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13% were in situations they experienced as
untenable, like financial ruin or guilt.
10% were depressed following worsening of their
health, or of a disability.
6% had either dementia or another psychiatric
illness; in three quarters of these people
depression symptoms were present.
Conversely, protective factors may include family
and social support systems, involvement in
activities, financial security, good mental health,
and effective coping mechanisms.
has examined the effectiveness of interventions
to reduce the risk of suicide in later life.
strategies for suicide prevention need to be ‘whole
of life,’ given the distal risk factors, and, as no
single prevention strategy is likely to be successful
alone, a multi-faceted, multi-layered approach is
This should include optimal detection
and management of depression and of high risk
individuals, as available evidence indicates that this
can reduce suicidal behaviour. A frail elder’s ability to
devise and carry out a suicide plan should also not
Better identification and treatment of depression
in elderly people is a priority, given its importance
in late-life suicide.2,7,8,16 Identifying and diagnosing
depression in elderly people can be challenging due
to communication difficulties caused by hearing
or cognitive impairment, other comorbidities with
physical symptoms similar to those of depression,
and a reluctance to discuss their feelings or
seek help from a health professional.
diagnosed, lifestyle changes should be encouraged,
acknowledging that these can be challenging
to initiate in individuals with depression.
changes include increasing physical activity to the
extent that is possible, and increasing engagement
in pleasurable activities and social interactions.
Pharmacotherapy and/or psychotherapy will
generally be required. The selective serotonin-
reuptake inhibitors (SSRIs) are considered first-
line pharmacotherapy. Cognitive behavioural
therapy focuses on identifying and reframing
negative, dysfunctional thoughts while increasing
participation in pleasurable and social activities.
Apart from depression, clinicians should also
be vigilant for physical illness, pain, functional
impairment and social disconnectedness.
Encouraging social connectedness is important.
Suicide and its prevention are complex, without
easy solutions. A raised awareness amongst
pharmacists is a good starting point. They can
also support elderly individuals and their doctors
through the identification and referral of depression,
optimal management of physical conditions and
improvement of pain control.
1. Elderly suicide alarming. Aust Nursing & midwifery
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Psychiatry Rep 2011;13(3):234–41 .
3. Australian Bureau of Statistics 2015. Causes of death,
Australia, 2013. Cat. no. 3303 .0 . Canberra: ABS.
4. Australian Institute of Health and Welfare. Harrison JE,
Henley G. 2014. Suicide and hospitalised self-harm
in Australia: trends and analysis. Injury research and
statistics series no. 93 . Cat. no. INJCAT 169. Canberra:
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rates and mental health funding, service provision and
national policy : a cross-national study. Int Psychogeriatr
6. Draper BM. Suicidal behaviour and suicide prevention in
later life. Maturitas 2014;79(2):179–83 .
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for prevention. Am J Prev Med 2014;47(3 Suppl
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individuals. What home care clinicians need to know.
Home Healthc Now 2015;33(9):476–81.
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developments: suicide in older people. BMJ
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of ageing. Br J Psychiatry 2013;202:81–3 .
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and practitioner perspectives. Int J Geriatr Psychiatry
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13. Ho RC, Ho EC, Tai BC, et al. Elderly suicide with and
without a history of suicidal behavior: implications for
suicide prevention and management. Arch Suicide Res
14. Draper B, Kolves K, De Leo D, et al. The impact of patient
suicide and sudden death on health care professionals.
Gen Hosp Psychiatry 2014;36(6):721–5 .
15. Australian Institute of Health and Welfare, 2016.
Australia’s health 2016. Australia’s health series no. 15.
Cat. no. AUS 199. Canberra: AIHW.
16. Cheung G, Merry S, Sundram F. Late-life suicide: Insight
on motives and contributors derived from suicide notes.
J Affect Disord 2015;185:17–23.
17. Zanni GR, Wick JY. Understanding suicide in the elderly.
Consult Pharm 2010;25(2):93–102.
18. Snowdon J. Suicide in late life. Reviews in Clin Geriartr
2001;11: 253–360 .
19. Canadian Agency for Drugs and Technologies in Health.
Diagnosing, screening, and monitoring depression in
the elderly: a review of guidelines. Ottawa (ON), 2015.
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Engl J Med 2014;371(13):1228–36.
21. Iliffe S, Manthorpe J. The prevention of suicide in later
life: a task for GPs? Br J Gen Pract 2005;55(513):261–2 .
Figure 1. Rate of suicide deaths in Australia per 100,000 population, by age group and sex, 2015.3
(a) Age-specific death rate. Deaths per 100,000 of estimated mid-year population for each age group.
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