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Suicide in the Geriatric Population: Risk Factors, Identification, and Management

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Abstract

Although the prevalence of suicide attempts among the geriatric population is lower than in other age groups, the proportion of attempts which result in suicide is greater. And when psychiatric hospitalization is deemed necessary, there is a presumption among referring providers and family members that the chosen inpatient setting has adequate resources and time for the evaluation and prevention of suicidal behavior. Therefore, an assessment of suicide risk in the geriatric psychiatric inpatient unit requires a more thorough evaluation than in the emergency department, community, or outpatient settings. This chapter reviews known risk factors in the aging population, strategies for appropriate assessment of suicidality, and recommendations for its management and prevention.

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References

  1. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014.

    Google Scholar 

  2. Kiosses DN, Szanto K, Alexopoulos GS. Suicide in older adults: the role of emotions and cognition. Curr Psychiatry Rep. 2014;16:495. Geriatric Disorders (W Mcdonald, Section Editor) Springer.

    Article  Google Scholar 

  3. Crosby AE, Cheltenham MP, Sacks JJ. Incidence of suicidal ideation and behavior in the United States, 1994. Suicide Life Threat Behav. 1999;29(2):131–40.

    CAS  PubMed  Google Scholar 

  4. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451–68. https://doi.org/10.1016/j.psc.2011.02.002.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Van Orden KA, Wiktorsson S, Duberstein P, Berg AI, Fassberg MM, Waern M. Reasons for attempted suicide in later life. Am J Geriatr Psychiatry. 2014;23:536–44.

    Article  Google Scholar 

  6. Van Orden KA, Conwell Y. Issues in research on aging and suicide. Aging Ment Health. 2016;20(2):240–51. https://doi.org/10.1080/13607863.2015.1065791.

    Article  PubMed  Google Scholar 

  7. Conwell Y, Rotenberg M. Caine Ed. Completed suicide at age 50 and over. J Am Geriatr Soc. 1990;38(6):640–4.

    Article  CAS  Google Scholar 

  8. Fung YL, Chan ZC. A systematic review of suicidal behavior in old age: a gender perspective. J Clin Nurs. 2011;20(15–16):2109–24.

    Article  Google Scholar 

  9. Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep. 2014;16(9):466. https://doi.org/10.1007/s11920-014-0466-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Conwell Y, Duberstein PR. Suicide in elders. Ann N Y Acad Sci. 2001;932:132–47. discussion 47–50.

    Article  CAS  Google Scholar 

  11. Conwell Y, Thompson C. Suicidal behavior in elders. Psychiatr Clin North A. 2008;31(2):333–56.

    Article  Google Scholar 

  12. Alexopoulos GS, Bruce ML, Hull J, Sirey JA, Kakuma T. Clinical determinants of suicidal ideation and behavior in geriatric depression. Arch Gen Psychiatry. 1999;56(11):1048–53.

    Article  CAS  Google Scholar 

  13. O’Connell H, Chin AV, Cunningham C, Lawlor BA. Recent developments: suicide in older people. BMJ. 2004;329(7471):895–9.

    Article  Google Scholar 

  14. Podgorski CA, Langford L, Pearson JL, Conwell Y. Suicide prevention for older adults in residential communities: implications for policy and practice. PLoS Med. 2010;7(5):e1000254. https://doi.org/10.1371/journal.pmed.1000254.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bhatt M, Perera S, Zielinski L, Eisen RB, Yeung S, El-Sheikh W, et al. Profile of suicide attempts and risk factors among psychiatric patients: a case-control study. PLoS One. 2018;13(2):e0192998. https://doi.org/10.1371/journal.pone.0192998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Isometsä E. Suicidal behavior in mood disorders—who, when, and why? Canadian journal of psychiatry. Revue Canadienne de Psychiatrie. 2014;59(3):120–30.

    PubMed  Google Scholar 

  17. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of evidence. Am J Psychiatry. 2002;159(6):909–16.

