Coping with the suicidal elderly: a physician's guide.

Advancing age is associated with a markedly increased risk of suicide. In the United States, one fourth of all suicides are carried out by citizens age 60 or older. The majority of American elders who commit suicide use a firearm to do so. Most suicidal elders look to their primary care physician for help, although they may not directly express their plan. Therefore, physicians must be alert to clues. By far the principal risk factor for suicide is major depression. The risk is heightened by recent losses, alcohol or drug abuse, psychosis, cognitive decline, and chronic disease. Hopelessness, anhedonia, self-reproach, guilt, and a formed lethal plan are signs of a life-threatening suicidal crisis which requires urgent intervention. Physicians must act decisively in recognition of the fact that suicidality is a transient, treatable condition.