Prevention of late life suicide: when, where, why and how

Suicide in late life is discussed from the perspective of four guidelines derived from preventive medicine; preventive efforts (1) are beneficial in proportion both to the prevalence and severity of a disease, (2) must consider how the outcome might affect individuals and society as a whole, (3) should take into account biological, psychological and social dimensions, (4) can only be effective if important and 'alterable' risk factors are identified. Possible risk factors for late life suicide which may be altered include social isolation, stressful circumstances, and affective disorder. Primary prevention may involve outreach programs to decrease social isolation, secondary prevention may include education of primary care physicians, and tertiary prevention may, in patients with severe affective disorder, include hospitalization and aggressive somatic therapies.