To investigate factors differentiating old-old elderly who died by suicide (those aged 75 years and older) from middle aged (those aged 50-64 years old) and young-old adults who took their own lives (aged 65 years to 74 years), and from living psychiatric outpatients 75 years and older who had no suicidal behaviors in the last six months before assessment.

Cases for psychological autopsy interviews were 117 old-old elderly who died by suicide between 1994 and 2009. Comparisons were 97 youngold adult and 98 middle aged suicides, and 117 psychiatric outpatients admitted to the Department of Psychiatry of the University of Parma (Italy), between 1994 and 2009. Information for suicide decedents was gathered through proxy-based interviews, and data regarding living comparisons were extracted from medical records.

A high number of old-old elderly were widowed and lived alone before death; widowhood was more prevalent in the old-old elderly than in the younger suicide groups and the living psychiatric comparisons. Also, old-old elderly were more frequently characterized by the presence of life stressors in the few months before deaths when compared with psychiatric living comparisons 75 years and older.

Clinicians involved in the prevention of suicide in the older adults should pay particular attention to loneliness and lack of social support, two conditions that may push the individual to feel hopeless, especially in those individuals who are facing stressful life events.