ELDER SUICIDE

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).

 

 

 

 

 

Comments