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

SUICIDE IN THE SUICIDE IN THE ELDERLYELDERLYJIMMIE D. MCADAMS, D.O.JIMMIE D. MCADAMS, D.O.

DIRECTOR OF PSYCHIATRYDIRECTOR OF PSYCHIATRY

SAINT ANN’S AT LAUREATESAINT ANN’S AT LAUREATE

20%20% 75%75% 39%39% ??%??% 90 MINUTES90 MINUTES

SYMPTOMS OF SYMPTOMS OF DEPRESSIONDEPRESSION

DEPRESSED MOOD MOST OF THE DEPRESSED MOOD MOST OF THE DAY, NEARLY EVERY DAYDAY, NEARLY EVERY DAY

MARKED DIMINISHED INTEREST OR MARKED DIMINISHED INTEREST OR PLEASURE IN ALMOST ALL PLEASURE IN ALMOST ALL CUSTOMARY ACTIVITIESCUSTOMARY ACTIVITIES

WEIGHT LOSS OR GAINWEIGHT LOSS OR GAIN TOO MUCH SLEEPTOO MUCH SLEEP TOO LITTLE SLEEPTOO LITTLE SLEEP

SYMPTOMS OF SYMPTOMS OF DEPRESSIONDEPRESSION

EITHER MARKEDLY SLOW OR EITHER MARKEDLY SLOW OR AGITATED MOVEMENTSAGITATED MOVEMENTS

LOSS OF ENERGYLOSS OF ENERGY POOR CONCENTRATIONPOOR CONCENTRATION SUICIDAL THOUGHTS/ATTEMPTSSUICIDAL THOUGHTS/ATTEMPTS HOPELESS/HELPLESSHOPELESS/HELPLESS WORTHLESSWORTHLESS

GERIATRIC SYMPTOMSGERIATRIC SYMPTOMS COGNITIVE IMPAIRMENTCOGNITIVE IMPAIRMENT APATHY AND SOCIAL WITHDRAWALAPATHY AND SOCIAL WITHDRAWAL FOCUS ON PAIN AND OTHER FOCUS ON PAIN AND OTHER

PHYSICAL COMPLAINTSPHYSICAL COMPLAINTS LITTLE OR NO SADNESS DISPLAYED LITTLE OR NO SADNESS DISPLAYED

OR ADMITTEDOR ADMITTED NEW ONSET ANXIETYNEW ONSET ANXIETY

RISK FACTORSRISK FACTORS POOR PHYSICAL HEALTHPOOR PHYSICAL HEALTH GENETICSGENETICS PRIOR DEPESSIONSPRIOR DEPESSIONS POOR SOCIAL SUPPORTPOOR SOCIAL SUPPORT POLYPHARMACYPOLYPHARMACY AGE RELATED CHANGES IN AGE RELATED CHANGES IN

NEUROTRANSMITER AND HORMONE NEUROTRANSMITER AND HORMONE METABOLISM AND FUNCTIONMETABOLISM AND FUNCTION

EPIDEMIOLOGYEPIDEMIOLOGY UP TO 17% OF THE ELDERLYUP TO 17% OF THE ELDERLY UP TO 40% OF NURSING HOME PTSUP TO 40% OF NURSING HOME PTS 1:1 MALE TO FEMALE RATIO1:1 MALE TO FEMALE RATIO

DEPRESSION KILLSDEPRESSION KILLS

DEPRESSED SMOKERS DEPRESSED SMOKERS 40% LESS LIKELY TO QUIT40% LESS LIKELY TO QUIT

LESS LIKELY TO ADHERE LESS LIKELY TO ADHERE TO DAILY LOW DOSE TO DAILY LOW DOSE ASPIRIN DOSE IN ASPIRIN DOSE IN CORNARY ARTERY CORNARY ARTERY DISEASE PTSDISEASE PTS

POST MYOCARDIAL POST MYOCARDIAL INFARCTION PTS MORE INFARCTION PTS MORE LIKELY TO DROP OUT OF LIKELY TO DROP OUT OF EXERCISE PROGRAMSEXERCISE PROGRAMS

INCREASES INCREASES MORBIDITY IN MORBIDITY IN MEDICAL MEDICAL ILLNESSESILLNESSES

INCREASES INCREASES MORTALITY IN MORTALITY IN POST MI PATIENTS, POST MI PATIENTS, NURSING HOME NURSING HOME PATIENTS, PATIENTS, CANCER, CHFCANCER, CHF

EVALUATIONEVALUATION

HISTORYHISTORY FROM THE PATIENTFROM THE PATIENT FROM THE FAMILYFROM THE FAMILY FROM OTHER CARE GIVERSFROM OTHER CARE GIVERS FROM THE THERAPISTFROM THE THERAPIST FROM THE FAMILY DOCTORFROM THE FAMILY DOCTOR FOCUS ON SYMPTOMS, SUICIDE, FOCUS ON SYMPTOMS, SUICIDE,

