Identifying Geriatric Patients at Risk for Suicide and Depression

S uicide represents a major cause of death in the United States, accounting for 31,000 deaths per year and an overall rate of 11.2/100,000 persons/year. 1-3 Few realize that there is a bimodal age distribution to the suicide curve. 4 The elderly and adoles-cents/young adults are the groups at greatest risk. 3,5 About one-fifth of all successful suicides are committed by persons over age 65, 6 with men over the age of 69 having the highest rate of completed suicide. 7 In 1988, the rate of completed suicide for individuals age 80-84 was 26.5/100,000 per-sons/year, compared to a rate of 12.4/100,000 persons/year for the general population. 8 An interesting trend, which has occurred since the early 1990s when managed care became prevalent, is an increase in number of suicides. 3 Recent studies show completed suicide rates of between 40 and 60/100,000 persons/year in men over the age of 80. 3,4,9,10 Elderly patients, particularly men, are more likely to successfully commit suicide when an attempt is made, because they are less likely to " cry for help, " have access to potentially harmful medications, and may use more lethal means (gunshots or hangings). 3,11 In addition, they are less physically resilient due to comorbid medical conditions. 3,5,8 A recent paper notes that more than 75% of the elderly who were successful in committing suicide had been recently diagnosed with a first episode of major depression, which was judged to be only " moderately severe " by their physicians. 8 Approximately 75% had seen their primary care physician within one month of their completed suicide. 12 Suicide risk factors in elderly populations include presence of mental and/or emotional disorders and moderate to heavy alcohol consumption. 3,5,6,12-14 These two factors are consistent with general population studies, which indicate that more than 90% of all people who commit suicide have a diagnosable psychiatric disorder at time of death. 3,5,8 Other identifiable risk factors in the elderly include quality-of-life issues, separation, divorce, recent death of a spouse, high comorbid medical disease rates, and being male and Caucasian. Comorbid