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SUICIDE IN THE ELDERLY

SUICIDE IN THE ELDERLY. JIMMIE D. MCADAMS, D.O. DIRECTOR OF PSYCHIATRY SAINT ANN’S AT LAUREATE. 20% 75% 39% ??% 90 MINUTES. SYMPTOMS OF DEPRESSION. DEPRESSED MOOD MOST OF THE DAY, NEARLY EVERY DAY MARKED DIMINISHED INTEREST OR PLEASURE IN ALMOST ALL CUSTOMARY ACTIVITIES

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SUICIDE IN THE ELDERLY

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  1. SUICIDE IN THE ELDERLY JIMMIE D. MCADAMS, D.O. DIRECTOR OF PSYCHIATRY SAINT ANN’S AT LAUREATE

  2. 20% • 75% • 39% • ??% • 90 MINUTES

  3. 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

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

  5. 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

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

  7. EPIDEMIOLOGY • UP TO 17% OF THE ELDERLY • UP TO 40% OF NURSING HOME PTS • 1:1 MALE TO FEMALE RATIO

  8. 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 DEPRESSION KILLS

  9. EVALUATION

  10. 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

  11. COMMUNICATION BARRIER • IMPAIRED HEARING • POOR COMPREHENSION • POOR MEMORY • EMBARESSMENT • POLYPHARMACY • PARANOIA

  12. MENTAL STATUS • ORIENTATION • INSIGHT • THOUGHT PROCESS AND CONTENT • HALLUCINATIONS • ATTENTION/CONCENTRATION • ABSTRACTION • MEMORY • AFFECT

  13. ALL DEPESSION SHOULD BE TREATED

  14. 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 • 2:3 HOMOCIDES:SUICIDES

  15. SUICIDE RISK FACTORS • GENDER • ATTEMPTS 1:4 MALE:FEMALE • COMPLETIONS 3:1 MALE:FEMALE • FEMALES ATTEMPT BY OVERDOSE • MALES BY GUNS OVER 60 % THE TIME

  16. SUICIDE RISK FACTORS • RACE • WHITES > AFRICAN AMERICANS > NATIVE AMERICANS • IMMIGRANTS

  17. SUICIDE RISK FACTORS • RELIGION • OVERALL A DETERANT • CATHOLIC < PROTESTANT/JEWISH • DEGREE OF ORTHODOXY • INTEGRATION IN THE RELIGION

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

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

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

  25. INDIRECT SELF-DESTRUCTIVE BEHAVIORS (ISB’S) • REFUSING TO EAT OR DRINK • FAILING TO COMPLY WITH MEDICAL TREATMENT • MEDICATION MIS-MANAGEMENT OR NONCOMPLIANCE • ENGAGING IN RISK TAKING BEHAVIOR

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

  27. 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

  28. WE MUST DO BETTER • PREVENTION OF RISK FACTORS • EARLY IDENTIFICATION OF RISK FACTORS • TREATMENT OF IDENTIFIABLE D/O • CRISIS INTERVENTION • REMOVAL OF MEANS

  29. WE MUST DO BETTER • DON’T ASK DON’T TELL • ASK DON’T TELL • LOOK AT ALL THE INFORMATION AND ASESS RISK, AND RESPOND APPROPRIATELY

  30. 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

  31. THANK YOU QUESTIONS ??

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