Older age is characterized by greater wellbeing, more meaning to life, and a better ability to manage emotions. However, old-age is a time of increased risk of suicide (1). Suicide rates are highest in those aged 70 years or older for both men and women in almost all regions of the world (2). In the United States, White males aged 85 and older are at the highest risk among all older adults (1, 3). Suicide in older adults has been partly attributed to psychiatric disorders, especially depression (1). It has been suggested that depressive symptoms in the context of death and suicidal ideation may signify a specific subtype of late-life depression (1). The significance of depression as a pathogenetic factor in geriatric suicide makes its timely recognition and successful treatment of vital importance. Cognitive deficits in later life have also been linked to suicide (3). Frontal executive function may be particularly relevant to suicidal behaviour in older adults because of its role in effective management of stressful circumstances (3). Social disconnectedness, physical illness and pain, functional impairment and personality traits of neuroticism and low openness to experience also contribute to suicidality in older adults (1, 3). Although average levels of neuroticism generally decline with age, neuroticism may contribute to the pathophysiology of geriatric suicide. Resiliency factors include integration in social networks and clubs, religious practice, having a hobby, and perceiving that life is meaningful and worth living. There is a stigma about psychiatric conditions in the general population. Among the old people, that stigma is even greater. This makes older adults less enthusiastic or even scared to seek mental health help. We need to try to change views and preconceptions that inhibit older adults from accessing effective care. Suicide among the older adults receives less attention in the professional literature than suicide in adolescents and younger adults (4). For example, it has been reported that a Medline search revealed that among articles that listed suicide as a focus only 21.4% were concerned subjects aged 65 years and over, and only 3.1% were concerned subjects aged 80 and over (4). It may reflect negative perceptions and attitudes toward aging and the aged in the Western cultures. Suicide is regarded as more acceptable for an older than a younger individual. Dr. Robert Kastenbaum (1932–2013), an expert on the psychology of aging and death and an author of several books, stated in his 1992 paper: ‘I am especially concerned about public policy approaches (such as ‘setting the limits’) that place a veneer of rational cost-benefit verbiage over a devaluation of the aged. . .’ (5). Late-life suicide is a cause for great concern that merits constant attention from researchers, health care providers, policy makers, and society at large. The people who are old now are the people who built the world we have inherited. They raised children and grandchildren, built houses and bridges, treated sick people, educated students, and made many other contributions to the betterment of the world. Older people should be treated with respect and care. A greater focus must be on ensuring that older adults have a support to lead viable and productive lives.

中文翻译：

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老年人自杀：一个未被充分认识和研究的问题

老年人的特点是幸福感更好，生活更有意义，管理情绪的能力也更好。然而，老年是自杀风险增加的时期 (1)。在世界几乎所有地区，70 岁或 70 岁以上的男性和女性的自杀率最高 (2)。在美国，85 岁及以上的白人男性在所有老年人中的风险最高 (1, 3)。老年人的自杀部分归因于精神疾病，尤其是抑郁症 (1)。有人提出，死亡和自杀意念背景下的抑郁症状可能意味着晚年抑郁症的一种特定亚型 (1)。抑郁症作为老年自杀致病因素的重要性，使得及时识别和成功治疗变得至关重要。晚年的认知缺陷也与自杀有关 (3)。额叶执行功能可能与老年人的自杀行为特别相关，因为它在有效管理压力环境中发挥作用 (3)。与社会脱节、身体疾病和疼痛、功能障碍和神经质的人格特征以及对经验的低开放度也会导致老年人的自杀倾向 (1, 3)。尽管神经质的平均水平通常随着年龄的增长而下降，但神经质可能会导致老年自杀的病理生理学。弹性因素包括融入社交网络和俱乐部、宗教活动、爱好以及认为生活是有意义和值得生活的。对一般人群的精神疾病有一种耻辱感。在老人们当中，这种耻辱甚至更大。这使得老年人对寻求心理健康帮助的热情降低，甚至害怕。我们需要努力改变阻碍老年人获得有效护理的观点和先入之见。与青少年和年轻人的自杀相比，老年人的自杀在专业文献中受到的关注较少 (4)。例如，据报道，Medline 搜索显示，在将自杀列为焦点的文章中，只有 21.4% 是 65 岁及以上的受试者，只有 3.1% 是 80 岁及以上的受试者 (4)。它可能反映了西方文化中对衰老和老年人的负面看法和态度。年长的人比年轻的人更容易接受自杀。罗伯特·卡斯滕鲍姆博士 (1932–2013)，一位衰老和死亡心理学专家和多本书的作者，在他 1992 年的论文中指出：“我特别关注公共政策方法（例如‘设定限制’），这些方法将合理的成本效益言辞贴上外衣超过了老年人的贬值。. .' (5). 晚年自杀引起了极大的关注，值得研究人员、医疗保健提供者、政策制定者和整个社会不断关注。现在年老的人是建造了我们继承的世界的人。他们抚养子孙，建造房屋和桥梁，治疗病人，教育学生，并为改善世界做出了许多其他贡献。老年人应该受到尊重和关怀。必须更加关注确保老年人得到支持，以过上可行和富有成效的生活。