SUBSTANCE, PSYCHOSIS, & MEDS SUBSTANCE, PSYCHOSIS, & MEDS

COMMUNICATION COMMUNICATION BARRIERBARRIER

IMPAIRED HEARING IMPAIRED HEARING POOR COMPREHENSIONPOOR COMPREHENSION POOR MEMORYPOOR MEMORY EMBARESSMENTEMBARESSMENT POLYPHARMACYPOLYPHARMACY PARANOIAPARANOIA

MENTAL STATUS MENTAL STATUS ORIENTATIONORIENTATION INSIGHT INSIGHT THOUGHT PROCESS AND CONTENTTHOUGHT PROCESS AND CONTENT HALLUCINATIONSHALLUCINATIONS ATTENTION/CONCENTRATIONATTENTION/CONCENTRATION ABSTRACTIONABSTRACTION MEMORYMEMORY AFFECTAFFECT

ALL DEPESSION ALL DEPESSION SHOULD BE TREATED SHOULD BE TREATED

SUICIDESUICIDE

30,622 DEATHS 200130,622 DEATHS 2001 55THTH LEADING CAUSE OF DEATH AGE 5-14 LEADING CAUSE OF DEATH AGE 5-14 33RDRD LEADING CAUSE OF DEATH AGE 15-24 LEADING CAUSE OF DEATH AGE 15-24 44THTH LEADING CAUSE OF DEATH AGE 25-44 LEADING CAUSE OF DEATH AGE 25-44 80 PEOPLE PER DAY COMMIT SUICIDE80 PEOPLE PER DAY COMMIT SUICIDE 132,353 HOSPITALIZED FOLLOWING 132,353 HOSPITALIZED FOLLOWING

ATTEMPTS, 116,639 TREATED & RELEASEDATTEMPTS, 116,639 TREATED & RELEASED 2:3 HOMOCIDES:SUICIDES2:3 HOMOCIDES:SUICIDES

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

GENDERGENDER ATTEMPTS 1:4 MALE:FEMALEATTEMPTS 1:4 MALE:FEMALE COMPLETIONS 3:1 MALE:FEMALECOMPLETIONS 3:1 MALE:FEMALE FEMALES ATTEMPT BY OVERDOSE FEMALES ATTEMPT BY OVERDOSE MALES BY GUNS OVER 60 % THE TIMEMALES BY GUNS OVER 60 % THE TIME

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

RACERACE WHITES > AFRICAN AMERICANS > NATIVE WHITES > AFRICAN AMERICANS > NATIVE

AMERICANSAMERICANS IMMIGRANTSIMMIGRANTS

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

RELIGIONRELIGION OVERALL A DETERANTOVERALL A DETERANT CATHOLIC < PROTESTANT/JEWISHCATHOLIC < PROTESTANT/JEWISH DEGREE OF ORTHODOXYDEGREE OF ORTHODOXY INTEGRATION IN THE RELIGIONINTEGRATION IN THE RELIGION

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

MARITAL STATUSMARITAL STATUS MARRIAGE REINFORCED BY CHILDREN MARRIAGE REINFORCED BY CHILDREN

LESSENS RISK 11/100,000LESSENS RISK 11/100,000 NEVER MARRIED 18/100,000NEVER MARRIED 18/100,000 WIDOWED 24/100,000WIDOWED 24/100,000 DIVORCED 43/100,000DIVORCED 43/100,000 DIVORCED MEN 69/100,000DIVORCED MEN 69/100,000 DIVORCED WOMEN 18/100,000DIVORCED WOMEN 18/100,000

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

OCCUPATIONOCCUPATION EMPLOYMENT, IN GENERAL, PROTECTS EMPLOYMENT, IN GENERAL, PROTECTS

AGAINST SUICIDEAGAINST SUICIDE HIGHER SOCIAL STATUS, INCREASES RISK HIGHER SOCIAL STATUS, INCREASES RISK

OF SUICIDEOF SUICIDE FALL IN SOCIAL STATUS GREATLY FALL IN SOCIAL STATUS GREATLY

INCREASES RISKINCREASES RISK PHYSICIANS ? HIGHER RISK FEMALE PHYSICIANS ? HIGHER RISK FEMALE

GREATER THAN MALESGREATER THAN MALES

SUICIDE RISK FACTORSSUICIDE RISK FACTORS

MENTAL HEALTHMENTAL HEALTH 95% OF ALL SUICIDES HAVE A DIAGNOSED 95% OF ALL SUICIDES HAVE A DIAGNOSED

MENTAL DISORDER/SUBSTANCE USE MENTAL DISORDER/SUBSTANCE USE DISORDERDISORDER

80% DEPRESSIVE DISORDERS/SUBSTANCE USE 80% DEPRESSIVE DISORDERS/SUBSTANCE USE 10% SCHIZOPHRENIA10% SCHIZOPHRENIA 5% DEMENTIA /DELIRIUM5% DEMENTIA /DELIRIUM TREATED AS AN INPATIENT INCREASES RISK 5-TREATED AS AN INPATIENT INCREASES RISK 5-

