Clinical Characteristics of Older Adults With Late-Onset Suicide Attempts: A Hospital-Based Retrospective Study

No previous study has fully described older adults who make a first suicide attempt late in life. We retrospectively reviewed adults ≥ 60 years admitted to a university psychiatric ward after an attempt to (1) detail their demographic and clinical features; (2) compare admission and discharge diagnoses to measure diagnostic shifts-especially from major depressive disorder (MDD) to dementia; and (3) determine whether certain dementia subtypes, notably dementia with Lewy bodies (DLB), are over-represented.

Medical charts of patients transported to the emergency department and hospitalised between April 2015 and March 2024 were screened. After excluding cases with psychiatric disorders before the age of 60 years, 63 late-onset attempters were analysed. Diagnoses were reassessed with DSM-5-TR and standard neurodegenerative criteria; discrepancies were resolved by two senior psychiatrists. Mini-Mental State Examination scores, suicide methods and demographics were compared across final diagnoses.

At discharge, psychiatric disorders predominated (65.1%), but dementia was present in 31.7%; DLB was the leading subtype (19.0%), followed by Alzheimer's disease (9.5%). Diagnostic revision was common: 17 patients (27.0%) changed diagnosis during hospitalisation, including 15 who shifted from MDD to dementia; 10 of these reclassifications were to DLB and six met criteria for psychiatric-onset DLB. Mini-Mental State Examination scores did not differ between MDD and DLB, although scores were lower in Alzheimer's disease. Suicide methods-most often drug overdose-showed no relation to diagnosis.

Almost one-third of older first-time attempters harboured unrecognised dementia, most frequently DLB and over one-quarter of initial MDD diagnoses converted to dementia after full assessment. Brief cognitive screens alone missed these cases. Routine post-attempt care for older adults should therefore include informant history, detailed neuropsychological testing and dementia-specific biomarkers to guide targeted prevention and treatment.