likely to use more lethal methods. Seventy-six percent of men and 33% of women who completed suicide used firearms, while 3% of men and 33% of women who completed suicide used overdose on medications in the United States (NCHS, 1992).

Risk factors that predispose to suicide differ across the life span. Widowhood (Smith et al., 1988), serious medical illness, and social isolation (Draper, 1994) are more likely to be salient vulnerability factors among older as opposed to younger adults. Whereas affective illness is a vulnerability factor across all age groups (Asgard, 1990; Rich et al., 1986b), the limited findings for dual diagnosis tend to be weak or negative in later life but consistently positive among young people (Asgard, 1990; Barraclough et al., 1974; Rich et al., 1986b). It is important to note that risk factors often co-occur, such as social isolation and depression, or social isolation and drug abuse, or depression and drug abuse. Considerations specific to suicide in the elderly include: (1) the greater likelihood that the elderly will die in or following a suicide attempt; (2) the greater prevalence of indirect self-destructive behaviors such as poor-adherence to treatment regimens in the elderly; and (3) co-morbid conditions that increase suicide risk, including bereavement, depression, and terminal illness.

There is greater likelihood of death in or following a suicide attempt in the elderly. While in younger age groups suicide attempts are more often impulsive and communicative acts, in later life most attempts can be considered “failed suicides.” Older individuals make fewer suicide attempts per completed suicide. The highest suicide attempt to completion rate is in younger women (200:1), compared with 4:1 in the elderly. Suicide attempts in the elderly are more likely to lead to completed suicide than in any other age group: 6% of individuals aged 55 and older died by suicide within a year of a suicide attempt compared to 2% of younger attempters (Gardner et al., 1964). The reasons for this low attempt to completion ratio are complex. The elderly are more medically fragile and frequently live alone, which increases the probability of a fatal outcome. Suicides in older people are often with high intent, long-planned and frequently involve highly lethal methods. The elderly are often less rescuable because of these aspects of their suicidal behavior. Furthermore, suicide methods selected by the elderly are less likely to be affected by short-term modeling effects, such as suicide epidemics. Although most people who kill themselves give direct or indirect warnings, older people are less likely to directly communicate their intent to die. As the elderly are often preoccupied with death and dying, their environment is more likely to miss the indirect warning that they give, such as “nothing is in front of me anymore.” However, contrary to common belief, lack of hope and depression are not part of normal aging, not even in the terminally ill elderly.



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