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Jang JS, Seo WS, Koo BH, Kim HG, Yun SH, Jo SH, Bai DS, Kim YG, Cheon EJ. The characteristics of elderly suicidal attempters in the emergency department in Korea: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:30-38. [PMID: 38155553 PMCID: PMC10834272 DOI: 10.12701/jyms.2023.01004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group. METHODS Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18-64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group. RESULTS Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01). CONCLUSION Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.
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Affiliation(s)
- Ji-Seon Jang
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Wan-Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Hey-Geum Kim
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok-Ho Yun
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - So-Hey Jo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae-Seok Bai
- Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
| | - Young-Gyo Kim
- Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
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Schaffer KB, Dandan T, Bayat D, Castelo MR, Reames SH, Hutkin-Slade L, Biffl WL. Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes. Eur Geriatr Med 2021; 13:119-125. [PMID: 34542844 PMCID: PMC8450697 DOI: 10.1007/s41999-021-00561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Older patients (Older) have complex health management needs often requiring additional resources. Mental health disorders are common among trauma patients, yet minimal information on older suicidal related injury and outcomes exists. A review of trauma patients with intentional self-inflicted injury at one trauma center was done to describe and identify unique elements of this cohort of patients. METHODS Trauma registry data from 2000 to 2019 were reviewed for intentional injury and data abstracted included demographics, injury severity, diagnoses, comorbidities and outcomes. Cohorts by age were compared: Older (65 +) vs Younger (< 65). Values considered significant at p ≤ 0.05. RESULTS 557 suicide attempts were identified with 9% among Older patients. Most patients were male with median age of 75 years for Older and 35 years for Younger cohort, with similar length of stay (LOS) and injury severity scores (ISS). Penetrating injury was more common among Older patients with firearm used most often, 34% vs 14% for Younger. Differences were evident between male and female Older patients with ISS 16.7 vs 5, p < 0.01 and mortality, p = 0.03. The outcome of discharge to home was significantly different between Older and Younger, 6% vs 20% (p < 0.05). A difference in mortality was evident, Older 38% vs Younger 18% (p < 0.05). CONCLUSION With the growing aging population, it is important to acknowledge the resultant increase in concomitant mental health issues and suicidality among older patients, where depression may be undiagnosed and untreated. Providing care within this cohort may reduce future attempts and lessen the burden on the health care system.
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Affiliation(s)
- Kathryn B Schaffer
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA.
| | - Tala Dandan
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Dunya Bayat
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Matthew R Castelo
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Summer H Reames
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Linda Hutkin-Slade
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Walter L Biffl
- Scripps Memorial Hospital Trauma Service, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
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Retrospektive Mortalitätsstudie nichtnatürlicher Todesfälle der Generation 65+ im Obduktionsgut der Rechtsmedizin Frankfurt am Main anhand zweier Zeitintervalle. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00475-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Zusammenfassung
Hintergrund und Ziel der Arbeit
Aufgrund des demografischen Wandels ist mit einer Änderung des Altersspektrums bei den Obduktionen zu rechnen. Ziel der Arbeit war die Untersuchung der nichtnatürlichen Todesfälle, bei denen die Verstorbenen ein Mindestalter von 65 Jahren erreicht hatten, da dieser Populationsgruppe zukünftig eine wachsende Bedeutung zukommen wird.
Material und Methoden
In dieser retrospektiven Mortalitätsstudie wurden alle nichtnatürlichen Todesfälle mit einem Sterbealter ≥ 65 Jahren analysiert, die in den Jahren 2000–2002 (Zeitraum I) und 2013–2015 (Zeitraum II) im Institut für Rechtsmedizin des Universitätsklinikums der Goethe-Universität in Frankfurt am Main obduziert wurden. Für die Analyse der suizidal Verstorbenen wurden zudem Daten nichtobduzierter Selbsttötungen (n = 100) aus Besichtigungen aufgenommen.
