factors for suicide ideation, and direct and indirect self-destructive behaviors among a sample of elderly inpatients.

METHODS

A cross-sectional study was conducted in 2009; 650 inpatients aged 60 years and over were screened from various medical services in teaching hospitals affiliated to Shiraz University of Medical Sciences in Iran. Suicidal ideation and behavior were measured with the Beck Scale for Suicidal Ideation (BSSI) and the Harmful Behavior Scale (HBS). Depression was measured with the Geriatric Depression Scale (GDS), medical burden with the geriatric version of the Cumulative Illness Rating Scale (CIRS-G), life events with the Paykel Life Event Scale, and social support with the Perceived Social Support Scale.

RESULT

Of the 650 patients screened with a mean age of 70.5 years (SD ± 7.5), 570 met inclusion criteria and of these 123 (21.6%) reported suicidal ideation on the BSSI and 80 (14.4%) had at least one self-destructive behavior included in the HBS. There was a significant correlation between suicide ideation and harmful behaviors (r = 0.503, p = 0.001). In a regression analysis, depressive symptoms, increased burden of medical conditions, marital status, history of substance use, history of traumatic life events, lack of perceived social support, and poor education were associated with both suicide ideation and harmful behavior. From demographic variables, living without a spouse and unemployment were predictors of suicidal ideation and behavior.

CONCLUSION

Hospitalized, physically ill elderly patients have high rates of suicidal ideation and self-destructive behavior and these vary according to psychosocial and clinical factors. The general hospital is therefore a potential site for the recognition of suicidal individuals and implementation of proximal suicide prevention strategies.

A study of the combined effects of the EHD3 and FREM3 genes in patients with major depressive disorder

Major depressive disorder (MDD) is a common chronic mental disease with diverse clinical presentation. Although the genome-wide association study (GWAS) has remarkably facilitated the understanding of genetic mechanisms of MDD at a deep molecular level, the combined effect of these disease-underlying genes still needs further investigation. A total of 1,062 unrelated patients with MDD and 992 unrelated healthy subjects were recruited from a Chinese Han population to test 16 MDD-associated genes identified by GWAS. A tag SNP-based linkage-disequilibrium map was then constructed over the loci that showed MDD association in the study sample. Of the 16 genes tested, EHD3 and FREM3 were associated with MDD in the Chinese population. The conditional test showed disease association for the rs619002(EHD3)-rs1112714(FREM3) combination (P = 0.0059) and for the rs644926(EHD3)-rs13130123(FREM3) combination (P = 0.007), of which a reduced risk was found for the rs619002(G)-rs1112714(T) combination (OR = 0, P = 4.02 × 10(-6) ) and for the rs644926(A)-rs11938298(G) combination (OR = 0.12, 95% CI = 0.035-0.39, P = 3.85 × 10(-6) ). Quantitative trait analysis revealed that rs13130123 in the FREM3 locus was strongly associated with the insomnia early symptom in patients carrying the rs619002(G) allele (P = 0.001) and those carrying the rs644926(A) allele (P = 0.00077). The combined effect of the EHD3 and FREM3 genes may play an important role in developing MDD. © 2012 Wiley Periodicals, Inc.

Prospective cohort study of suicide attempters aged 70 and above: one-year outcomes

BACKGROUND

Most elderly persons who attempt suicide suffer from depression. This study aimed to investigate one-year outcomes in suicide attempters aged 70+, and to identify predictors of these outcomes.

METHODS

101 persons (mean age 80) who were hospitalized after a suicide attempt were interviewed at baseline and followed for one year by record linkage. Face-to-face interviews were carried out with 71% of those who were alive after one year (60 out of 85). Outcome measures included major/minor depression, Montgomery-Asberg Depression Rating Scale (MADRS) score, repeat non-fatal/fatal suicidal behavior and all-cause mortality.

RESULTS

One half (52%) of all those who were interviewed scored <10 on the MADRS at follow-up. Among those with major depression at baseline, two thirds (26 out of 39) no longer fulfilled criteria for this disorder. Factors associated with non-remission of major depression (MADRS ≥ 10) included higher baseline depression and anxiety scores, higher suicide intent and lower Sense of Coherence. There were two suicides and six non-fatal repeat attempts. The relative risk of death (any cause) was 2.53 (95% CI = 1.45-4.10, p<0.001).

LIMITATIONS

This is a naturalistic study; participants received non-uniform treatment as usual. The proportion with repeat suicidal behavior was lower than anticipated and the study was thus underpowered with regard to this outcome.

CONCLUSIONS

Half of the surviving attempters were free from depressive symptoms at one-year follow-up and there were relatively few repeat attempts. However, all cause mortality remained high in this elderly cohort.

Suicides in late life

Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.