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Participants included all US veterans aged 65 years or older who received care at VA medical centers from October 1, 2011, to September 30, 2013. Data were analyzed from April 20, 2021, to May 31, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220103-7\"><jats:title>Exposures<\/jats:title><jats:p>Frailty, defined based on a validated cumulative-deficit frailty index measured using electronic health data and categorized into 5 levels: nonfrailty, prefrailty, mild frailty, moderate frailty, and severe frailty.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220103-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcome was suicide attempts through December 31, 2017, provided by the national Suicide Prevention Applications Network (nonfatal attempts) and Mortality Data Repository (fatal attempts). Frailty level and components of the frailty index (morbidity, function, sensory loss, cognition and mood, and other) were assessed as potential factors associated with suicide attempt.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220103-9\"><jats:title>Results<\/jats:title><jats:p>The study population of 2\u202f858\u202f876 participants included 8955 (0.3%) who attempted suicide over 6 years. Among all participants, the mean (SD) age was 75.4 (8.1) years; 97.7% were men, 2.3% were women, 0.6% were Hispanic, 9.0% were non-Hispanic Black, 87.8% were non-Hispanic White, and 2.6% had other or unknown race and ethnicity. Compared with patients without frailty, risk of suicide attempt was uniformly higher among patients with prefrailty to severe frailty, with adjusted hazard ratios (aHRs) of 1.34 (95% CI, 1.27-1.42; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) for prefrailty, 1.44 (95% CI, 1.35-1.54; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) for mild frailty, 1.48 (95% CI, 1.36-1.60; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) for moderate frailty, and 1.42 (95% CI, 1.29-1.56; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) for severe frailty. Lower levels of frailty were associated with greater risk of lethal suicide attempt (aHR, 1.20 [95% CI, 1.12-1.28] for prefrail veterans). Bipolar disorder (aHR, 2.69; 95% CI, 2.54-2.86), depression (aHR, 1.78; 95% CI, 1.67-1.87), anxiety (aHR, 1.36; 95% CI, 1.28-1.45), chronic pain (aHR, 1.22; 95% CI, 1.15-1.29), use of durable medical equipment (aHR, 1.14; 95% CI, 1.03-1.25), and lung disease (aHR, 1.11; 95% CI, 1.06-1.17) were independently associated with increased risk of suicide attempt.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220103-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study found that among US veterans aged 65 years or older, frailty was associated with increased risk of suicide attempts and lower levels of frailty were associated with greater risk of suicide death. Screening and involvement of supportive services across the spectrum of frailty appear to be needed to help reduce risk of suicide attempts.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2022.5144","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T16:01:00Z","timestamp":1677081660000},"page":"287","source":"Crossref","is-referenced-by-count":26,"title":["Association of Frailty With Risk of Suicide Attempt in a National Cohort of US Veterans Aged 65 Years or Older"],"prefix":"10.1001","volume":"80","author":[{"given":"Randall L.","family":"Kuffel","sequence":"first","affiliation":[{"name":"San Francisco VA Health Care System, San Francisco, California"},{"name":"Northern California Institute for Research and Education, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth T.","family":"Morin","sequence":"additional","affiliation":[{"name":"San Francisco VA Health Care System, San Francisco, California"},{"name":"Hoag Memorial Hospital Presbyterian, Newport Beach, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Covinsky","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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