前言：65歲以上高齡者相較於其他年齡層有較高的自殺死亡風險，且台灣高齡者自殺死亡率高於世界及其他地區水平，過往台灣在探討自殺死亡率研究，經常將65歲以上做為一個族群分析，而不同年齡之高齡者自殺死亡率分析則缺少了近年Covid-19疫情之分析。高齡者為較脆弱的群體，除了需了解自殺死亡之人口學危險因子外，且因其身體狀況較不佳，特別是在生理與精神科疾病方面，有必要了解65歲以上不同年齡層之自殺死亡之健康危險因子，疾病對於不同年齡層的影響是否存在差異。而過往台灣高齡者自殺死亡中，男性主要使用上吊，女性則是固液體中毒，但目前缺少近年65歲以上細部年齡層及地區變項之分析，透過由自殺方法之自殺死亡率、自殺方法分率可觀察各自殺方法占比消長，對防治有重要意義。
研究目的：為了解我國高齡者的自殺情形及危險因子，以提供高齡者自殺防治之策略，本研究目的分為四點，其一，了解我國高齡者自殺死亡率之變化趨勢；其二，影響我國高齡者自殺死亡之人口學危險因子；其三影響我國高齡者自殺死亡之健康危險因子；其四，我國高齡者自殺死亡方法分布與變化趨勢。
研究方法：本研究透過2011-2021年全民健康保險研究資料庫與死因統計檔的串聯，對高齡者自殺死亡風險進行深入分析，並針對不同目的有其相對應之分析策略，目的（1）高齡者自殺死亡率之變化趨勢、（2）透過泊瓦松迴歸了解影響高齡者自殺死亡之人口學危險因子、（4）高齡者自殺死亡方法分布與變化趨勢，採用橫斷性研究；目的（3）採用巢式病例對照研究，透過1:4比例，將2017年至2021年自殺死亡高齡者與非自殺死亡高齡者進行比較，在經過校正年代、性別、年齡、戶籍地後，回顧指標日之過去一年健康情形，使用條件邏輯迴歸了解影響高齡者自殺死亡之健康危險因子。
研究結果：在2011-2021年期間，共有11,022名自殺死亡之高齡者，男性自殺死亡率較女性嚴重，年齡越高，自殺死亡率越高。65歲以上整體年齡標準化自殺死亡率在T3後呈下降趨勢，即便至T4（Covid-19疫情期間）仍保持下降，與原住民相關的地區變項，如：東部地區、山地/平地原鄉、偏遠地區，在T4降到正常水準。我國男性（RR=2.04）、85-89歲（RR=1.76）、低收入者（RR=2.03）；以及地區變項：鄉（RR=1.23）、鎮（RR=1.18）、高齡化市鎮（RR=1.23）、偏遠鄉鎮（RR=1.22）、農業市鎮（RR=1.15）、東部地區（RR=1.24）、原民平地鄉（RR=1.12）、偏遠地區（RR=1.12）自殺死亡風險較高。在疾病方面，精神科疾病以憂鬱症 (OR=6.64)、雙極性疾患 (OR=4.38)、其他精神疾病 (OR=3.39)、思覺失調症 (OR=1.83)對高齡者影響最大；生理疾病為癌症 (OR=1.43) 、中風 (OR=1.38)、慢性阻塞性肺病 (OR=1.44)、慢性腎臟病 (OR=1.35)、高血壓 (OR=1.23)；重大傷病(OR=1.84)也會增加自殺死亡風險。進一步以不同年齡進行健康危險因子分析，結果發現，不論是在精神科疾病、生理疾病，年齡越高，健康對自殺死亡的影響則降低。在2011-2021年，65歲以上的高齡者在自殺方法的使用上有著明顯的性別差異，男性主要是使用上吊 (39.4%)方法做自殺，其次為固液體中毒 (25%)。女性主要使用固液體中毒 (31.1%)，其次為上吊 (30.7%)。且進行年齡分層分析後發現，上吊會隨者年齡越高，使用比例越高；溺水、氣體中毒則會隨者年齡越高，使用比例越低。以都市化程度觀察自殺方法使用差異，上吊在不同都市化程度中佔比差異並不大；固液體中毒部分，會隨著地區越偏遠，有著更高的占比；溺水與墜落，則特別在高度都市化市鎮佔比為最高。
結論：年齡越高的高齡者具有較高的自殺死亡風險，65歲以上其他年齡層在下降的同時，85歲以上的高齡者卻有攀升的趨勢，代表65歲以上不同年齡層在自殺死亡情形有不同的表現。某些特性，包括：較低都市化地區(高齡化、農業、偏遠地區)與非直轄市，可能因為支持性環境不足，有較高的自殺死亡風險，但整體趨勢也在下降。精神科疾病與生理疾病對高齡者具有自殺死亡影響，且會隨著年齡越高而降低。高齡者所使用的自殺方法會因不同性別、年齡層、都市化程度而有所差異。綜上，應針對高齡者的不同特性而採用相對應的自殺防治策略。

Introduction: Individuals aged 65 and older face a higher risk of suicide mortality compared to other age groups, and the suicide mortality rate among the elderly in Taiwan is higher than the global and regional averages. Previous research in Taiwan on suicide mortality has often treated individuals aged 65 and older as a single group, lacking an analysis of suicide mortality across different elderly age groups, especially considering the recent impact of the COVID-19 pandemic. The elderly are a more vulnerable population, and it is essential to understand not only the demographic risk factors for suicide mortality but also the health risk factors specific to different age groups within the elderly population, particularly in terms of physical and psychiatric conditions. There may be differences in how diseases affect various age groups. In past studies of elderly suicide mortality in Taiwan, men primarily used hanging as a method, while women tended to resort to poisoning by solid or liquid substances. However, there is currently a lack of detailed analysis by specific age groups and regional variables for those aged 65 and older. Observing the changes in the proportion of different suicide methods through suicide mortality rates and method-specific suicide rates can provide significant insights for prevention and intervention strategies. To understand the suicide situation and risk factors among the elderly in Taiwan and to provide strategies for suicide prevention among this population, this study has four objectives. First, to examine the trends in suicide mortality rates among the elderly in Taiwan. Second, to identify the demographic risk factors that influence suicide mortality among the elderly. Third, to analyze the health risk factors associated with suicide mortality in this age group. Fourth, to investigate the distribution and trends of suicide methods among the elderly in Taiwan.
