1. Suicide Risk Among the Elderly PUAD 6601 Project Chris A. Moses Fall 2011 12 April 2012

3. Problem Definition Georgia has a major issue with suicide among the elderly. Because of other medical issues that normally affect the elderly have similar symptoms, the risk factors for suicide in this group may go undetected.

4. Statistics on Suicide (US) - 2009 Ranked # 10 in leading causes of death, homicide is ranked 15 th Avg 1 suicide every 1 hour and 30 minutes 3.7 males deaths by suicide for every female but 3 females attempts to 1 male 25 attempts for every death (4:1 elderly)

5. Who Is At Risk? Men are 5 times more likely than women to commit suicide. Whites are 3 times more likely than blacks to commit suicide. Although many suicides are committed by young people, suicide rates increase with age.

6. Who Is At Risk? - continued Suicide rates are higher in Georgia’s rural counties than in urban counties. Suicide rates are highest for widowed and divorced persons and lowest for married persons. The hospitalization rate for attempted suicide is 1.5 times higher for women than for men.

7. Signs & Symptoms Persistent sad, anxious, or "empty" feelings Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Irritability, restlessness Loss of interest in activities or hobbies once pleasurable, including sex Fatigue and decreased energy Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping Overeating, or appetite loss Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

8. Risk Factors Depression, other medical disorders or substance abuse disorder Prior suicide attempt A family history of mental disorder or substance abuse A family history of suicide Family violence, including physical or sexual abuse Having guns or firearms in the home Being in prison or jail Being exposed to other's suicidal behavior

9. National Suicide Statistics at a Glance - 2006

10. Source:http://webappa.cdc.gov/cgi-bin/broker.exe

12. Georgia Suicide Rates Georgia Suicide Rates 1999 - 2009 (Age 65+) Area (age group)19992000200120022003200420052006200720082009 US (65+)15.915.3 15.614.614.314.714.214.314.8 US (Total)10.7 10.811.010.811.0 11.111.511.812.0 Georgia (65+)16.313.316.113.717.610.913.912.516.013.5 Georgia (Total)10.710.310.910.511.115.69.89.510.111.5 Data Source: http://oasis.state.ga.us

13. Options 1.Do nothing, ignore the problem 2.Treatment with medicine alone 3.Treatment with therapy alone 4.Treatment with a combination of therapy and medicine 5.Education of doctors and general public on the signs and risk factors of suicide

14. Options - continued 6.Mandatory screening for people over age of 65 7.Services and programs that specialize in issues of people over age 65 8.Continue research on risk factors and alternatives for elderly patients 9.Restrict access to lethal and common methods of suicide

15. Evaluation Criteria CriteriaHighMedLow D1Potential to reduce or avoid self-injury or death Not likelySomewhatHighly likely D2Cost$30K or greaterGreater than $20K but less than $30K Less than $20K D3Community impactNational levelState levelCounty level D4Implementation strategy DifficultSome obstacles but very possible Easy with little to no obstacles D5Legal impactYesN/ANo D6Ethical impactYesN/ANo

16. Evaluation of Options OptionD1D2D3D4D5D6 C1High$81,834.16 High Low High C2Medium$1,500 Low HighMediumLow C3Medium$2,000 Low HighMediumLow C4Medium$3,500 Low HighMediumLow C5Medium$25,000 Medium HighLowMediumLow C6Low>$1 M High MediumLow C7Low>$30K High MediumLow C8Low>$30K High Low C9Low>$30K High

17. Recommendation C(2) Treatment with medicine alone C(3) Treatment with therapy alone C(4) Treatment with a combination of therapy and medicine C(5) Education of doctors and general public on the signs and risk factors of suicide

18. Implementation Plan

19. Evaluation Plan Measure progress in suicide prevention education Track suicide trends over period of time

20. Questions?