10 TIMES 10 TIMES

GERIATRIC SPECIFICGERIATRIC SPECIFIC

AGE 65-69 13.1/100,000AGE 65-69 13.1/100,000 AGE 70-74 15.2/100,000AGE 70-74 15.2/100,000 AGE 75-79 17.6/100,000AGE 75-79 17.6/100,000 AGE 80-84 22.9/100,000AGE 80-84 22.9/100,000 85 + 21/100,00085 + 21/100,000

GERIATRIC SPECIFICGERIATRIC SPECIFIC

85% OF SUICIDES WERE MEN85% OF SUICIDES WERE MEN 15% OF SUICIDES WERE WOMEN15% OF SUICIDES WERE WOMEN 70+% INVOLVED THE USE OF A 70+% INVOLVED THE USE OF A

FIREARM. 78% MALE, 35% FEMALEFIREARM. 78% MALE, 35% FEMALE DISPRPORTIONATE EFFECT ON THE DISPRPORTIONATE EFFECT ON THE

ELDERLYELDERLY

RISKRISK

HISTORY OF SUICIDE ATTEMPTHISTORY OF SUICIDE ATTEMPT ACUTE SUICIDAL IDEATIONACUTE SUICIDAL IDEATION SERIOUSNESS OF PREVIOUS SERIOUSNESS OF PREVIOUS

ATTEMPTATTEMPT PRESENCE OF FIREARMPRESENCE OF FIREARM MAJOR DEPRESSIVE D/OMAJOR DEPRESSIVE D/O SEVERE HOPELESSNESSSEVERE HOPELESSNESS

RISKRISK

SOCIALLY ISOLATEDSOCIALLY ISOLATED DRINKING TOXIC LIQUIDDRINKING TOXIC LIQUID CUTTING SELFCUTTING SELF FAMILY HISTORY OF SUICIDEFAMILY HISTORY OF SUICIDE REFUSING TO EATREFUSING TO EAT SUBSTANCE ABUSESUBSTANCE ABUSE

INDIRECT SELF-INDIRECT SELF-DESTRUCTIVE BEHAVIORS DESTRUCTIVE BEHAVIORS (ISB’S)(ISB’S)

REFUSING TO EAT OR DRINKREFUSING TO EAT OR DRINK FAILING TO COMPLY WITH MEDICAL FAILING TO COMPLY WITH MEDICAL

TREATMENTTREATMENT MEDICATION MIS-MANAGEMENT OR MEDICATION MIS-MANAGEMENT OR

NONCOMPLIANCENONCOMPLIANCE ENGAGING IN RISK TAKING ENGAGING IN RISK TAKING

BEHAVIORBEHAVIOR

ISB’SISB’S

MORE COMMON IN COMMUNITY MORE COMMON IN COMMUNITY DWELLERSDWELLERS

? MORE ACCEPTABLE OPTION TO ? MORE ACCEPTABLE OPTION TO HASTEN DEATHHASTEN DEATH

CONSCIOUS VS. SUBCONSCIOUSCONSCIOUS VS. SUBCONSCIOUS

WE CAN DO BETTERWE CAN DO BETTER

20% DR. VISIT WITHIN 24 HOURS20% DR. VISIT WITHIN 24 HOURS 75% DR. VISIT WITHIN ONE MONTH75% DR. VISIT WITHIN ONE MONTH 39% DR. VISIT WITHIN ONE WEEK39% DR. VISIT WITHIN ONE WEEK ??% CAN WE PREVENT??% CAN WE PREVENT ONE ELDERLY SUICIDE EVERY 90 ONE ELDERLY SUICIDE EVERY 90

MINUTESMINUTES

WE MUST DO BETTERWE MUST DO BETTER

PREVENTION OF RISK FACTORSPREVENTION OF RISK FACTORS EARLY IDENTIFICATION OF RISK EARLY IDENTIFICATION OF RISK

FACTORSFACTORS TREATMENT OF IDENTIFIABLE D/OTREATMENT OF IDENTIFIABLE D/O CRISIS INTERVENTIONCRISIS INTERVENTION REMOVAL OF MEANSREMOVAL OF MEANS

WE MUST DO BETTERWE MUST DO BETTER

DON’T ASK DON’T TELLDON’T ASK DON’T TELL ASK DON’T TELLASK DON’T TELL LOOK AT ALL THE INFORMATION AND LOOK AT ALL THE INFORMATION AND

ASESS RISK, AND RESPOND ASESS RISK, AND RESPOND APPROPRIATELYAPPROPRIATELY

SUICIDESUICIDE DO YOU FEEL LIKE A BURDEN DO YOU FEEL LIKE A BURDEN FEEL YOURSELF OR OTHERS MAY FEEL YOURSELF OR OTHERS MAY

BE BETTER OFF IF YOU WERE DEADBE BETTER OFF IF YOU WERE DEAD THOUGHT ABOUT TAKING YOUR THOUGHT ABOUT TAKING YOUR

LIFE.----- METHOD, MEANS, INTENTLIFE.----- METHOD, MEANS, INTENT

THANK YOUTHANK YOU

QUESTIONS ??QUESTIONS ??