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Saving Lives in New York Volume 2: Approaches and Special Populations
ness of suicidal ideation and behavior in
late life.
Reduction of late life suicides is a realistic
goal. Creative partnerships of primary care
providers, the mental health care sector,
aging services, and other agencies and
insurers will be needed to achieve it.
II. Action Steps
1. State policy should reflect the fact that
the suicide rate for elderly (>65)males is
the highest for any sub-population in
New York.
2. Depression is more prevalent among
elders than the general population.
However, it is not a normal part of the
aging process and should be treated
appropriately. Validated, self-administered
voluntary screening tools for
depression should be routinely used
with elderly patients in primary care
health offices. Diagnosis and treatment
of depression in elders should be
aggressively pursued in the primary
care practitioner’s office.
3. Gatekeeper programs and telephone
support (warm lines) systems should be
implemented and evaluated as “indicated”
preventive interventions for isolated,
high-risk elders. These services should
be part of a comprehensive network of
offerings, including case-finding, acute
response, multi-disciplinary assessments,
and other support services.
4. Elders tend to employ more lethal
means of self-harm in the act of suicide.
Restricting access to such means
of self-harm as firearms and household
poisons could save lives.
5. Since the vast majority of elders who
die by suicide have seen their health
care provider within 30 days of their
death, it is essential that such visits
include an assessment of suicidal
thoughts, intent and plans they may
have.
6. Chronic pain and debilitating physical
illnesses are frequent precursors to suicide
among elders. Death of a spouse,
loss of companions and socialisolation
are also contributing risk factors.
7. Greater emphasis should be placed in
medical, nursing and social service
training on recognizing and treating
depressive disorders and suicidal states
in elders.
8. Research should seek to determine
whether treatments designed to mitigate
hopelessness and related effects in
older people are effective in lowering
suicide risk.
9. Include high-risk suicidal elders in controlled
clinical trials of preventive interventions,
while guaranteeing the ethical
conduct of the research and the
rights of the subjects themselves.
III. Prevalence
Older people in the United States have a
higher suicide rate than any other segment
of the population. While the elderly constitute
12.7% of the population in 1998, they
accounted for 19.0% of completed suicides
(Murphy, 2000). The suicide rate for the
general population was 11.3/100,000.
Combined rates for men and women of all
races rose through young adulthood to a
high of 15.5/100,000 in the 40-44 year age
group, plateaued through mid-life, and rose
to a peak of 22.9/100,000 in 80-84 year
olds. The increased suicide risk with aging
is accounted for in large part by the strikingly
high rates for white males in later life.
In 1998, the group at highest risk was
white males aged 85 and older, whose rate
of 62.7/100,000 was almost six times the
nation’s age-adjusted average (National
Center for Health Statistics, 2001).
In contrast, rates for women peak in midlife
and remain stable, or decline slightly,
thereafter. This pattern is unlike patterns in
most other countries of the world where,
according to statistics reported by the
World Health Organization, later life is the
highest risk for both men and women
(Pearson and Conwell, 1995). Suicide rates
for the general population have remained
relatively stable throughout the second half
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