Suicide in centenarians: the international landscape

Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood

Background

High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear.

Methods

Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults.

Results

The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals.

Discussion

This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.

Elderly suicides in Turkey

Due to the unique physical and psychosocial characteristics of this age group, it is expected that the characteristics of elderly suicides are different from other groups. Knowing the characteristics of elderly suicides guides prevention strategies. The objective of this study was to evaluate the demographic characteristics, methods and reasons for suicide in elderly suicide cases using the data of the Turkish Statistical Institute between 2002 and 2019. Of the completed suicides among older adults, 4,208 (74%) cases were men and 1,481 (26%) were women. Crude suicide rates of all elderly age groups were higher than the general population. Illness was the most common reason for suicide. The second leading cause of suicide was marital conflicts in women, while financial difficulties were observed in men. Hanging was the most common method in both genders. It is remarkable that the use of gunshot considerably increases as years progress and the ratio of men (n:962) to women (n:16) reach 60. Considering these findings together with epidemiologic data predicting that this increase in the elderly population will almost double within less than 30 years, it is apparent that suicide is a major issue among older adults.

EUROLD: preliminary results of the ecological study on suicide and its associated socioeconomic variables in people over 85 in Europe

The present study aims to compare the suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries. In addition, the study aims to perform a preliminary analysis of which socioeconomic factors could explain higher suicide rates in this age group in Europe. An analysis of the Eurostat database has been made. In this pilot phase, certain socioeconomic variables representative of people over 85 years of age were chosen based on criteria of suitability, according to the bibliography available for other regions and availability of the information provided. The conditional suicide rate in this age group with respect to the overall suicide rate in each country has been calculated. Furthermore, Spearman correlations between the suicide rates in this age group and the chosen socioeconomic factors were performed. Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, suicide in this age group was associated with different economic ratios, the old-age dependency ratio, and the self-perceived health ratio. After performing a multivariate regression, the model that best explained the differences between the European countries included the variables "old-age dependency ratio" and "economic impossibility to buy new clothes ratio." Different socioeconomic factors, specifically poverty and economic inequality, added to the old-age dependency ratio, could explain huge differences between the suicide rates in people over 85 years of age in the different European countries.

Late-life suicide in an aging world

Suicide is an important problem among older adults and in particular older men. Risk factors for suicide in older adults include the loss of a loved one, loneliness and physical illness. Suicide in older adults is often attributed to the development of depression due to bereavement or loss of physical health and independence. However, suicide prevention in old age requires avoiding overly simplistic therapeutic approaches. This Perspective discusses the impact of social determinants of health, cultural narratives and the coronavirus disease 2019 (COVID-19) pandemic on suicide among older adults and proposes strategies for a multifaceted approach to suicide prevention.

Suicide in late life: A viewpoint

Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. With the aging of the world population and the growing number of mononuclear families, the risk of an increase in isolation, loneliness and dependency does not appear ungrounded. The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.

To Live or Die: What to Wish at 100 Years and Older

Previous research has shown that will to live is a strong predictor for survival among older people, irrespective of age, gender, and comorbidities. However, research on whether life at age 100 is perceived as worth living is limited. The available literature has presented evidence for good levels of positive attitudes and life satisfaction at such an advanced age, but it has also suggested that a longing for death is common. This study aimed to add to the existing data on this matter by exploring centenarians' will to live and the associated factors. The sample comprised 121 centenarians (mean age, 101 years; SD, 1.63 years), 19 (15.7%) of whom were males, from two centenarian studies (PT100). Answers to open questions were analyzed to identify the centenarians' will to live and the reasons behind it. Three groups were created (willing to live longer, not willing to live longer, no clear positioning) and further analyzed in terms of sociodemographic characteristics, health status, social functioning, and well-being. Of the total sample, 31.4% expressed willingness to live longer, 30.6% did not, and 38% presented no clear positioning. The presence of the Catholic religion (God) was referred for centenarians in all three groups. Annoyance, uselessness, loss of meaning, disconnection, and loneliness were the most common justifications for being reluctant to live longer. Positive valuation of life and good self-rated health, followed by having a confidant and reduced pain frequency, were the factors associated with being willing to live longer. The results of the study contribute to the understanding of the psychological functioning of individuals with exceptional longevity, particularly concerning the factors behind willingness to live at such an advanced age.

Suicide prevention in older adults

BACKGROUND

Suicide among older adults is a multifactorial problem with several interrelated factors involved that vary with age, gender and culture. The number of suicides is highest in those aged 70 years or older in almost all regions of the world. With the increase in life expectancy, and the decrease in mortality due to other causes of death, we could expect the absolute number of older adults' suicide continue increasing.

METHODS

Review of the literature on suicide protective factors of suicide among older adults.

