Introduction

Elderly people have a higher risk of completed suicide than any other age group worldwide.1 Despite this, suicide in elderly people receives relatively little attention, with public health measures, medical research, and media attention focusing on younger age groups.2 We outline the epidemiology and causal factors associated with suicidal behaviour in elderly people and summarise the current measures for prevention and management of this neglected phenomenon.

Sources and selection criteria

We searched Medline and the Cochrane database for original research and review articles on suicide in elderly people using the search terms “suicide”, “elderly”, and “older”.

Dispelling the myths (Greek and otherwise)

From time immemorial, suicidal feelings and hopelessness have been considered part of ageing and understandable in the context of being elderly and having physical disabilities. The Ancient Greeks tolerated these attitudes in the extreme and gave elderly people the option of assisted suicide if they could plead convincingly that they had no useful role in society. Such practices were based on the assumption that once an individual had reached a certain age then they no longer had any meaningful purpose in life and would be better off dead. Although not as extreme, ageist beliefs in modern, especially industrialised, societies are based on similar assumptions. Sigmund Freud echoed such views, while suffering from incurable cancer of the palate:

It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear.

The burden of suicide is often calculated in economic terms and, specifically, loss of productivity. Despite lower rates of completed suicide in younger age groups, the absolute number of younger people dying as a result of suicide is higher than that for older people because of the current demographic structure of many societies.1 Younger …