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  WEIGHT LOSS OR GAIN  TOO MUCH SLEEP  TOO LITTLE SLEEP

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

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

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

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

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

EVALUATION

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

COMMUNICATION BARRIER  IMPAIRED HEARING  POOR COMPREHENSION  POOR MEMORY  EMBARESSMENT  POLYPHARMACY  PARANOIA

MENTAL STATUS  ORIENTATION  INSIGHT  THOUGHT PROCESS AND CONTENT  HALLUCINATIONS  ATTENTION/CONCENTRATION  ABSTRACTION  MEMORY  AFFECT

ALL DEPESSION SHOULD BE TREATED

SUICIDE  30,622 DEATHS 2001  5 TH LEADING CAUSE OF DEATH AGE 5-14  3 RD LEADING CAUSE OF DEATH AGE  4 TH LEADING CAUSE OF DEATH AGE  80 PEOPLE PER DAY COMMIT SUICIDE  132,353 HOSPITALIZED FOLLOWING ATTEMPTS, 116,639 TREATED & RELEASED  2:3 HOMOCIDES:SUICIDES

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

SUICIDE RISK FACTORS  RACE  WHITES > AFRICAN AMERICANS > NATIVE AMERICANS  IMMIGRANTS

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

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

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

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

GERIATRIC SPECIFIC  AGE /100,000  AGE /100,000  AGE /100,000  AGE /100,000  /100,000

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

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

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

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

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

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

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

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

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

THANK YOU QUESTIONS ??