• Kimberly A Van Orden, Adam Simning, Yeates Conwell, Ingmar Skoog, and Margda Waern.
• Department of Psychiatry, University of Rochester Medical Center, Rochester, NY. Electronic address: kimberly_vanorden@urmc.rochester.edu.
• Am J Geriatr Psychiatry. 2013 Aug 1;21(8):803-10.

ObjectiveTo determine whether death ideation in late life is associated with markers of elevated risk for suicide, or reflects normal psychological processes in later life.Design/SettingPopulation-based cross-sectional study in Gothenburg, Sweden.ParticipantsThe sample consists of 345 men and women of age 85 years (born 1901-1902) and living in Gothenburg, Sweden.Main Outcome MeasuresThe Paykel Scale measured the most severe level of suicidality over an individual's lifetime. Other key measures were severity of depression and anxiety and frequency of death/suicidal ideation over the previous month.ResultsLatent class analysis revealed distinct groups of older adults who reported recent death ideation. Recent death ideation did not occur apart from other risk factors for suicide; instead individuals reporting recent death ideation also reported either 1) recent high levels of depression and anxiety, or 2) more distant histories of serious suicidal ideation (indicative of worst point severity of suicidal ideation)-both of which elevate risk for eventual suicide.ConclusionsOur results indicate a heterogeneous presentation of older adults who report death ideation, with some presenting with acute distress and suicidal thoughts, and others presenting with low distress but histories of serious suicidal ideation. The presence of death ideation is associated with markers of increased risk for suicide, including "worst point" active suicidal ideation.Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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