Ergebnisse
Aus den 1206 Obduktionen resultierten 669 natürliche (55,5 %) und 404 nichtnatürliche (33,5 %) Todesfälle. Darunter ergaben sich 221 Unfälle (Zeitraum I n = 105; Zeitraum II n = 116), 82 Suizide (Zeitraum I n = 55; Zeitraum II n = 27), 41 Todesfälle im Zusammenhang mit medizinischen Interventionen (Zeitraum I n = 7; Zeitraum II n = 34) und 40 Tötungsdelikte (Zeitraum I n = 23; Zeitraum II n = 17). Verkehrsunfälle und Stürze bilden die größten Subgruppen bei den Unfällen. Erhängen und Erschießen sind die am meisten angewandten Suizidarten. Vergleicht man Zeitraum I mit II, so fällt die signifikante Zunahme von Todesfällen im Zusammenhang mit ärztlichen Maßnahmen auf. Eine signifikante Abnahme von Suizidenten ist durch die abnehmende Obduktionsrate in dieser Gruppe zu begründen. Die relative und absolute Fallzahl an Tötungsdelikten im Obduktionsgut weisen keine wesentliche Veränderung auf.
Diskussion/Schlussfolgerung
Die Ergebnisse dieser Studie stimmen großteils mit der Literatur überein. Im Zeitvergleich zeigt sich eine relative Zunahme nichtnatürlicher Todesfälle im gerontologischen Obduktionsgut. Dies wird durch den Anstieg von Obduktionen nach iatrogenen Komplikationen wesentlich mitgeprägt.
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The characteristics of older people suicides by sex and age subgroups. Leg Med (Tokyo) 2020; 46:101721. [DOI: 10.1016/j.legalmed.2020.101721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 12/23/2022]
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Zeppegno P, Gattoni E, Mastrangelo M, Gramaglia C, Sarchiapone M. Psychosocial Suicide Prevention Interventions in the Elderly: A Mini-Review of the Literature. Front Psychol 2019; 9:2713. [PMID: 30687173 PMCID: PMC6333652 DOI: 10.3389/fpsyg.2018.02713] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022] Open
Abstract
In Europe the elderly population is projected to increase from 18.5% (93.9 million) in 2014 to 28.7% (149.1 million) by 2080. In the United States it is estimated that by 2030 more than 20% of the population will be aged 65 years or over. This specific population is at high risk of unrecognized or untreated psychiatric illnesses and suicide. It is well known that completed suicide rate increases with age in both men and women. Although elderly people attempt suicide less often than other age groups, they show a higher completion rate. Generally, the methods chosen by elderly are more lethal, the intent is more serious, they are more determined, and they show fewer warning signs than the younger population. A recent systematic review and meta-analysis of psychosocial intervention, following self-harm in adults, found that cognitive behavioral therapy was the most effective therapy in these patients. Unfortunately, there have been few reported trials of other potentially effective interventions. Because the scientific literature on psychosocial suicide prevention interventions in the elderly is still scant, we conducted a mini-review in order to take stock of the situation. Studies were identified through electronic searches of the Cochrane library, MEDLINE, Scopus and the Web of Science databases. PRISMA guidelines were followed and only seven articles met the inclusion criteria. No firm conclusions can be drawn about this topic because there is still very little data and studies use inconsistent outcome measures and designs. Nonetheless, the existing data suggests that psychosocial interventions are promising.
