Transcript suicide in the elderly

SUICIDE IN THE
ELDERLY
JIMMIE D. MCADAMS, D.O.
DIRECTOR OF PSYCHIATRY
SAINT ANN’S AT LAUREATE
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20%
75%
39%
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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
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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
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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
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IMPAIRED HEARING
POOR COMPREHENSION
POOR MEMORY
EMBARESSMENT
POLYPHARMACY
PARANOIA
MENTAL STATUS
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ORIENTATION
INSIGHT
THOUGHT PROCESS AND CONTENT
HALLUCINATIONS
ATTENTION/CONCENTRATION
ABSTRACTION
MEMORY
AFFECT
ALL DEPESSION
SHOULD BE TREATED
SUICIDE
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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
SUICIDE RISK FACTORS
 GENDER
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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
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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
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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
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
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SOCIALLY ISOLATED
DRINKING TOXIC LIQUID
CUTTING SELF
FAMILY HISTORY OF SUICIDE
REFUSING TO EAT
SUBSTANCE ABUSE
INDIRECT SELFDESTRUCTIVE 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
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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 ??