Elder Suicide
While depression is not ususual among elders suicide is also far too prevalent and also can and should be addressed.
On this section about
Depression there will be over time some information about elder suicide,
including demographics, warning signs, risk factors, evaluation tips,
etc.
You should Know
- Elderly suicide is not part of the natural course of aging
- Elderly suicide is very often the result of untreated depression
- Elderly depression needs to be recognized and treated
- Anyone who expresses a wish to die should be carefully screened for depression and cognitive impariments
- Elderly suicide is preventable
Demographics(Elder Suicide)
- The highest rate of any age group
- 85% of elder suicides are male
- Elder male rates are 50 % above the national average.
- After age 60 rate decdlines for women
- Firearms are the most common means
- From 66 - 90 % a have diagnosiable mental illness
- From 2-4 % completed suicides are terminally ill.
Elder Risk Factors
The following are factors or
characteristics to look for. They do not cause suicide and their
presence does not mean that a particular individual will attempt
suicide. However, if any are present then be more aware.
- Male, White and Old,Old(over 85)
- Depression
- Access to Firearms
- Substance Abuse
- Social Isolation
- Physical Illness or Fear of Prolonged Illness
- Major Changes in Social Role(s)
- Missed Opportunities in Clinical Settings
Warning Signs
- Giving away possessions
- Getting affairs in order
- Saying good bye
- Sudden interest or disinterest in religion
- A plan
What You Can Do
- Ask the question
- Listen actively
- Persuade them to seek help
- Involve others
- Accompany them to help
- Make a referral
SUICIDE ASSESSMENT EVALUATION AND TRIAGE
This tool was developed by Dr. Douglas Jacobs and provided by Screening for Mental Health.
I.IDENTIFY RISK FACTORS
Note those which can be modified to reduce risk.
- Current/past
psychiatric diagonses especially schizophrenia, alcohol/substance abuse,
personality disorders(class B). Co-morbidity increases risk.
- Key symptoms including impulsivity, hopelessness, anxiety, panic, insomnia, command hallucinations
- History of prior suicide attempts, aborted suicide attempts or self-injurious behavior.
- Family history of suicide, attempts or Axis I psychiatric diagnoses which require hospitalization.
- Stressors:
Triggering events leading to humilitation, shame, despair(i.e.- loss of
relationsip, financial, or health status- real or imagined). On-going
medical illness(CNS disorders, pain), history of abuse or neglect.
Intoxication.
- Access to firearms.
II. Identify Protective Factors
Note those which can be modified to reduce risk.
- Current/past
psychiatric diagonses especially schizophrenia, alcohol/substance abuse,
personality disorders(class B). Co-morbidity increases risk.
- Key symptoms including impulsivity, hopelessness, anxiety, panic, insomnia, command hallucinations
- History of prior suicide attempts, aborted suicide attempts or self-injurious behavior.
- Family history of suicide, attempts or Axis I psychiatric diagnoses which require hospitalization.
- Stressors:
Triggering events leading to humilitation, shame, despair(i.e.- loss of
relationsip, financial, or health status- real or imagined). On-going
medical illness(CNS disorders, pain), history of abuse or neglect.
Intoxication.
- Access to firearms.
II. Identify Protective Factors
Note those which can be enhanced.
- Internal: Ability to cope with stress; Religious beliefs; Frustration tolerance; Absence of psychosis
- External: Responsibility for children or beloved pets; Positive therapeutic relationships. Social supports.
III. CONDUCT SUICIDE INQUIRY
Specific questions about thoughts, plans, behaviors, intent.
- IDEATION(Expressed thoughts/ideas): Frequency, intensity, duration in last 48 hurs, past month and worst ever
- PLAN: Evaluate steps taken to enact the plan. Timing, location,lethality and availaility are keys.
- BEHAVIORS: Rehearsals(tying a noose, loading a gun), aborted attempts, past attempts.
- INTENT: Expectations of plan's lethality can reveal intent. Ambivalence(reasons to die vs. reasons to live).
- HOMICIDAL IDEATION: Assess(especially character disordered males dealing with separation).
IV. DETERMINE RISK LEVEL/INTERVENTION
- Assessment of risk level is based on clinical judgement after completing above steps 1-3.
- Risk level needs to be reassessed as individual or environmental circumstances change.
RISK LEVEL - LOW
RISK/PROTECTIVE FACTORS - Modifiable risk factors; Strong protective factors
SUICIDALITY - Thoughts of death, no plan, intent, or behavior.
POSSIBLE INTERVENTIONS - Outpatient referral, symptom reduction;Give emergency informtion.
RISK LEVEL - MODERATE
RISK/PROTECTIVE FACTORS - Multiple risk factors/ Few protective factors
SUICIDALITY - Suicidal ideation with plan, but no intent or behavior
POSSIBLE INTERVENTIONS - Admission may be necesssary depending on risk factors. Develop crisis plan. Give emergency information.
RISK LEVEL -HIGH
RISK/PROTECTIVE FACTORS - Comorbidity, high risk diagnosis, minimal protecive factors.
SUICIDALITY - Perisistent suicidal ideation with strong intent, suicide rehearsal,, aborted attempt or failed attempt.
POSSIBLE INTERVENTIONS - Admission Generally Indicated Unless a Significant Change Reducs risk. Suicide precautions.
V. DOCUMENTATION
SUICIDE ASSESSMENT
Should be conducted
at first contct, and for any subsquent suicidal behavior/ideation, or
pertinent clinical change; For in-patients prior to increasing
privileges and at discharge note follow-up instructions.
Documentation Includes:
Risk level, the
basis for its determination and the treatment plan to address/reduce the
current risk( i.e., medication, seting, ECT., contact with significant
others, consultation).