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Affiliation(s)
- Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Institute of Psychiatry, University Hospital Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Institute of Psychiatry, University Hospital Maggiore della Carità, Novara, Italy
| | - Martina Mastrangelo
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Institute of Psychiatry, University Hospital Maggiore della Carità, Novara, Italy
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
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Cheung G, Merry S, Sundram F. Late-life suicide: Insight on motives and contributors derived from suicide notes. J Affect Disord 2015; 185:17-23. [PMID: 26142690 DOI: 10.1016/j.jad.2015.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were: (i) to investigate the proportion of older people writing suicide notes in New Zealand; (ii) to compare the socio-demographic and clinical variables of older suicide note writers and non-note writers; and (iii) to perform a thematic analysis of the content of suicide notes. METHODS The Coronial Services provided records of all suicide cases aged 65 years and over (n=225) between July 2007 and December 2012. We were able to determine whether there was a suicide note written in 212 cases. The content of 39 coroners/medical examiners' excerpts and 5 suicide notes was available for thematic analysis using a general inductive approach. FINDINGS 88 (41.5%) older people left a suicide note. Logistic regression showed that female gender (OR=2.8, 95% CI=1.4-5.7, p=0.005) and Caucasian ethnicity (OR=13.7, 95% CI=1.7-111.0, p=0.014) are significantly associated with older people writing suicide notes. 33.3% of those who left a suicide note gave health-related reasons for their suicide and a significant proportion (73.3%) of them had underlying medical conditions. Another common theme is around people leaving specific instructions and wishes. CONCLUSIONS Apart from gender and ethnicity, suicide note writers are similar to non-writers on broad socio-demographic and clinical factors. Suicide notes indicated free will in and reasons for their suicide and emotional/farewell messages to their loved ones. Many documented poor quality of life or physical illness but the progression of these factors to suicide in older people should be further researched.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Sally Merry
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
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Cheung G, Merry S, Sundram F. Medical examiner and coroner reports: uses and limitations in the epidemiology and prevention of late-life suicide. Int J Geriatr Psychiatry 2015; 30:781-92. [PMID: 25962908 DOI: 10.1002/gps.4294] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/10/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Late-life suicide is a growing public health concern in many parts of the world. Understanding the contributory factors to completed suicide is essential to inform the development of effective suicide risk assessment and management. The aim of this study is to synthesise the findings in studies that used coroner or medical examiner records to determine these contributory factors. METHODS The databases of Scopus (from 1960), MEDLINE (from 1946) and PsychINFO (from 1806) were searched in August 2013, to identify studies that used coroner or medical examiner records for investigating the epidemiological, sociodemographic characteristics and clinical aspects of late-life suicide. RESULTS In total, 25 studies were identified. There was a lack of standardisation of variables assessed between studies leading to incomplete datasets in some work. However, a diagnosis of depression was found in 33%, and depressive mood/symptoms in 47% of cases. About 55% had a physical health problem. Terminal illness was associated with a smaller proportion (7.1%) of the cases. Older people were more likely to have had contact with primary care rather than mental health services prior to suicide. CONCLUSIONS Despite their limitations, coroner and medical examiner records provide an opportunity for examining suicide epidemiology. Targeting primary care providers where late-life depression and physical illness can be detected and treated is a potential strategy to address late-life suicide.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, 1142, New Zealand
| | - Sally Merry
- Department of Psychological Medicine, The University of Auckland, Auckland, 1142, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, Auckland, 1142, New Zealand
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Omalu BI, Macurdy KM, Koehler SA, Nnebe-Agumadu UH, Shakir AM, Rozin L, Wecht CH. Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania : A 10-year retrospective review (1990-1999). Forensic Sci Med Pathol 2015; 1:125-37. [PMID: 25869950 DOI: 10.1385/fsmp:1:2:125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2005] [Indexed: 11/11/2022]
Abstract
Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.
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Affiliation(s)
- Bennet I Omalu
- Allegheny County Coroner's Office, 542 Fourth Avenue, 15219, Pittsburgh, PA,
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Abstract
The maltreatment of elders aged 60 years and older is a worldwide problem with an increasing frequency. Individuals are living longer, resulting in a larger elder segment of populations. Furthermore, as medicolegal investigative and epidemiologic research progresses, more cases are recognized and reported. Elders are a vulnerable population not only because of advanced age and acquired diseases and frailty, but also because of a lack of education in the realm of overall elder healthcare and pathophysiology. Therefore, when investigating an elder death, the challenge is even greater as the medicolegal death investigator and forensic pathologist/medical examiner attempt to separate normal or expected findings from maltreatment. A methodical approach starting with the initial death and scene investigation, followed by a complete elder autopsy and concluding with an organized elder death review, will allow proper classification of cause and manner of death as well of prevention of future cases of elder maltreatment.
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Affiliation(s)
- A. Howe Julie
- Franklin, Jefferson, and Saint Charles County Medical Examiner Offices, St. Louis, MO
| | | | - S. King Pat
- Georgia Department of Human Services - Division of Aging Services, Atlanta, GA
| | - Chevas Yeoman
- Georgia Department of Human Services - Division of Aging Services, Atlanta, GA
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Heppner HJ, Christ M, Gosch M, Mühlberg W, Bahrmann P, Bertsch T, Sieber C, Singler K. Polypharmacy in the elderly from the clinical toxicologist perspective. Z Gerontol Geriatr 2013; 45:473-8. [PMID: 22915001 DOI: 10.1007/s00391-012-0383-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions. AIM This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy. METHODS From 2006-2009, all PICN inquiries involving individuals > 70 years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning. RESULTS Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70 years; 156 (4.8%) of 3,272 T-ICU patients were > 70 years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%. CONCLUSION Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.
