Introduction

Suicide in old age is an important topic for several reasons. First, rates are proportionately higher in older people in almost all countries of the world where reasonably reliable statistics can be obtained. For example,(1) in 1992-1993 in Estonia where suicide incidence is among the highest, the overall rate in males per 100 000 total population was 64.1, but in elderly men (over the age of 74 years) the rate was 90.0. In the United States where suicide is neither especially common nor rare in the same period the overall rate for males per 100 000 total population was 20.1, but 40.1 in elderly men. Males over 75 years of age in all countries except Poland are the group with the highest incidence of all.(2) Rates for older women are usually less than for their male counterparts. Although rates vary from year to year and birth cohort to cohort, this pattern of high incidence in elderly males has tended to be constant. It is therefore surprising that much more research has been conducted on suicide, suicidal behaviour, and suicidal thinking in younger than in older people.

A second reason for the importance of suicide is that the proportion of older people in the population is rising worldwide. Indeed, the increase in developing countries is likely to be even greater than in developed countries. In the United Kingdom about 5 per cent of the population were over 64 years of age at the turn of the nineteenth to twentieth centuries. At the end of the twentieth and beginning of the twenty-first centuries the proportion is around 16 per cent. It follows, therefore, that unless suicide prevention becomes a great deal more effective than at present, more and more older people are likely to kill themselves in the coming years.

As with younger people, completed suicide in old age may be seen as part of a continuum from suicidal thinking through deliberate self-harm (which does not lead to death), to completed suicide. An added component within this continuum for older people is that of 'indirect self-destructive behaviour', such as refusal to eat and drink or 'turning one's face to the wall' which is clearly intended to hasten death. Finally, although this section does not deal with euthanasia and related issues, assisted suicide in people with terminal illness such Alzheimer's disease and cancer may also be seen as part of the suicide continuum.

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