Abstract Body

Suicide in old age is frequently considered the result of a rational decision. Accumulation of physical illnesses, frailty, dependence on others, loss of partner and loneliness are often seen as reasons that might justify suicidal acts. Depression is an important risk factor for suicidal behaviour even at very advanced age. However, ageistic views tend to consider depression as a normal feature of the aging process; it is possible that its presence can be overestimated or perhaps generalized more than necessary by making it the scapegoat of any situation related to suicide. In fact, adopting an attitude that involves excessive simplification of problems, where everything is attributable to ‘depression’, can induce a rigid prescriptive approach, often limited to the indication of an antidepressant drug. In this way, the appreciation of the multifactorial nature of an individual’s crisis becomes too narrow and the chances of counteracting the complexities of a dangerous suicide progression too modest. From a prospect of suicide prevention, approaching a patient carefully and prudently is always to be preferred to the disposition that considers life events as inevitable as well as all reactions related to them, including the most extreme, such as suicide. This attitude can lead to a poor involvement of the treating physicians, who might become too acceptant of the ‘unavoidability’ of the unfavourable progression of their patient. Such a passive approach may especially characterise the relationship with patients of very advanced age, where stressors of physical and non-physical nature easily aggregate, multiplying their impacting power.

Abstract Body

Mental health care remains a pillar of suicide prevention also in late life, but the range of interventions should include attention to the many socio-environmental conditions that are relevant to this stage of life. Community programs that promote a sense of worthiness and belonging should be strongly encouraged in order to preserve personal identity and social integration. Loneliness has to be counteracted in its many facets and with vigour, given its multiple negative impacts.

The fight against stigma and ageistic views - still deeply rooted even among health workers – should be carried out with determination. Active promotion of a culture of resilience and adaptation to different phases of life and the changes imposed by them should constitute the founding bases of all efforts aimed at promoting a successful aging process. Combating discrimination against older people, as well as promoting basic social determinants of health, would help prevent suicide. However, these issues are still very underrepresented in the global agenda of health care. While having an effective impact on the numerous forms of discrimination would require legal interventions by governments, fighting stigma would primarily involve education aimed at changing beliefs and attitudes. Promotion of human rights, with particular regard to protection against abandonment, abuse and violence - particularly deleterious aspects in old age – appears as essential for personal empowerment of older individuals. Once become more powerful, older people may become more capable of defending their interests in terms of quality of life and protection against risk factors for suicide.