The recent suicide of my elderly father reflects an important public health issue. The majority of suicides are adult suicides and, in many countries, there is a surprisingly high rate of suicides amongst elderly men 1,2. However, the focus in ‘developed’ countries is on youth suicide 2,3. The danger of this focus is that the risk of suicide in other age groups may not be recognised. Indeed, although there may be a difference in ‘years lost’, suffering does not distinguish between the young and the old.

My father visited his general practitioner (GP) 2 days before he ended his life, however depression and suicidal risk were not detected. Indeed, the majority of older people who end their lives visit their local doctor in the week preceding their death without their depression and suicidal risk being detected 2,4,5. A number of reasons for this have been suggested.

First, signs of depression in older people may be misinterpreted and dismissed as age-related changes—or related to another illness or disability that the person is suffering from.1 Second, older persons often do not present with the classic symptoms of depression.1 Third, it can be very difficult for many people, and particularly men, to disclose to a GP or other people how they are feeling, and they may actively hide this.4

My father had a number of known risk factors for suicide and was experiencing symptoms that could be attributed to depression. Even his suicide note said that he was suffering from depression. Furthermore, family members had noticed a number of changes in his behaviours and attitudes over the previous year; however, these were not known collectively by any one person.

As many older people visit GPs, an opportunity exists for the identification of depression and suicidal ideation and appropriate treatment.1,5,6 There are guidelines for GPs in New Zealand regarding the recognition, treatment, and management of both depression and youth suicidal behaviour. Similar guidelines could be developed that address other age groups—and that information could then be re-presented to GPs every few years to refresh their understanding and to capture new and locum staff. It is important that the differing presentations of elderly people are recognised, and that specialist questioning skills are used.

The signs of suicide amongst adults are often not recognised by the relatives and friends of older people and by the general community.6 Public awareness raising with regards to elder suicide should be considered. Finally, research is required that helps to illuminate the causes and treatment of self-inflicted death by older people.

Name withheld by request