Frailty and Suicide Risk Among Older Adult Veterans

A recent study found frailty was associated with suicide attempt risk among U.S. veterans ages 65 and older.

Study participants were 2,858,876 veterans (mean age 75.4) who received care at U.S. Department of Veterans Affairs (VA) medical centers from October 1, 2011, through September 13, 2013. The sample population was 2.3% female and 97.7% male, 9.0% non-Hispanic Black, 87.8% non-Hispanic White, and 2.6% “other” or unknown ethnicity. Among all participants, 16.6% had diagnosed substance use disorder (SUD) and 6.8% had diagnosed post-traumatic stress disorder (PTSD).

The study integrated databases from VA health care services, Centers for Medicare & Medicaid Services, and other national suicide data. Using suicide attempts through December 31, 2017, as the main outcome measure, researchers analyzed degree of frailty categorized into five levels (nonfrailty; prefrailty; and mild, moderate, and severe frailty).

The researchers found that the risk of suicide attempts was higher in veterans with all levels of frailty compared to those without frailty. Risk of lethal suicide attempts was associated with lower levels of frailty. A total of 8,995 (0.3%) participants had a documented suicide attempt and 5,497 had died by suicide by the end of the study period. The greatest percentage of suicide attempts was found among those with mild or moderate frailty and the smallest percentage among those without frailty. Veterans with prefrailty had the highest cumulative incidence of fatal suicide attempts over time. The risk of any suicide attempt was 48% higher among older veterans with moderate frailty compared to veterans without frailty. The presence of chronic pain, use of durable medical equipment (e.g., motorized wheelchair), lung disease, SUD, PTSD, or other mental health disorder increased the risk of suicide attempts as well as deaths.

The sample for this study was predominantly male (97.7%); women have only recently begun to enter the military in large numbers and are not well represented in the older veteran population. This means caution should be used in generalizing these results to female veterans. The findings may also be less generalizable to people of color, non-veterans, and veterans who do not use VA services. Since frailty was only measured once (at baseline), these results cannot account for the effects of progressive disabilities over time. Nonetheless, this study highlights the importance of assessing and addressing depression and suicidality among frail older adults.

Kuffel, R. L., Morin, R. T., Covinsky, K. E., Boscardin, W. J., Lohman, M. C., Li, Y., Byers, A. L. (2023). Association of frailty with risk of suicide attempt in a national cohort of US veterans aged 65 years or older. JAMA Psychiatry, 80(4): 287-295. doi:10.1001/jamapsychiatry.2022.5144