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Suicide in older people.

The elderly population size is growing worldwide due to the increased life expectancy of older adults (Oeppen & Vaupel, 2002). This is also affecting the number of the “oldest” old people (80+ years; Jeune & Skythe, 2001; Shah, 2007a). Suicide rates in many countries increase with aging (Bertolote & De Leo, 2012; Shah, 2007b). Thus, prevention of suicide in old age is an important public health concern. Any preventative strategy needs to be appropriately informed by accurate data. In this context, national statistics on suicide are needed (World Health Organization [WHO], 2014), but they are sensitive to the accuracy of the registration of the causes of death. The validity and reliability of the registration of the causes of death vary between countries, particularly for suicide. Registration depends on: the availability of appropriate administrative infrastructure; the legal decisions on how and who should determine cause of death; and the procedures to determine cause of death (Shah & De, 1998a). The validity of the suicide registration is also affected by other factors including cultural and religious factors, and the stigma attached to suicide may lead to under-reporting of suicides (Abrahams, Abrahams, & Jacob, 2005; Wasserman, Cheng, & Jiang, 2005). Older people are often viewed by those around them as being more traditional in relation to religious and cultural values. Hence, religious and cultural stigma attached to suicide may be more strongly perceived in relation to older people. These issues too may contribute to misclassification of suicides and subsequent under-reporting. Even in cohort studies, the national legal definitions of suicide are often used. Some of the difficulties with using the legal definitions of suicide in older people and other related issues are discussed here.