Introduction/Background: Suicide in older people is a historically neglected research area. Local audits had suggested that Cornwall had a higher than average suicide rate, and people aged 75 years and over appeared to be at particularly high risk. Heterogeneity between studies and variations in presenting suicide statistics can make comparison of rates difficult. Aims: The study aimed to explore in depth the epidemiology of suicide in elderly people in Cornwall, to develop an understanding of the risk factors (including sources of stress), suicide methods, locations, and warnings, and consequently to identify potential preventive strategies. Methods: A mixed methods approach was taken, combining quantitative epidemiological study of suicide using Office for National Statistics (ONS) Public Health Mortality Files with qualitative retrospective case study analysis using coroner’s records and local audit database. All completed suicides (and some systematically selected open verdicts) in people aged 75 years and over occurring in Cornwall between 2006 and 2010 were included. A questionnaire survey of rural community dwelling people aged 75 years and over (n = 49) in a part of Cornwall was also carried out to identify the main sources of stress associated with ageing in the local area. Results: Some discrepancies in the number of open verdicts reported by the coroner and ONS were noted. Although suicide in the over 75 age group was responsible for only 0.3 % of all-cause mortality in males and 0.1 % in females, the overall suicide rate in this age group in Cornwall was significantly higher than the average for the UK, with a Standardised Mortality Ratio of 172 (95 % CI 123 to 236). Males aged between 75 and 84 years had the highest suicide rate in Cornwall (mean of 25.8 deaths per 100,000 population, 95 % CI 1.1 to 50.5). Jumping from a height and suffocation were the most frequently used methods, accounting for 8 and 7 of the 34 deaths respectively. 28 of the 34 suicides took place at home. Depressive illness, physical illness and bereavement were the most commonly identified risk factors. Concerns revealed in survey responses were closely related to suicide risk factors, including fear of losing independence, bereavement, physical illness, isolation, and fear of becoming a burden. Warnings included previous self-harm or attempted suicide, suicide ideation or plans, behavioural changes and researching euthanasia. Discussion: As persons aged 75 and over are at significantly higher risk of suicide in Cornwall than other regions, there is a need to reduce the number of suicides in this group. Possible preventive measures include reducing access to means (in particular for jumping incidents), earlier detection of depression in the physically ill, bereavement counselling, more social groups and support groups in rural areas, helping people to retain their independence, and a change in societal attitudes towards elderly people. There may also be a need to improve the accuracy of suicide statistics. Conclusion: Health services, councils, voluntary groups and the community as a whole should work together to prevent suicide in older people. Future controlled studies should assess the effectiveness of interventions and focus more on differences between subgroups of elderly people.

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