CHICAGO -- Primary care physicians may be the only ones to see the red flags associated with suicide in elderly patients, because most elderly suicide victims never come to the attention of psychiatrists.

Primary care physicians should be highly alert to signs of depression and increasing social isolation among their elderly patients, particularly those who live alone, Dr. George El-Nimr said in a poster session at a meeting of the International Psychogeriatric Association.

"Previous studies have shown that attempted suicide and deliberate self-harm are associated with social isolation, which was also round to be associated with the onset of suicidal ideation," said Dr. El-Nimr of Hollins Park Hospital in Warrington, England. Yet data suggest that more than 80% of" elderly who commit suicide never see a psychiatrist before their death and that only about 15% are under psychiatric care when they commit suicide.

Dr. El-Nimr conducted a retrospective study of 200 suicides of people aged 60 years and older that occurred in Cheshire from 1989 to 2001.

Women, whether living alone or with someone else, were more likely than men to have contacted their primary care physician and to have been known to psychiatric services before suicide.

"Women seem to have a higher tendency to utilize services and ask for help," Dr. El-Nimr said. "They also appear to present their problems in a way that attracts the attention of relevant psychiatric services."

And, he added, children who urge an elderly parent to get help are more likely to have an impact on mothers than on fathers. But since most suicide victims never get a psychiatric referral, their primary care physicians must be alert for any danger sign: depression, which can present as physical ailments; alcoholism; social isolation; and living alone.

It's also important to note the presence or absence of close family members, whether spouses or children, he said. 'According to our study, childless women and widowed men, as well as the socially isolated, are at a particular risk."

If danger signs emerge, an integrated care approach is likely to be most successful.

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