    Article  Google Scholar 

  18. Betz ME, Arias SA, Segal DL, Miller I, Camargo CA Jr, Boudreaux ED. Screening for suicidal thoughts and behaviors in older adults in the Emergency Department. J Am Geriatr Soc. 2016;64(10):e72–7. https://doi.org/10.1111/jgs.14529. Epub 2016 Sep 6

    Article  PubMed  PubMed Central  Google Scholar 

  19. Alphsa L, Brashearb H R, Chappell P, Conwell Y, , Dubravac S, Khine N A, Kozauerg N, Hartleyh D M, Milleri D S, Schindler RJ, Siemersk E R, Stewart M, Yaffel K, Considerations for the assessment of suicidal ideation and behavior in older adults with cognitive decline and dementia. Alzheimer Dement (Translational Research & Clinical Interventions) 2 (2016) 48–59. doi:https://doi.org/10.1016/j.trci.2016.02.001.

    Article  Google Scholar 

  20. Heisel MJ, Duberstein PR, Lyness J, Feldman MD. Screening for suicide ideation among older primary care patients. J Am Board Fam Med. 2010a;23(2):260–9. https://doi.org/10.3122/jabfm.2010.02.080163. PMCID: PMC3138552 NIHMSID: NIHMS301729 PMID: 20207936.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Heisel MJ, Flett GL. Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults. Aging Ment Health. 2016;20(2):208–21. https://doi.org/10.1080/13607863.2015.1072798. Epub 2015 Aug 19.

    Article  PubMed  Google Scholar 

  22. Batterham PJ, Ftanou M, Pirkis J, Brewer JL, Mackinnon AJ, Beautrais A, Fairweather-Schmidt AK, Christensen H. A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research. Psychol Assess. 2015;27(2):501–12. https://doi.org/10.1037/pas0000053. Epub 2014 Dec 15.

    Article  PubMed  Google Scholar 

  23. Erlangsen A, Stenager E, Conwell Y. Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study. Soc Psychiatry Psychiatr Epidemiol. 2015;50:1427–39.

    Article  Google Scholar 

  24. Fassberg MM, Cheung G, Canetto SS, et al. A systematic review of physical illness, functional disability, and suicidal behavior among older adults. Aging Ment Health. 2016;20(2):166–94.

    Article  Google Scholar 

  25. Suresh Kumar PN, Anish PK, George B. Risk factors for suicide in elderly in comparison to younger age groups. Indian J Psychiatry. 2015;57(3):249–54. https://doi.org/10.4103/0019-5545.166614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Waern M, Rubenowitz E, Runeson B, Skoog I, Wilhelmson K, Allebeck P. Burden of illness and suicide in elderly people: case control study. BMJ. 2002a;324:1355.

    Article  Google Scholar 

  27. Voaklander DC, Rowe BH, Dryden DM, et al. Medical illness, medication use and suicide in seniors: a population-based case–control study. J Epidemiol Community Health. 2008;62:138–46.

    Article  CAS  Google Scholar 

  28. Waern M, Runeson BS, Allebeck P, et al. Mental disorder in elderly suicides: a case-control study. Am J Psychiatry. 2002b;159:450.

    Article  Google Scholar 

  29. Heikkinen ME, Lonnqvist JK. Recent life events in elderly suicide: a nationwide study in Finland. Int Psychogeriatr. 1995;7:287–300.

    Article  CAS  Google Scholar 

  30. Britton PC, Duberstein PR, Conner KR, Heisel MJ, Hirsch JK, Conwell Y. Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. Am J Geriatr Psychiatry. 2008;16(9):736–41.

    Article  Google Scholar 

  31. Conwell Y, Duberstein PR, Hirsch JK, Conner KR, Eberly S, Caine ED. Health status and suicide in the second half of life. Int J Geriatr Psychiatry. 2010;25(4):371–9.

