Comparison of rates of suicide methods used by the elderly in England and Wales

Because suicide rates have traditionally increased with age (Shah and De, 1998; Shah, 2007), the observed reduction in suicide rates among older people may be an important contributor to the U.K. government's target to reduce suicide rates in the general population by at least one-sixth of the 1996 baseline by 2010 (Department of Health, 1999). Previous studies have observed that suicide rates in older people have declined in both sexes over the 12-year period (1985–1996) and 24-year period (1979–2002) in England and Wales (Hoxey and Shah, 2000; Shah et al., 2001), although the rates are still considerably higher than those among younger adults. It is believed that a better understanding of the methods used by older people for suicide may lead to the development of targeted preventative strategies, which are expected to meet the challenge of sustaining this observed decline in suicide rates among older people over time in England and Wales (Lindesay, 1991; Dennis and Lindesay, 1995).

Traditionally, elderly men use more violent methods of suicide, including hanging, strangulation and suffocation, shotgun and larger firearm discharge, and sharp objects (Shah and De, 1998; Harwood et al., 2000; Hoxey and Shah, 2000; Tadros and Salib, 2000; Salib and Green, 2003). Older women tend to use more passive methods of suicide, in particular drug overdose (Hoxey and Shah, 2000; Harwood et al., 2000; Tadros and Salib, 2000). In addition, Tadros and Salib (2000) found that older age groups tended to use methods which required less physical energy, and which they had access to, and that overall the most common method of suicide used by the elderly was poisoning by drug overdose, whereas hanging was the most common method for younger adults.

Data on suicides and open verdicts (pertaining to deaths from injury and poisoning), for the seven year period 2001–07, was ascertained from the Office of National Statistics (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=618). Data on suicides and open verdicts were available for 21 five-year age-bands for both sexes between < 1 year and 95+ years for both sexes. These data were collapsed into the following age-bands for both sexes: (i) under the age of 65 years, and (ii) aged 65 years and over.

Standardized mortality ratios (SMRs) were calculated for each method of suicide in older men and women by using younger men and women respectively as the standard population. SMRs were also calculated for each method of suicide in older women by using older men as the standard population. An SMR of 1 implies that the mortality rate is the same as in the standard population. A number higher than 1 implies an increased mortality rate whereas a number below 1 implies a reduced mortality rate than in the standard population. The results are considered statistically significant if the 95% confidence interval around the SMR does not include 1.

There was a significantly higher rate of suicides in older men than women for the following methods: for hanging, strangulation and suffocation the SMR was 0.19 (95% CI −0.04–0.42); for drowning and submersion the SMR was 0.53 (95% CI 0.08–0.98); for other unspecified firearm discharge the SMR was 0.014 (95% CI −0.26–0.28); and for sharp objects the SMR was 0.17 (95% CI −0.50–0.84). The rates for the total number of suicides were likewise significantly higher in older men than older women, with an SMR of 0.40 (95% CI 0.22 – 0.58). The only method in which the SMRs were higher for older women than men were antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs not elsewhere classified; however, these did not reach statistical significance. The rates for total male suicides were significantly higher for older men than younger men, SMR 2.04 (95% CI 1.28–2.80), and although there were no significant differences in total rates between older and younger women, rates were higher for older than younger women.

This study found that, overall, suicide rates among older people in England and Wales were higher in men than women, which supports previous observations (Hoxey and Shah, 2000; Shah et al., 2001). The finding that rates for violent methods of suicide were higher in older males than females, have also been previously observed (Shah and De, 1998; Harwood et al., 2000; Hoxey and Shah, 2000; Tadros and Salib, 2000; Salib and Green, 2003). However, this study also found that older men had higher rates of drowning than older women, which although supporting the findings of Hoxey and Shah (2000), was contrary to the results of Harwood et al. (2000), who found that this method was more common in older women than men.

This study did not support previous findings that elderly women use more passive methods of suicide (Hoxey and Shah, 2000; Harwood et al., 2000; Tadros and Salib, 2000). Although rates for poisoning by antiepileptic, sedative-hypnotic, anitparkinsonism and psychotropic drugs were higher in older women than men, these result were non significant. In addition, for all other forms of suicide by poisoning the rates were higher for older men than women, but again these were non significant.

The finding that overall rates were significantly higher in older than younger men was as expected, as traditionally suicide rates increase with ageing (Shah and De, 1998). A similar trend was found for females, although these did not reach statistical significance. However, there were no significant differences in the method of suicide used by the elderly compared to the young, for either males or females, as were found in a previous study (Tadros and Salib, 2000).

The results of this current study support the view that the U.K. government should be targeting the elderly in order to meet its suicide reduction targets (Department of Health, 1999). The differences in the methods of suicide between older men and women, and older and younger adults of both sexes, suggest a need to develop specific preventative strategies to reduce access to these methods of suicide for different age and sex groups, in order to sustain the observed decline in elderly suicide rates.