RESULTS

Improvements on social determinants of health and the timely detection and early treatment of affective disorders are key interventions. Prevention based on community actions and training of gatekeepers may have positive impact. Community programs that promote a sense of usefulness, belonging and that contribute to preserve social integration should be encouraged. Governments should develop the improvement of retirement programs and the development of support systems. The access to general health and mental health services should be facilitated and Primary Care professionals should receive proper training to detect and manage older persons at risk. Actively promoting a culture of coping to different stages of life and to the changes imposed by the advancing of age should form the essential part of a process bringing to better successful aging avenues.

CONCLUSIONS

Suicide prevention in older adults should broaden its focus and pay attention to the many socio-environmental conditions that may be relevant in older age, especially social isolation, financial security and physical health.

Risk of Neuropsychiatric Diseases According to the use of a Leukotriene Receptor Antagonist in Middle-Aged and Older Adults with Asthma: a Nationwide Population-Based Study Using Health Claims Data in Korea

BACKGROUND

Although a leukotriene receptor antagonist (LTRA) is an effective drug for asthma, there has been increasing concern regarding neuropsychiatric (NP) adverse reactions. However, evidence for this association is not sufficient, especially in adults.

OBJECTIVE

To investigate the association between the use of an LTRA and the risk of developing NP diseases in adults with asthma.

METHODS

We performed a nationwide, retrospective, cohort study using data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS). We selected asthma patients with no previous use of an LTRA, and NP outcomes were defined by the registration of certain International Classification of Diseases, 10th Revision codes (F00-F59) during follow-up. We obtained the hazard ratio (HR) for NP diseases according to the use of an LTRA.

RESULTS

Overall, 61,571 asthma patients without LTRA experience were enrolled, and 12,168 of them took an LTRA during the follow-up period. In the adjusted model, the HR for newly diagnosed NP diseases showed no significant difference according to use of an LTRA (HR 1.01; 95% confidence interval 0.83-1.23; P = .952). Subgroup analysis for associations between duration of LTRA use and risk of NP disease indicated no significance for all groups (<6, 6 to <12, 12 to <24, and ≥24 months). Common NP diseases included dementia (75.4% vs 76.1%), mood disorders (12.68% vs 12.80%), and panic disorders (5.63% vs 3.53%) in LTRA users and non-LTRA users, respectively, and there was no significant difference in the prevalence of each NP disease in either group.

CONCLUSIONS

The current study showed the use or duration of LTRA exposure was not associated with the occurrence of NP diseases in Korean adult asthmatics.

Suicidal behaviour in older age: A systematic review of risk factors associated to suicide attempts and completed suicides

In older age, several observational studies investigated risk factors for suicide attempts/completed suicides; however, contrasting evidence came from population-based setting. In the present systematic review, we described through a narrative synthesis the significant associations existing among risk factors and suicide attempts/completed suicides in subjects aged >65 years. From the 39 population-based studies selected in six different databases until February 15, 2021, we analyzed the most frequent 28 risk factors for suicidal behaviour. The risk factors more associated to suicide attempts than other variables frequently related to suicidal behavior in older age were: depressive disorders, methods employed to self-harm (particularly poisoning), and psychotropic drug utilization followed by psychological factors and disability. Moreover, male sex, violent methods to self-harm, any psychiatric disorder (depression, anxiety and bipolar disorders), a poor medical condition, stressors/bereavement, and living alone appeared to be more significant for predicting completed suicides in late life. In older age, efforts for suicide prevention should be based on strategies to assess and treat psychiatric disorders along with psychological interventions, particularly in males.

[Prevention of suicide of the elderly in France. To a multimodal strategy against depression and isolation: CQFDi]

ISSUE

Suicide is a major problem of public health around the world, and if suicidal mortality rates have declined in recent years, the elderly remain a category of the world's population at major risk of suicide. Seventeen percent of deaths by suicide across the world are individuals over the age of 65. The existence of suicidal ideas for an individual in this age group increases the risk of suicide attempt in the year by 34. In France, about a little less than a quarter of suicides belong to persons over 60-years-old. More risk factors found in the international literature are in the foreground of mental disorders and in particular the major depression episode, then secondarily addictions, neuro-degenerative disorders as well as pain and other diseases. Depression is found in 60% to 90% of suicides. We notice also that older people privileged the general practitioner as interlocutor to discuss their problems and worries much more than psychiatrists or psychologists. In fact, two-thirds of the elderly who committed suicide had consulted their general practioner in the month prior to suicide and half in the 10 last days. That raises the question of the identification of depression and the evaluation of suicidal risk. On the other side, there is an abundant literature about psychosocial risk factors especially on the influence of isolation and lack of social support as well as on conflicts and family losses. In France, more than 4 million of the elderly live alone. So, while the world population is increasing and life expectancy lengthens, it is important to already act for elderly suicide prevention.

