Suicidal ideation (SI) and suicide attempts (SA) continue to be a serious concern among older adults, with depression affecting an estimated 7% of all adults over age 65 years (11) and the highest worldwide suicide rates documented for older men.(3,7) Suicide prevention for older adults has unique challenges because older suicidal individuals are more likely to use advance planning and less likely to ask for help.(9) Prior work has suggested that clinicians may under-diagnose or under-treat depression and SI among older adults.(21-22) Early recognition and treatment of depression, as well as improved management of chronic health conditions, can make a difference among older adults by improving quality of life and reducing morbidity and mortality.(25) There is evidence that targeted interventions in primary care settings can improve rates of screening and treatment for depression (41), but very little is known about SI/SA among older emergency department (ED) patients, who may be at increased risk compared to the general population because of comorbidities (32) and acute physical (32) or psychosocial (33) stresses. While some EDs are moving towards universal screening for SI/SA, most still rely on targeted questioning triggered by clinician concern. Understanding which older ED patients may be suicidal could help clinicians more easily identify this high-risk group, and understanding current patterns of treatment-including identification of disparities in care between older and younger patients with SI/SA-could help improve ED care. The overall goal of this research is to lay the groundwork for the development of effective ED-based interventions for suicide prevention by better describing the population of older ED patients with self-harm/SI/SA. For our first specific aim, we use the large database from a multi-site trial of universal ED screening for SI/SA (Emergency Department Safety Assessment and Follow-up Evaluation, ED-SAFE) to provide an estimate of the prevalence of SI/SA among older ED patients, including variations among age groups. For our second specific aim, we will conduct a more detailed retrospective chart review at one ED to describe the patient characteristics and ED treatment of older ED patients with SI/SA, including possible disparities in care. The findings from this research proposal will provide the essential scientific foundation for future design and implementation of evidence-based interventions to improve ED recognition and care of older adults with suicidal thoughts or behaviors. Such interventions have the potential to improve the quality of life of older adults with mental illness and to prevent premature death from suicide.
Depression, suicidal thoughts, and suicide are common among older adults and have significant negative effects on physical health, well-being, morbidity and mortality. Age-adjusted suicide rates are highest among older men, and suicide prevention can be difficult in this age group because older adults are more likely to use lethal methods and advance planning and are less likely to ask for help. Unfortunately, medical providers may under-recognize the signs of depression or suicidality among older adults and therefore miss opportunities for intervention. Emergency departments (EDs) care for large volumes of older patients, but very little is known about suicidal thoughts or behaviors among older ED patients. In order to develop effective suicide prevention approaches for older ED patients, it is important we understand the magnitude of the problem (prevalence of suicidal thoughts or behaviors among older patients), patient characteristics associated with suicidal thoughts or behaviors (to help clinicians identify these high-risk patients), and current patterns f care of older and younger patients with suicidal thoughts or behaviors (to identify and address age-based disparities in care).
| Betz, Marian E; Kautzman, Mack; Segal, Daniel L et al. (2018) Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Res 260:30-35 |
| Arias, Sarah A; Boudreaux, Edwin D; Segal, Daniel L et al. (2017) Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department. J Am Geriatr Soc 65:2272-2277 |
| Betz, Marian E; Arias, Sarah A; Segal, Daniel L et al. (2016) Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department. J Am Geriatr Soc 64:e72-e77 |
