Suicide Prevention in Older Adults: Adding Dementia to the Conversation

 

Practice Transformation Institute (PTI) is a leading provider of continuing medical education and experiential learning programs for Patient-Centered Medical Homes and other care transformation initiatives.  PTI offers programs and to empower physicians, practice teams, and others in care delivery systems to improve care and outcomes. Each month, PTI offers a brief blog or article addressing a specific practice need or relevant population. For more information or to suggest future topics of interest, please contact PTI at (248) 475-4736 or email info@transformcoach.org.

 

This month, we address suicide prevention in older adults.

Suicide Prevention in Older Adults: Adding Dementia to the Conversation

Suicide prevention is crucial across the lifespan.  While much of the information on suicide prevention focuses on younger populations, older adults face distinct risks that may be overlooked in routine care. Loss of a spouse or social connections, chronic illness, pain, declining independence, and changes in cognitive or functional status create periods of increased vulnerability.  For physicians and care teams, recognizing these transitions, including the period around a new dementia diagnosis, creates an important opportunity to identify risk early, strengthen support, and proactively intervene.

Suicide Risk and Dementia: The Evidence Base

In 2023, Americans aged 85 and older had the highest overall age-specific suicide rate (22.7 deaths/100,000) (Centers for Disease Control and Prevention, 2025).  The gender difference is particularly striking.  Among men aged 75 and older, the 2023 suicide rate was 40.7 per 100,000, compared with 5.1 among women in that age group.

A large U.S. study of 2.67 million Medicare beneficiaries aged 65 and older and newly diagnosed with Alzheimer’s disease or related dementias found a suicide rate of 26.42 per 100,000 person-years during the first year after diagnosis. Overall suicide mortality was approximately 53% higher than expected, with the highest relative risk among people aged 65-74. In this study, risk was highest during the first 90 days following a dementia diagnosis. Rural residence and recent mental health, substance use, or chronic pain conditions were also associated with increased risk (Centers for Disease Control and Prevention, 2025).

Another population study (Schmutte, et al., 2021) found that dementia across the course of the disease was not associated with increased suicide risk, but risk was elevated during the first three months following diagnosis. Risk was further increased among people diagnosed before age 65 and those with a psychiatric comorbidity.

Suicide Prevention in Older Adults: Opportunities for Care Teams to Intervene

In addition to recognizing increased suicide risk in older adults, it is important to consider and integrate dementia diagnoses in this population.  The greatest concern is not necessarily advanced dementia.

Recognize a dementia diagnosis as a potential high-risk transition, not just a clinical event.

For clinicians, a new dementia diagnosis represents more than the beginning of a treatment and care plan. It also represents an important window for suicide screening and prevention. During this period, an individual has awareness and functional capacity and requires increased attention. 

Studies have found the highest suicide risk occurred within 90 days of a new dementia diagnosis, supporting suicide risk screening and support at the time of a new diagnosis, particularly among patients under age 75. In addition to screening, important conversations include how the patient is processing the diagnosis, losses the patient anticipates, available support, and changes family members noticed. 

Look for cumulative risk rather than a single risk factor.

Suicide risk increases with chronic illness, pain, mental health and substance use issues, isolation, functional loss, and unmet SDOH (social drivers of health). This creates a concept of cumulative vulnerability and the need to recognize when multiple changes are occurring in a patient’s life.

Make suicide prevention a care team responsibility.

Beyond screening, cumulative vulnerability creates a strong role for the care team: nursing, behavioral health, care management, social work, Community Health Workers (CHWs), and others. A CHW or care manager may learn that a patient has stopped social interactions, isn’t filling prescriptions, or is telling family members that they are becoming a burden. These observations need to be communicated back to the clinical team for action.

Suicide prevention in older adults requires recognizing periods of increased vulnerability, asking the right questions, connecting patients and families with support, and ensuring that concerns identified by any care team member reach a clinician. Together, these actions create a system of care in which early recognition, communication, and coordinated response make prevention possible before crises occur.

 

 

References

Centers for Disease Control and Prevention (2025). Garnett, M.F. & Zehner, A.M. Changes in suicide rates in the United States from 2022 to 2023. NCHS Datra Brief No. 541, September 2025.

 

Schmutte, T., Olfson, M., Maust, D.T., Xie, M., & Marcus, S.C. (2021). Suicide risk in the first year following dementia diagnosis in older adults. Alzheimers Dementia, 18(2), 262-271. Doi: 10.1002/alz12390.