Q: 87 years old male has been brought to the ER after a welfare check by his neighbor. The patient was found on the floor and appears to be hypovolemic and dehydrated. The neighbor also brought many empty bottles of prescription meds. The patient lives alone. After interviewing and examining the patient, the ER physician calls for admission with suspicion of suicidal ideation. ICU admission is warranted as older patients are more likely to complete suicide.
A) True
B) False
Answer: A (True)
Suicide in older patients is an under-recognised issue. They account for almost a quarter of all completed suicides. Though they attempt suicide less often than younger people, they are more successful at completion. In subgroups, males at age 85 or above have the highest rate of completed suicide. The list of risk factors is long, including:
- hopelessness
- insomnia
- restlessness
- impaired concentration
- active psychosis
- active alcohol use
- unremitting pain
- comorbid physical illness
- terminal illness or worsening of physical illness
- widowhood
- social isolation
- personality disorders
- prior suicide attempt
- family history of suicide
#psychiatry
#geriatrics
References:
1. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep 1999; 47:1.
2. Waern M, Runeson BS, Allebeck P, et al. Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 2002; 159:450.
3. Nguyen BL, Lyons BH, Forsberg K, et al. Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2021. MMWR Surveill Summ 2024; 73:1.
4. Bruce ML, Ten Have TR, Reynolds CF 3rd, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA 2004; 291:1081.
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