Materials and methods: This study conducts an in-depth analysis of suicide mortality risk among the elderly by linking data from the National Health Insurance Research Database (NHIRD) and cause of death statistics from 2011 to 2021. Different analytical strategies are employed corresponding to each research objective. For objective (1), the trend in suicide mortality rates among the elderly, (2) identifying demographic risk factors influencing elderly suicide mortality using Poisson regression, and (4) analyzing the distribution and trends of suicide methods among the elderly, a cross-sectional study design is adopted. For objective (3), a nested case-control study is conducted, comparing elderly individuals who died by suicide between 2017 and 2021 with those who did not, at a ratio of 1:4. After adjusting for variables such as year, gender, age, and household registration area, the study retrospectively examines the health status of these individuals in the year prior to the index date. Conditional logistic regression is used to identify health risk factors associated with suicide mortality among the elderly.
Results and discussion: Between 2011 and 2021, a total of 11,022 elderly individuals died by suicide in Taiwan, with suicide mortality rates being more severe among men than women. The suicide mortality rate increased with age. The overall age-standardized suicide mortality rate for those aged 65 and above showed a declining trend after T3, and this decline persisted even into T4 (the COVID-19 pandemic period). Regional variables related to Indigenous populations, such as the eastern region, mountainous/flatland Indigenous areas, and remote areas, normalized to typical levels by T4. The suicide mortality risk was higher among men (RR=2.04), those aged 85-89 (RR=1.76), and low-income individuals (RR=2.03). Region-specific variables also indicated higher risks in townships (RR=1.23), towns (RR=1.18), aging towns (RR=1.23), remote townships (RR=1.22), agricultural towns (RR=1.15), the eastern region (RR=1.24), flatland Indigenous areas (RR=1.12), and remote areas (RR=1.12). Regarding diseases, psychiatric disorders had the most significant impact on the elderly, with depression (OR=6.64), bipolar disorder (OR=4.38), other mental illnesses (OR=3.39), and schizophrenia (OR=1.83) being the most influential. Among physical illnesses, cancer (OR=1.43), stroke (OR=1.38), chronic obstructive pulmonary disease (OR=1.44), chronic kidney disease (OR=1.35), and hypertension (OR=1.23) were significant risk factors. Catastrophic illness (OR=1.84) also increased the risk of suicide mortality. A further analysis of health risk factors across different age groups revealed that as age increased, the impact of both psychiatric and physical illnesses on suicide mortality decreased. During the period from 2011 to 2021, there were significant gender differences in the methods of suicide among the elderly. Men primarily used hanging (39.4%), followed by poisoning by solid or liquid substances (25%). Women mainly used poisoning by solid or liquid substances (31.1%), followed by hanging (30.7%). Age-stratified analysis showed that the proportion of suicides by hanging increased with age, while the use of drowning and gas poisoning decreased with age. When observing the differences in suicide methods based on the degree of urbanization, the proportion of suicides by hanging did not vary across different levels of urbanization. However, the use of poisoning by solid or liquid substances increased in more remote areas. Drowning and falling were more prevalent in highly urbanized towns.
Conclusion: Elderly individuals of advanced age have a higher risk of suicide mortality, with those aged 85 and above showing an upward trend in suicide rates even as rates among other age groups over 65 are declining. This indicates that different age groups within the elderly population exhibit varying patterns of suicide mortality. Certain characteristics, such as living in less urbanized areas (aging, agricultural, or remote regions) and non-municipal areas, may contribute to higher suicide mortality risks, possibly due to a lack of supportive environments. However, the overall trend is still one of decline. Both psychiatric and physical illnesses have an impact on suicide mortality among the elderly, and this influence tends to decrease with advancing age. The methods of suicide used by the elderly also vary depending on gender, age group, and the level of urbanization. In summary, suicide prevention strategies should be tailored to the specific characteristics of the elderly population.

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