    Article  Google Scholar 

  32. Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, et al. A systematic review of elderly suicide prevention programs. Crisis. 2011;32(2):88–98. https://doi.org/10.1027/0227-5910/a000076.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Purcell B, Heisel MJ, Speice J, Franus N, Conwell Y, Duberstein PR. Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older. Am J Geriatr Psychiatry. 2012;20(8):717–23.

    Article  Google Scholar 

  34. Van Orden K, Conwell Y. Suicides in late life. Curr Psychiatry Rep. 2011;13(3):234–41.

    Article  Google Scholar 

  35. Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870–7. https://doi.org/10.1007/s11606-014-2767-3.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Conwell Y, Lyness JM, Duberstein P, et al. Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc. 2000;48(1):23–9.

    Article  CAS  Google Scholar 

  37. Tu YA, Chen MH, Tsai CF, Su TP, Bai YM, Li CT, Lin WC, Liu ME, Pan TL, Chen TJ, Tsai SJ. Geriatric suicide attempt and risk of subsequent dementia: a nationwide longitudinal follow-up study in Taiwan. Am J Geriatr Psychiatry. 2016;24(12):1211–8. https://doi.org/10.1016/j.jagp.2016.08.016. Epub 2016 Sep 5.

    Article  PubMed  Google Scholar 

  38. Seyfried LS, Kales HC, Ignacio RV, Conwell Y, Valenstein M. Predictors of suicide in patients with dementia. Alzheimers Dement. 2011;7(6):567–73.

    Article  Google Scholar 

  39. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600.

    Article  Google Scholar 

  40. Wand APF, Peisah C, Draper B, Brodaty H. Understanding self-harm in older people: a systematic review of qualitative studies. Aging & Mental Health. 2018;22(3):289–98.

    Article  Google Scholar 

  41. Shea SC. The interpersonal art of suicide assessment: interviewing techniques for uncovering suicidal intent, ideation, and actions. In: Simon RI, Hales RE, editors. The American Psychiatric Publishing textbook of suicide assessment and management. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc.; 2012. p. 29–56.

    Google Scholar 

  42. Cardell R, Bratcher KS, Quinnett P. Revisiting “suicide proofing” an inpatient unit through environmental safeguards: a review. Perspect Psychiatr Care. 2009;45(1):36–44.

    Article  Google Scholar 

  43. Wand AP, Peisah C, Draper B, Brodaty H. Carer insights into self-harm in the very old: a qualitative study. Int J Geriatr Psychiatry. 2019:1–7.

    Google Scholar 

  44. Edwards SJ, Sachmann MD. No-suicide contracts, no-suicide agreements, and no-suicide assurances: a study of their nature, utilization, perceived effectiveness, and potential to cause harm. Crisis. 2010;31(6):290–302.

    Article  Google Scholar 

  45. Vannoy SD, Tai-Seale M, Duberstein P, Eaton LJ, Cook MA. Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide. J Gen Intern Med. 2011;26(9):1005–11.

    Article  Google Scholar 

  46. Heisel MJ, Flette GL. Investigating the psychometric properties of the geriatric suicide ideation scale (GSIS) among community residing older adults. Aging Ment Health. 2016;20(2):208–21. https://doi.org/10.1080/13607863.2015.1072798. Epub 2015 Aug 19B.

    Article  PubMed  Google Scholar 

  47. Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013a;346:–f3646. https://doi.org/10.1136/bmj.f3646.

    Article  Google Scholar 

  48. Nelson CJ, Delucchi KL, Schneider LS. Moderators of outcome in late-life depression: a patient-level meta-analysis. Am J Psychiatry. 2013;170:6.

    Article  Google Scholar 

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Correspondence to Laura B. Dunn .

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Shenava, M., Hitching, R., Dunn, L.B. (2019). Suicide in the Geriatric Population: Risk Factors, Identification, and Management. In: Fenn, H., Hategan, A., Bourgeois, J. (eds) Inpatient Geriatric Psychiatry . Springer, Cham. https://doi.org/10.1007/978-3-030-10401-6_8

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  • DOI: https://doi.org/10.1007/978-3-030-10401-6_8

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