Suicide Risk in Older Adults: 5 D's of Suicide Risk in Older Adults

[0:00]What do you see are some of the risk factors for older adults in suicidality or suicidal thinking? I find it useful to have a framework and the the framework that uh I think is about as simple as it can get in something this complicated is what I call the five D's. Um in addition to demography, right? So older male white is, um depression. Um that mental illness is a powerful driver of suicide risk and we need to understand the the underlying condition that somebody has. Um and for older adults, it's far more often depression, clinical depression than is the case. For other diagnoses, if they're there, they constitute increased risk, definitely, but depression is that much more common in its association with suicide in older people than is the case in middle age and younger. Um so depression, uh second is disease, or physical illness that, um, that older people face a lot of that. Of course, the the um predictive value of of a depression diagnosis is quite high with regard to suicide outcomes. The predictive value in an older person of physical illness is, of course, very low because it's so the base rate of physical illness is so high. But nonetheless, there are studies that show that certain physical illnesses are additional risk factors above and beyond depression and those things tend to be neurological conditions. Um central nervous system kinds of things, so it might be strokes or Parkinson's disease or dementia, uh epilepsy. Um and then, um the third D, associated with that is is disability or or functioning. In older people, that's just a big deal, of course, being able to maintain independent functioning, um is critical for older people to be able to optimize that and to help the older person kind of redefine, um what they regard as acceptable independence. And that's a transition that that we all need to go through as our our functioning is impaired, but some people, um can become then increasingly suicidal, we're at greater risk facing that functional impairment. So that's the the third D. Good. Fourth, uh disconnectedness. Um, we know that social connections, both the objective measurement of the, uh, depth primarily of one's social network. The ability to call on individuals, to feel close to people, to feel as if you belong, uh, is critically important to health. So it's both objective and subjective in that and there are lots of important studies now that show that the lack of that social connectedness is associated with suicide risk as well as with mortality from hypertension and diabetes. Uh, the likelihood of of developing cognitive impairment, uh, and on from there. So, that is a big, big, um, modifiable risk factor, I would add important concept. And then the, uh, the fifth is deadly means back to that notion that older adults who die by suicide do so with a firearm. Something like 96% of firearm deaths among older people in the US each year are suicides. So that link between firearms and suicide is especially tight for older people and it's another, um, of those five D's. I think we need to fold into our diagnostic, uh process just simply by understanding as is the recommendation for primary care practitioners and others that you need to know if an older person has a firearm in the home and develop strategies for managing that risk if they become depressed or suicidal.