PERSPECTIVES

Suicide prevention actions whose efficacity have been demonstrated around the world are designed as part of multimodal strategies combining several levers of action. The consensual recommendations for prevention of elderly suicide recommend the association of actions on the reduction of depression and combating social isolation in connection with the training of front-line actors such as general practitioners. As a result of these experiments and recommendations, the first francophone multimodal strategy was developed to act both on depression and social isolation: the Coopération Québec France sur la dépression et l'isolement (CQFDi) program which will be implemented in France and Quebec in 2019.

CONCLUSION

It has been proven that multimodal suicide prevention strategies allow a reduction in the number of suicides. The CQFDi program focuses on at risk of suicide population and aims to reduce the suicide rate of elderly people in France.

Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

OBJECTIVE

To investigate sociodemographic and gender factors associated with suicide and suicide attempts among new users of antidepressants aged 75 and above.

DESIGN

Register-based cohort study.

SETTING

National population-based cohort of Swedish residents aged ≥75 years.

PARTICIPANTS

185 225 patients who initiated antidepressant medication between 1 January 2007 and 31 December 2013 were followed until 31 December 2014.

MAIN OUTCOME MEASURES

Suicide and suicide attempts. Fine and Gray regression models were used to analyse the sociodemographic factors (age, country of birth, marital status, education level, last occupation, income and social allowance) associated with suicidal behaviours in the entire cohort and by gender.

RESULTS

During follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) for suicide were lower among older age groups (aSHR 0.73, 95% CI 0.53 to 0.99 for those 85-89 years; and aSHR 0.53, 95% CI 0.33 to 0.86 for those ≥90 years). A similar pattern was observed for suicide attempts. Suicide attempts were more common among those born in foreign countries (aSHR 1.58, 95% CI 1.16 to 2.15 for those born in another Nordic country; and aSHR 1.43, 95% CI 1.06 to 1.93 for those born in non-Nordic countries). In the gender-stratified analyses, being single or divorced, and born in another Nordic country was associated with a higher risk of suicide among men. Educational and occupational history and being born in a non-Nordic country influenced risk of suicidal behaviours in women.

CONCLUSION

Suicidal behaviours occurred more commonly among new users who were 'younger' old adults and those with foreign background, suggesting that those groups might require greater support when initiating antidepressant therapy. Our findings suggest the need for gender-specific, multifaceted approaches to the prevention of suicidal behaviours in late life.

Suicide in older adults: a comparison with middle-aged adults using the Queensland Suicide Register

BACKGROUND

Globally, suicide rates increase with age, being highest in older adults. This study analyzed differences in suicides in older adults (65 years and over) compared to middle-aged adults (35-64 years) in Queensland, Australia, during the years 2000-2012.

METHODS

The Queensland Suicide Register was utilized for the analysis. Annual suicide rates were calculated by gender and age group, and odds ratios with 95% confidence intervals were examined.

RESULTS

In Queensland, the average annual rate of suicides for older adults was 15.27 per 100,000 persons compared to 18.77 in middle-aged adults in 2000-2012. There were no significant changes in time trends for older adults in 2002-2012. Suicide methods differed between gender and age groups. Older adults who died by suicide were more likely to be male, widowed, living alone or in a nursing home, and out of the work force. The prevalence of untreated psychiatric conditions, diagnosed psychiatric disorders, and consultations with a mental health professional three months prior to death was lower in older adults than middle-aged adults. Somatic illness, bereavement, and attention to suicide in the media were more common among older adults than middle-age adults. Older females were particularly more likely to pay attention to suicide in the media.

CONCLUSION

Our findings show older adults who died by suicide were more likely to experience somatic illnesses, bereavement, and pay attention to suicide in the media compared to middle aged. Preventing suicide in older adults would therefore require holistic and comprehensive approaches.

Suicide rates in five-year age-bands after the age of 60 years: the international landscape

BACKGROUND

There is paucity of studies examining suicide rates in narrow five-year age-bands after the age of 60 years. This study examined suicide rates in eight five-year age-bands between the age of 60 and 99 years because this will allow more precise comparison between the young old (60-79 years) and the oldest old (80+ years) age groups.

METHODS

Data on the number of suicides (International Classification of Diseases - ICD-10 codes, X60-84) in each of the eight five-year age-bands between the age-bands 60-64 years and 95-99 years in both gender for as many years as possible from 2000 were ascertained from three sources: colleagues with access to national data, national statisics office websites and email contact with the national statistics offices. The population size for the corresponding years and age-bands was estimated for each country using data provided by the United Nations website.

RESULTS

In men, suicide rates continued to increase for each of the seven five-year age-bands from 60-64 years to 90-94 years age-band, and then declined slightly for the 95-99 year age-band. In women, suicide rates continued to increase for each of the six five-year age-bands from 60-64 years to 85-89 years age-bands, and then declined slightly for the 90-94 years and 95-99 years age-bands.

CONCLUSIONS

The overall global suicide rates for each of the eight five-year age-bands are sufficiently large for them to constitute a public health concern. This is especially important given the ongoing rise in the elderly population size and the paucity of data on risk and protective factors for suicide in the five-year age-bands after the age of 60 years.