Even though younger people may have more suicide attempts, older adults are more likely to actually complete suicide (with a 25% success rate). True rates of older adult suicide are not always clear. For example, if an older adult dies from a medication overdose, it might be ruled as an accident rather than suicide, or if there is no suicide note, the cause of death may not be ruled as suicide (Diggle-Fox, 2016). Healthcare clinicians often feel uncomfortable addressing suicide with patients, but it is a critical component of healthcare.

There are many risk factors for suicide to be mindful of, including social isolation, mental health disorders, and physical illness (Conejero et al., 2018). Social isolation can be due to loss of spouse or loved ones, loss of health (including sensory loss), loss of independence, or becoming homebound. These situations can cause older individuals to feel like they do not belong, or they are a burden.

Mental disorders such as bipolar disorder, depression, substance use, and anxiety play a role in the increased risk of suicide. Keep in mind though, that many individuals who complete or attempted suicide were not diagnosed with a mental health disorder (Diggle-Fox, 2016). Those who are in the early stages of dementia have an increased risk of suicide because there is an awareness of the diagnosis and fear of being a burden, whereas those in later stages have a decreased risk as they are less likely to have the mental capacity to carry out a plan.

Physical ailments are another risk factor-those with cancer are at higher risk for the first year after diagnosis, and patients on dialysis are more at risk for the first 3 months. Increased suicide risk is also true for older patients with newly diagnosed severe illness or chronic pain (Diggle-Fox, 2016). Assess the patient's sense of usefulness, feeling of social connectedness, and psychological pain associated with chronic physical illness, as these factors also correlate with higher suicidal tendencies (Conejero et al., 2018).

Be aware of the methods older adults have been known to use during suicide attempts, including firearms, natural gas, hanging, suffocation, cutting, jumping, poisoning, and overdose. Assess the home for possible tools or weapons, including knives, guns, rope, and medications. Monitor for warning signs of impending suicide-talk of death, alterations in patterns of daily activities, mood swings, or differences in usual medication, alcohol, or drug use (Diggle-Fox, 2016).

What to do when you assess a patient at risk for suicide? Obviously, the primary care provider needs to be notified and a referral made to a mental health professional. Then, the healthcare team can create a plan of care. Ensure mental and physical illnesses are addressed, and encourage socialization. Increase the frequency of contact with the patient (even via phone or text), and if not already involved in the case, therapies may be added to ensure the patient is able to complete their activities of daily living and have proper adaptive equipment. Social work may be necessary to help with financial burden, food, shelter, and companionship. During each home visit or contact, the patient should be reassessed for suicide risk and the plan of care altered as necessary. Other recommendations include counseling/psychotherapy, medication (any antidepressant needs 2 months of monitoring due to increase in suicidal ideations during that time), a suicide contract where individuals discuss and sign a contract with a plan not to act out suicidal behaviors, with names and numbers of individuals to call when suicidal feelings occur (Diggle-Fox, 2016). High-risk suicidal patients may need more immediate intervention, including admission to a hospital or mental health facility.

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