SUICIDE IN THE ELDERLY

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SUICIDE IN THE ELDERLY

• JIMMIE D. MCADAMS, D.O.
• DIRECTOR OF PSYCHIATRY
• SAINT ANNS AT LAUREATE

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• 20
• 75
• 39
• ??
• 90 MINUTES

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SYMPTOMS OF DEPRESSION

• DEPRESSED MOOD MOST OF THE DAY, NEARLY EVERY DAY
• MARKED DIMINISHED INTEREST OR PLEASURE IN ALMOST
  ALL CUSTOMARY ACTIVITIES
• WEIGHT LOSS OR GAIN
• TOO MUCH SLEEP
• TOO LITTLE SLEEP

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SYMPTOMS OF DEPRESSION

• EITHER MARKEDLY SLOW OR AGITATED MOVEMENTS
• LOSS OF ENERGY
• POOR CONCENTRATION
• SUICIDAL THOUGHTS/ATTEMPTS
• HOPELESS/HELPLESS
• WORTHLESS

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GERIATRIC SYMPTOMS

• COGNITIVE IMPAIRMENT
• APATHY AND SOCIAL WITHDRAWAL
• FOCUS ON PAIN AND OTHER PHYSICAL COMPLAINTS
• LITTLE OR NO SADNESS DISPLAYED OR ADMITTED
• NEW ONSET ANXIETY

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RISK FACTORS

• POOR PHYSICAL HEALTH
• GENETICS
• PRIOR DEPESSIONS
• POOR SOCIAL SUPPORT
• POLYPHARMACY
• AGE RELATED CHANGES IN NEUROTRANSMITER AND
  HORMONE METABOLISM AND FUNCTION

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EPIDEMIOLOGY

• UP TO 17 OF THE ELDERLY
• UP TO 40 OF NURSING HOME PTS
• 11 MALE TO FEMALE RATIO

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DEPRESSION KILLS

• DEPRESSED SMOKERS 40 LESS LIKELY TO QUIT
• LESS LIKELY TO ADHERE TO DAILY LOW DOSE ASPIRIN
  DOSE IN CORNARY ARTERY DISEASE PTS
• POST MYOCARDIAL INFARCTION PTS MORE LIKELY TO
  DROP OUT OF EXERCISE PROGRAMS

• INCREASES MORBIDITY IN MEDICAL ILLNESSES
• INCREASES MORTALITY IN POST MI PATIENTS, NURSING
  HOME PATIENTS, CANCER, CHF

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EVALUATION
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HISTORY

• FROM THE PATIENT
• FROM THE FAMILY
• FROM OTHER CARE GIVERS
• FROM THE THERAPIST
• FROM THE FAMILY DOCTOR
• FOCUS ON SYMPTOMS, SUICIDE, SUBSTANCE, PSYCHOSIS,
  MEDS

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COMMUNICATION BARRIER

• IMPAIRED HEARING
• POOR COMPREHENSION
• POOR MEMORY
• EMBARESSMENT
• POLYPHARMACY
• PARANOIA

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MENTAL STATUS

• ORIENTATION
• INSIGHT
• THOUGHT PROCESS AND CONTENT
• HALLUCINATIONS
• ATTENTION/CONCENTRATION
• ABSTRACTION
• MEMORY
• AFFECT

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ALL DEPESSION SHOULD BE TREATED
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SUICIDE

• 30,622 DEATHS 2001
• 5TH LEADING CAUSE OF DEATH AGE 5-14
• 3RD LEADING CAUSE OF DEATH AGE 15-24
• 4TH LEADING CAUSE OF DEATH AGE 25-44
• 80 PEOPLE PER DAY COMMIT SUICIDE
• 132,353 HOSPITALIZED FOLLOWING ATTEMPTS, 116,639
  TREATED RELEASED
• 23 HOMOCIDESSUICIDES

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SUICIDE RISK FACTORS

• GENDER
• ATTEMPTS 14 MALEFEMALE
• COMPLETIONS 31 MALEFEMALE
• FEMALES ATTEMPT BY OVERDOSE
• MALES BY GUNS OVER 60 THE TIME

