Geriatric Suicide Prevention: The Trauma Center’s Role in Preventing the Next Injury
Suicide prevention is often discussed in terms of adolescents, young adults, or middle-aged adults. Older adults deserve the same attention.
Some of the highest suicide rates in the United States occur among older adults, particularly older men. And because older adults are also more likely to experience serious consequences from falls, firearm injuries, medication-related harm, and other traumatic injuries, trauma centers are uniquely positioned to become part of the prevention strategy.
The opportunity is bigger than screening a patient who presents after a suicide attempt.
Trauma centers can use the patients, patterns, and injuries they see every day to identify opportunities to prevent suicide among older adults before the next traumatic injury occurs.
The Numbers Should Get Our Attention
Suicide among older adults is easy to overlook when considering only the total number of suicide deaths. The most recent CDC data, shown in the table below, indicate that people age 85+ have the highest suicide rate of any age group in the United States.
The disparity is particularly striking among men. In 2023, men age 75 and older had a suicide rate of 40.7 deaths per 100,000 -- the highest rate among male age groups. (Source)
The problem is not simply about age. Older adults experience a combination of risk factors that can increase vulnerability to suicide:
Social isolation and loneliness
Bereavement and loss of a spouse or close friends
Declining physical function or independence
Chronic pain
Serious or progressive illness
Depression and other mental health conditions
Cognitive impairment
Alcohol or substance use
Financial stress
Changes in housing or living arrangements
Loss of driving privileges or mobility
Access to firearms or medications
A history of previous suicide attempts or self-harm
Why Should Trauma Centers Care About Geriatric Suicide?
Yesterday's post was about the role of trauma center in suicide prevention. This philosophy also extends to geriatric suicide prevention. Because trauma centers already see many of the patients and circumstances associated with suicide risk.
A 2025 multicenter study -- Geri-screen -- screened 408 injured patients age 55 and older at five Level I trauma centers. More than one-third screened positive for depressive symptoms, nearly 40% reported a firearm in the home, and 20% of patients experiencing suicidal ideation had a firearm in the home. The authors concluded that identifying depression, suicidal ideation, and access to lethal means during trauma hospitalization may provide an opportunity for intervention before discharge. (PubMed)
That is a significant finding for trauma programs. An older adult admitted after a fall may not look like a suicide prevention patient.
The trauma center may be one of the few healthcare environments where an older adult's physical condition, functional status, social circumstances, family relationships, medication use, and injury history are evaluated simultaneously. That creates an important suicide prevention opportunity.
The trauma center can become a critical connection point between injury care, behavioral health, primary care, family and caregivers, EMS, and community resources.
Older Adults Are Not Just "Geriatric Trauma Patients"
As we know, age alone does not tell us enough. Two 80-year-old patients can have completely different levels of health, independence, social support, cognition, and resilience. The same is true for suicide risk.
A trauma program that simply creates a "patients age 65 and older" suicide screen may be missing important information. The more useful questions may include:
Does the patient live alone?
Has the patient recently experienced a major loss?
Has there been a recent decline in independence?
Is there a history of depression or substance use?
Has the patient had previous self-harm or suicide-related encounters?
Does the patient have access to firearms?
Are medications safely managed?
Is there evidence of cognitive impairment?
Does the patient have reliable family or caregiver support?
Is the patient experiencing uncontrolled pain?
Has the patient expressed hopelessness or a desire not to continue living?
These questions do not replace validated suicide-risk assessment, but they help the trauma program understand where its prevention opportunities may exist.
Firearms Make Lethal-Means Safety Particularly Important
One of the most important reasons trauma centers should pay attention to geriatric suicide prevention is the role of firearms. In 2022, firearms were involved in 70.6% of suicide deaths among people age 65 and older, the highest proportion of firearm-involved suicide deaths among the age groups examined by CDC. (Source) This matters because access to a highly lethal method can dramatically change the consequences of a suicidal crisis.
Trauma centers already have expertise in firearm injury prevention. They see the consequences of unsecured firearms firsthand. That creates opportunities for conversations about secure firearm storage, family involvement, and recognition of changing risk following a new diagnosis, loss, or injury.
Importantly, lethal-means counseling does not have to be reserved for patients who present after a suicide attempt. A trauma center could consider whether firearm-safety conversations should be incorporated into prevention efforts for selected older adults based on local injury data and identified risk factors.
The Trauma Center's Registry Can Tell a Story
Once again, this is where trauma program data become particularly valuable. The trauma registry can help identify patterns that may not be obvious from individual patient encounters.
Consider asking:
How many older adults present after intentional self-harm?
How many have repeat trauma or ED encounters?
How many injuries involve firearms? Medication or poisoning?
How many patients live alone?
How often is depression, substance use, or cognitive impairment documented?
How often are behavioral-health concerns identified?
What happens after discharge?
Are there geographic patterns?
Are particular age groups—such as patients 75 or 85 and older—overrepresented?
The answers may reveal a very different prevention opportunity than simply looking at the total number of suicide attempts. For example, suppose a trauma center's data show that a disproportionate number of older adults with self-inflicted injuries who live alone, have access to firearms, have repeated ED encounters, and have a documented history of alcohol use. That is no longer simply a suicide statistic. It is a trauma prevention problem that can be investigated.
Discharge May Be the Most Important Intervention Point
For many older trauma patients, the hospital stay is only the beginning. An older adult may leave the hospital with a new fracture, reduced mobility, chronic pain, medication changes, loss of independence, or a new need for assistance with activities of daily living. Those changes can have profound psychological consequences.
Trauma programs should consider whether discharge planning for at-risk older adults addresses adequate follow-up with behavioral health, primary care, and home health. Consideration should be given to medication management, substance use treatment, and social isolation. The trauma center may not own every piece of this process. But it should know who does.
Geriatric Suicide Prevention Can Become an Injury Prevention Priority
A trauma center might begin with a relatively narrow question: What does our own data tell us about older adults and suicide-related injury?
From there, the program can develop a targeted intervention.
If firearms are prominent, consider lethal-means safety.
If repeat self-harm encounters are common, strengthen the trauma-to-behavioral-health transition.
If alcohol or substance use is prominent, integrate screening and referral.
If social isolation appears repeatedly, build relationships with senior-serving community organizations.
If older adults with recent falls or functional decline appear particularly vulnerable, explore opportunities to connect fall prevention with suicide prevention.
This is much stronger than creating a generic "suicide awareness" campaign. It is data-driven injury prevention.
Geriatric Injury Prevention and Suicide Prevention Can Intersect
Most trauma centers already have a geriatric trauma injury prevention initiatives. But they might also look for opportunities to provide suicide prevention when it addresses physical safety and psychological safety.
For example:
Fall prevention + depression screening + social isolation assessment + medication review + firearm safety + behavioral-health referral
This more comprehensive approach recognizes that older adults' injury risk is influenced by a much broader set of physical, social, and psychological factors.
The Bottom Line
Geriatric suicide prevention should not be viewed as solely a behavioral-health issue. For trauma centers, it is also an injury-prevention issue.
Trauma programs already have the infrastructure to identify injury patterns, evaluate high-risk populations, conduct performance improvement, build community partnerships, and develop targeted prevention interventions. The next step is to apply that infrastructure to an often-overlooked population.
Older adults should not have to present after a suicide attempt for the trauma center to become part of the prevention strategy.
The goal of injury prevention has always been to prevent the next injury. For geriatric patients, that may sometimes mean preventing the next suicide.
