[Suicidal behavior in the aged]

Suicide in the elderly has been underemphasized in gerontological research. This deficit is even more surprising as the aged, especially the very old male group, have the highest suicide rate in the population. This pattern has not markedly changed over time. The very old male is at highest risk of suicide, a fact still waiting for a conclusive explanation. Epidemiologists have predominantly investigated four groups of risk factors for suicide in old age; (1) chronic and painful illnesses, (2) psychiatric disorders (mainly depression), (3) conflicts and stress in interpersonal relationships, and (4) social isolation and loneliness. Suicide finally results from stressful life events, losses and conflicts, which, through an accumulating effect, end up in hopelessness and despair. The research literature does not offer a convincing explanation for the characteristics of suicide in old age. Sociologists (e.g. Durkheim) have tried to explain suicide in the aged by stressing the "anomic" situation in old age, characterized by disintegration, the "roleless role" decreasing influence and weakening ties to groups and institutions in society. Psychiatrists on the other hand (e.g. Ringel, Henseler) offer explanations derived from a psychodynamic point of view. In their opinion, suicide is the final solution to a severe neurotic crisis. The psychiatric explanation for suicide tends to neglect stressful life events, losses and environmental influences which result in an intolerable life situation, and finally in a self-destroying reaction. The life-event paradigm and the cognitive personality theory give the opportunity to develop a model in which environmental and psychological (personality) variables can be exemplified. Furthermore, their interdependence can be described. The function of this model is primarily heuristic. It can stimulate more specific research in the field of suicide and suicide attempts in old age.