Sessa Francesco, Polito Rita, Li Rosi Giuseppe, Salerno Monica, Esposito Massimiliano, Pisanelli Daniela, Ministeri Federica, Messina Antonietta, Carotenuto Marco, Chieffi Sergio, Messina Giovanni, Monda Marcellino
Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
Front Psychiatry. 2024 Sep 2;15:1449526. doi: 10.3389/fpsyt.2024.1449526. eCollection 2024.
The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.
预防老年人自杀的任务是一项重要的社会负担，因为65岁以上的老年人面临着一些独特的心理因素，这些因素会增加自杀风险。此外，当发现一具老年尸体时，法医检查是确定确切死因、将其归类为自杀或排除自杀的基本工具。在这种情况下，本综述旨在探讨可能与老年人自杀行为相关的神经生物学因素。本综述的另一个目标是探讨围绕老年人自杀的法医方面问题，阐明法医调查的重要性。特别是，本综述研究了神经递质失衡、认知障碍、神经炎症、与老年自杀相关的社会心理因素以及神经退行性疾病等问题。此外，还探讨了政策考量、法律框架、心理健康评估、伦理影响和法医调查等法医方面的问题。鉴于这一现象的重要性，尤其是在西方国家，出现了对老年人自杀行为进行重点筛查工具的需求，以便加以控制。因此，本综述对文献进行了详尽的评估，深入探讨了在法医背景下神经生物学与老年人自杀相关的心理健康之间微妙的相互作用。理解这一复杂现象的不同方面对于提出新的、更有效的干预措施至关重要，这些措施支持诸如家庭支持等针对性举措，并改善医疗保健，特别是针对脆弱的老龄化社会，以降低老年人自杀风险。