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Affiliation(s)
- H J Heppner
- Department of Emergency and Intensive Care Medicine, Klinikum Nuremberg, Prof.-E.-Nathan-Str. 1, 90419, Nuremberg, Germany.
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Suicidio en el anciano. ACTA ACUST UNITED AC 2013; 43 Suppl 1:80-4. [DOI: 10.1016/j.rcp.2013.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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Alejandro Gómez G. Evaluación del riesgo de suicidio: enfoque actualizado. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Novel Suicide by Division of a Chronically Infected, Externalised Axillofemoral Graft Presenting Challenges in Prehospital Assessment of Mental Capacity. Case Rep Emerg Med 2012; 2012:795648. [PMID: 23326724 PMCID: PMC3542950 DOI: 10.1155/2012/795648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 12/25/2011] [Indexed: 11/17/2022] Open
Abstract
Assessing a patient's competence to give informed consent in pre-hospital care is difficult. In the presented case an elderly patient attempted suicide by division of a chronically infected and externalised prosthetic arterial graft. He was able to comprehend his situation and understand the consequences of declining treatment. Without prior knowledge of his medical care and psychological state, however, we did not believe we could fully assess the patient's ability to act in his own best interest. After sedation and resuscitation he was transferred to hospital. This case report discusses a unique method of suicide and the challenge of obtaining valid consent in prehospital care.
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Abstract
BACKGROUND AND AIMS Suicide in later life stages is of growing concern as the life expectancy of Western populations is rising. Therefore, a population- based study concerning elderly suicide was undertaken. METHODS The study included 1008 suicides in Middle Franconia (Bavaria/Germany) between 2004 and 2007. Data was analyzed regarding gender, method chosen, initiating motive and chronobiological factors at the time of death. RESULTS Higher rates of suicides were observed in the population at risk over 65 years old, in both sexes (age-adjusted suicide rate per 100,000 inhabitants for men: 42.52; 95% CI 8.64- 37.47; for women: 8.64; 95% CI 6.81-10.96). There were significant differences regarding the method chosen (chi2=21.3; df=6; p=0.002) and the underlying motive, "mental/physical illness", was the predominant stressor (chi2=73.0; df=6; p<0.001). CONCLUSIONS Suicide in the elderly population differs significantly from that in younger people. Understanding of this phenomenon must be further elucidated, since suicide is difficult to prevent, and its risk is expected to increase still further among the elderly.
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Sturgiss EA. Suicide in people over 65 years of age in the Australian Capital Territory. J Forensic Leg Med 2009; 16:338-9. [DOI: 10.1016/j.jflm.2008.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 10/27/2008] [Accepted: 12/09/2008] [Indexed: 11/16/2022]
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Crandall M, Luchette F, Esposito TJ, West M, Shapiro M, Bulger E. Attempted suicide and the elderly trauma patient: risk factors and outcomes. ACTA ACUST UNITED AC 2007; 62:1021-7; discussion 1027-8. [PMID: 17426562 DOI: 10.1097/01.ta.0000229784.88927.6e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the scope and burden of hospitalizations for suicide attempts among elderly patients in the United States. METHODS The National Trauma Data Bank (NTDB, American College of Surgeons, Chicago, IL, 2002) was used for this study. It is a multistate database of hospitalizations for traumatic injury in the United States. Information on all patients reported to the database from 1995 to 2002 was analyzed. Logistic regression was used to analyze the risk factors for suicide attempt in elderly patients, compared with both a younger suicidal cohort and a cohort of elderly patients injured in a motor vehicle collision (MVC). The impact of age on outcome after failed suicide attempt was also analyzed. RESULTS A total of 1,812 persons aged 65 and over were hospitalized for suicide attempts during the study period, comprising 9.5% of total hospitalizations for suicide attempts. Regression analysis demonstrated that elderly patients who attempted suicide were more likely to be male, white, to have used a firearm, and to have insurance than younger patients. They were more likely to have a psychiatric condition but less likely to have insurance than elderly patients hospitalized for MVCs. Mortality was higher for elderly patients hospitalized for suicide attempts than for younger patients who attempted suicide. Suicidal elderly were less likely to be discharged to home than either younger suicidal patients or elderly patients hospitalized after MVCs. CONCLUSIONS The failed suicide attempt is an opportunity for intervention. By better understanding risk factors and outcomes of suicide attempts among elderly patients, we can identify higher risk groups and begin to tailor social service programs, psychiatric interventions, and medical care. A multimodality approach to suicide prevention for the elderly would include compassionate, appropriate, psychosocial interventions, and could be studied prospectively to analyze its impact.