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SUICIDE RISK FACTORS

• RACE
• WHITES gt AFRICAN AMERICANS gt NATIVE AMERICANS
• IMMIGRANTS

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SUICIDE RISK FACTORS

• RELIGION
• OVERALL A DETERANT
• CATHOLIC lt PROTESTANT/JEWISH
• DEGREE OF ORTHODOXY
• INTEGRATION IN THE RELIGION

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SUICIDE RISK FACTORS

• MARITAL STATUS
• MARRIAGE REINFORCED BY CHILDREN LESSENS RISK
  11/100,000
• NEVER MARRIED 18/100,000
• WIDOWED 24/100,000
• DIVORCED 43/100,000
• DIVORCED MEN 69/100,000
• DIVORCED WOMEN 18/100,000

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SUICIDE RISK FACTORS

• OCCUPATION
• EMPLOYMENT, IN GENERAL, PROTECTS AGAINST SUICIDE
• HIGHER SOCIAL STATUS, INCREASES RISK OF SUICIDE
• FALL IN SOCIAL STATUS GREATLY INCREASES RISK
• PHYSICIANS ? HIGHER RISK FEMALE GREATER THAN
  MALES

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SUICIDE RISK FACTORS

• MENTAL HEALTH
• 95 OF ALL SUICIDES HAVE A DIAGNOSED MENTAL
  DISORDER/SUBSTANCE USE DISORDER
• 80 DEPRESSIVE DISORDERS/SUBSTANCE USE
• 10 SCHIZOPHRENIA
• 5 DEMENTIA /DELIRIUM
• TREATED AS AN INPATIENT INCREASES RISK 5-10 TIMES
  

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GERIATRIC SPECIFIC

• AGE 65-69 13.1/100,000
• AGE 70-74 15.2/100,000
• AGE 75-79 17.6/100,000
• AGE 80-84 22.9/100,000
• 85 21/100,000

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GERIATRIC SPECIFIC

• 85 OF SUICIDES WERE MEN
• 15 OF SUICIDES WERE WOMEN
• 70 INVOLVED THE USE OF A FIREARM. 78 MALE, 35
  FEMALE
• DISPRPORTIONATE EFFECT ON THE ELDERLY

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RISK

• HISTORY OF SUICIDE ATTEMPT
• ACUTE SUICIDAL IDEATION
• SERIOUSNESS OF PREVIOUS ATTEMPT
• PRESENCE OF FIREARM
• MAJOR DEPRESSIVE D/O
• SEVERE HOPELESSNESS

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RISK

• SOCIALLY ISOLATED
• DRINKING TOXIC LIQUID
• CUTTING SELF
• FAMILY HISTORY OF SUICIDE
• REFUSING TO EAT
• SUBSTANCE ABUSE

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INDIRECT SELF-DESTRUCTIVE BEHAVIORS (ISBS)

• REFUSING TO EAT OR DRINK
• FAILING TO COMPLY WITH MEDICAL TREATMENT
• MEDICATION MIS-MANAGEMENT OR NONCOMPLIANCE
• ENGAGING IN RISK TAKING BEHAVIOR

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ISBS

• MORE COMMON IN COMMUNITY DWELLERS
• ? MORE ACCEPTABLE OPTION TO HASTEN DEATH
• CONSCIOUS VS. SUBCONSCIOUS

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WE CAN DO BETTER

• 20 DR. VISIT WITHIN 24 HOURS
• 75 DR. VISIT WITHIN ONE MONTH
• 39 DR. VISIT WITHIN ONE WEEK
• ?? CAN WE PREVENT
• ONE ELDERLY SUICIDE EVERY 90 MINUTES

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WE MUST DO BETTER

• PREVENTION OF RISK FACTORS
• EARLY IDENTIFICATION OF RISK FACTORS
• TREATMENT OF IDENTIFIABLE D/O
• CRISIS INTERVENTION
• REMOVAL OF MEANS

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WE MUST DO BETTER

• DONT ASK DONT TELL
• ASK DONT TELL
• LOOK AT ALL THE INFORMATION AND ASESS RISK, AND
  RESPOND APPROPRIATELY

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SUICIDE

• DO YOU FEEL LIKE A BURDEN
• FEEL YOURSELF OR OTHERS MAY BE BETTER OFF IF YOU
  WERE DEAD
• THOUGHT ABOUT TAKING YOUR LIFE.----- METHOD,
  MEANS, INTENT

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THANK YOU

• QUESTIONS ??