Suicidal Ideation In Older Adults

Later life is a period that is associated with multiple losses along with changes in health status, autonomy, roles and relations. It is this change and sense of loss that may lead to a person to develop late life depression and eventually commit suicide.67 Expression of suicidal ideations is a risk factor for death by suicide68and is an important clinical risk indicator of suicide in both the elderly as well as young. However, the elderly seem to be less prone to communicate their suicidal intentions69. Identifying predictors of suicidal ideation in older adults hence leads to an improved understanding of suicide risk in this age group70. Findings show that during initial assessment

showed that suicide related ideation among older adults is strongly associated with depressive symptoms. In this study found that the single strongest predictor among the independent variables of depressive symptomatology, hopelessness and impulsivity, is hopelessness. However of note is the near complete absence of hopelessness in patients who were not overtly depressed and impulsivity being more pronounced in this group and the fact that impulsivity appeared to predict suicide related ideations more broadly than hopelessness alone, with and without a broad presentation of depressive symptomatology in the study.74 A study by Turvey et al. who showed that amongst the various risk factors for late life suicide, depressive symptoms showed the strongest association with late life suicide75. Physical illness is a common antecedent to suicide in older people, though prevalence figures vary widely from 34% to 94%; however the risk of suicide associated with physical illness is unclear because there are few controlled studies (Waern et al., 2002)76 . Other factors that have been associated with late-life are chronic severe pain, debilitating disease, and diagnosis of a terminal illness77. Also, of older adult suicides who have been studied through a psychological autopsy method, it is most often the case that a psychiatric illness, in particular depression, was present prior to

Dombrovski and colleagues81, for instance, have reported that elderly suicidal depressives performed worse on measures of frontal executive function as well as memory and attention tests than did non-suicidal elderly depressives. Frontal executive function may be notably pertinent to suicidal behaviour in older adulthood because of its role in effective management of stressful circumstances.

Cognitive constriction is also an element in older adult suicide. The common cognitive state in suicide is mental constriction, like rigidity in thinking, narrowing of focus, tunnel vision, and concreteness. The person experiences mixtures of a trauma like poor health or rejection from a family member, moments before his or her death79.

Identification-aggression, an idea hypothesized by Sigmund Freud, is another factor in older adult suicide. With this idea, Freud believed that intense identification (attachment) with a lost or rejecting person is crucial in understanding the suicidal person. If this emotional attachment isn't met, the suicidal person experiences a deep pain (discomfort) and desires to egress or escape78(Leenaars,2003).

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Surprisingly there is lack of research on suicidal behavior of elderly patients with depression in Indian context. A study done by trivedi et al, reported that suicidality in elderly patients with depression was strongly associated with impulsivity and