Suicide - Age 65+ in South Dakota

South Dakota

Suicide is a troubling public health issue that leaves a lasting impact on families and communities. Between 2000 and 2021, the suicide rate in the United States increased by 36%. Suicide accounted for more than 48,000 deaths in 2021. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), that same year, 12.3 million adults seriously thought about suicide, 3.5 million made a plan and 1.7 million actually attempted suicide.

Suicide attempts among older adults are more likely to be fatal than suicide attempts among younger people. Older adults may be frail and are often isolated, decreasing their chances of rescue; they are also more likely to have a determined plan and use extremely lethal means. Firearm suicide rates are highest among adults age 65 and older; in 2018, 70% of older adults who committed suicide used a firearm. 

Older adults may also exhibit passive self-harm behaviors that can cause death, such as refusing food, medications or liquids; these are rarely recorded as suicide attempts or as deaths by suicide. 

The economic burden of suicide among adults age 65 and older was estimated at more than $42.6 billion in direct and indirect costs in 2019.

According to America’s Health Rankings analysis, suicide rates are higher among:

• Men age 65 and older, who have a rate more than six times higher than women of the same age. 
• Adults age 85 and older compared with those ages 65-84. 
• White older adults, who have a rate more than four times higher than Black older adults.
• Lesbian, gay and bisexual adults compared with straight adults. Lifetime discrimination and victimization of LGBTQ+ individuals may contribute to this higher suicide rate.

Risk factors for suicide among older adults include mental illness, depression, previous suicide attempts, substance use problems, chronic pain, physical illness, declining function, disability, family discord or loss, family history of suicide and social isolation. Dementia and other forms of impaired cognitive ability have also been linked to suicidal behavior in older adults.

Suicide is often preventable. Preventing suicide among older adults may require the use of multiple and aggressive interventions because of the lethality of their attempts. 

Several interventions have proven effective at preventing suicide and reducing risk factors among older adults, including:

• Primary care interventions using care coordinators.
• Telephone counseling (primarily effective among women).
• Education and community activities to improve resilience.
• Pharmacotherapy in conjunction with psychotherapy sessions. 

Some doctors and researchers are urging caregivers of older adults with dementia to secure or eliminate firearms from their environment. 

SAMHSA, in partnership with the Administration on Aging, has published a brief to help health care and social services organizations prevent suicide among older adults. Additionally:

• The Suicide Prevention Resource Center provides strategic planning and training material for those wanting to help develop and implement suicide prevention efforts. They also provide information on established programs and contacts specific to each state. 
• SAGE is an organization that advocates for LGBTQ+ older adults and has a 24-hour LGBTQ+ Elder Hotline (877-360-LGBT(5428)) certified in crisis response. 

The 988 Suicide & Crisis Lifeline provides free, confidential support for people in distress 24/7, everywhere in the U.S. Their website offers additional forms of crisis support, and the previous National Suicide Prevention Lifeline number (1-800-273-TALK(8255)) is still active and usable.

Reducing the overall suicide rate is a Healthy People 2030 leading health indicator.

Betz, Marian E., Alexander D. McCourt, Jon S. Vernick, Megan L. Ranney, Donovan T. Maust, and Garen J. Wintemute. “Firearms and Dementia: Clinical Considerations.” Annals of Internal Medicine 169, no. 1 (July 3, 2018): 47. https://doi.org/10.7326/M18-0140.

Conwell, Yeates, Kimberly Van Orden, and Eric D. Caine. “Suicide in Older Adults.” Psychiatric Clinics of North America, Geriatric Psychiatry: Advances and Directions, 34, no. 2 (June 1, 2011): 451–68. https://doi.org/10.1016/j.psc.2011.02.002.

Fredriksen-Goldsen, Karen I., and Anna Muraco. “Aging and Sexual Orientation: A 25-Year Review of the Literature.” Research on Aging 32, no. 3 (May 2010): 372–413. https://doi.org/10.1177/0164027509360355.

Garnett, Matthew F. “QuickStats: Percentage of Suicides and Homicides Involving a Firearm Among Persons Aged ≥10 Years, by Age Group — National Vital Statistics System, United States, 2020.” MMWR. Morbidity and Mortality Weekly Report 71, no. 19 (May 13, 2022): 670. https://doi.org/10.15585/mmwr.mm7119a5.

Kiosses, Dimitris N., Katalin Szanto, and George S. Alexopoulos. “Suicide in Older Adults: The Role of Emotions and Cognition.” Current Psychiatry Reports 16, no. 495 (September 18, 2014). https://doi.org/10.1007/s11920-014-0495-3.

Lapierre, Sylvie, Annette Erlangsen, Margda Waern, Diego De Leo, Hirofumi Oyama, Paolo Scocco, Joseph Gallo, et al. “A Systematic Review of Elderly Suicide Prevention Programs.” Crisis 32, no. 2 (January 1, 2011): 88–98. https://doi.org/10.1027/0227-5910/a000076.

National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, D.C.: National Academies Press, 2020. https://doi.org/10.17226/25663.

“Older Americans Behavioral Health Issue Brief 4: Preventing Suicide in Older Adults.” Substance Abuse and Mental Health Services Administration (SAMHSA), Administration on Aging, 2012. https://acl.gov/sites/default/files/programs/2016-11/Issue%20Brief%204%20Preventing%20Suicide.pdf.

Peterson, Cora, Gabrielle F. Miller, Sarah Beth L. Barnett, and Curtis Florence. “Economic Cost of Injury — United States, 2019.” MMWR. Morbidity and Mortality Weekly Report 70, no. 48 (December 3, 2021): 1655–59. https://doi.org/10.15585/mmwr.mm7048a1.

Price, James H., and Jagdish Khubchandani. “Firearm Suicides in the Elderly: A Narrative Review and Call for Action.” Journal of Community Health 46, no. 5 (October 2021): 1050–58. https://doi.org/10.1007/s10900-021-00964-7.

Ramchand, Rajeev, Megan S. Schuler, Michael Schoenbaum, Lisa Colpe, and Lynsay Ayer. “Suicidality Among Sexual Minority Adults: Gender, Age, and Race/Ethnicity Differences.” American Journal of Preventive Medicine 62, no. 2 (February 1, 2022): 193–202. https://doi.org/10.1016/j.amepre.2021.07.012.

Stone, Deborah M. “Notes from the Field: Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021.” MMWR. Morbidity and Mortality Weekly Report 72 (2023). https://doi.org/10.15585/mmwr.mm7206a4.