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More than 1 in 5 older adults who commit suicide disclose their intention to kill themselves before taking their own lives, a study suggests.

Overall, 23 percent of suicide victims age 50 or older shared suicidal thoughts with another person in the month before their death, the study found. Disclosure rates were higher among the elderly and more common when people had chronic health problems or suffered from depression.

Many older adults who commit suicide without sharing their intentions in advance may have been reluctant to discuss these feelings because they were afraid how doctors or family members might react, said lead study author Namkee Choi, of the University of Texas at Austin Steve Hicks School of Social Work.

“Some older adults at risk of suicide may not want to disclose their suicide intent if they think family members and healthcare and social service providers may force them into inpatient treatment or dismiss their disclosure,” Choi said by email.

“Healthcare providers, especially primary care physicians who frequently see older adults with health problems and depression, should routinely assess suicide risk along with access to guns and other means of suicide,” Choi added.

Choi and colleagues examined data on 46,857 suicide deaths among adults 50 or older from 2005 through 2014.

Overall, 10,971 people in the study had disclosed an explicit intent to take their own lives, shared an indirect interest in doing something to end their pain and suffering, or attempted suicide at least once in the month before they died.

This didn’t include people who shared their plans to kill themselves right before they did it, because this didn’t provide time to intervene to stop the suicide, researchers note in the American Journal of Preventive Medicine.

People who did share their intentions before committing suicide were more likely to be older, white, married and military veterans, the study found.

Individuals who disclosed suicidal thoughts were also more likely to have depression and to have chronic health problems, the study also found.

Most often, people who shared suicidal thoughts told an intimate partner or other family member, not a health professional.

People were less likely to share their intentions to commit suicide when they planned to use a gun or try to hang or suffocate themselves than when they were considering other methods, the study also found.

One limitation of the study is that researchers lacked data to distinguish between verbal disclosure of suicidal thoughts and unsuccessful suicide attempts, the authors note.

Even so, the findings highlight a need for health-care providers to discuss suicide with older adults in a way that’s sensitive and encourages conversation, said Linda Ganzini, a psychiatry researcher at Oregon Health and Science University in Portland, who wasn’t involved in the study.