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Affiliation(s)
- Marie Crandall
- Division of Trauma and Surgical Critical Care, Northwestern University, IL 60611, USA.
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Inoue K, Tanii H, Fukunaga T, Abe S, Kaiya H, Nata M, Okazaki Y. Significant correlation of yearly suicide rates with the rate of unemployment among men results in a rapid increase of suicide in Mie Prefecture, Japan. Psychiatry Clin Neurosci 2006; 60:781-2. [PMID: 17109721 DOI: 10.1111/j.1440-1819.2006.01603.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
A subcategory of elder maltreatment is the fatal outcome, or elder homicide. Some cases of elder homicide result from chronic abuse and/or neglect, while others appear to be sudden, with no pertinent history. The research and literature of elder homicide are lacking, making the investigation of each case difficult; the typical victim, perpetrator, scenario, and cause of death are not known. Components of homicide such as sexual assault and toxicology also lack study. We analyzed all elder deaths over a 20-year period. Cases included those with victims greater than or equal to 65 years of age. These deaths totaled 2137: natural = 1506, accident = 344, suicide = 139, homicide = 127, and undetermined = 21. Focusing on homicides, variables analyzed were age, race, gender, cause of death, location of death, time of year, motive, perpetrator, toxicology, and sexual assault component. By identifying the typical victim, perpetrator, scenario, and autopsy findings, these cases can be more completely investigated and possibly prevented.
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Affiliation(s)
- Kim A Collins
- Department of Pathology, Forensic Section, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Loving RT, Kripke DF, Elliott JA, Knickerbocker NC, Grandner MA. Bright light treatment of depression for older adults [ISRCTN55452501]. BMC Psychiatry 2005; 5:41. [PMID: 16283925 PMCID: PMC1298312 DOI: 10.1186/1471-244x-5-41] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 11/09/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery. METHODS In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (<10 Lux) light for one hour a day at three different times (morning, mid-wake and evening). A placebo response washout was used for the first week. Wake treatment was conducted prior to the initiation of treatment, to explore antidepressant response and the interaction with light treatment. Urine and saliva samples were collected during a 24-hour period both before and after treatment and assayed for aMT6s and melatonin respectively to observe any change in circadian timing. Subjects wore a wrist monitor to record light exposure and wrist activity. Daily log sheets and weekly mood (GDS) and physical symptom (SAFTEE) scales were administered. Each subject was given a SCID interview and each completed a mood questionnaire (SIGH-SAD-SR) before and after treatment. Also, Hamilton Depression Rating (SIGH-SAD version) interviews were conducted by a researcher who was blind to the treatment condition. A control group of healthy, age-matched, volunteers was studied for one day to obtain baseline data for comparison of actigraphy and hormone levels. RESULTS Eighty-one volunteers, between 60 and 79 years old, completed the study. Both treatment and placebo groups experienced mood improvement. Average GDS scores improved 5 points, the Hamilton Depression Rating Scale (HDRS) 17 scores (extracted from the self-rated SIGH-SAD-SR) improved 6 points. There were no significant treatment effects or time-by-treatment interactions. No significant adverse reactions were observed in either treatment group. The assays of urine and saliva showed no significant differences between the treatment and placebo groups. The healthy control group was active earlier and slept earlier but received less light than the depressed group at baseline. CONCLUSION Antidepressant response to bright light treatment in this age group was not statistically superior to placebo. Both treatment and placebo groups experienced a clinically significant overall improvement of 16%.
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Affiliation(s)
- Richard T Loving
- Department of Psychiatry, University of California, San Diego, USA
| | - Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, USA
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Mühlberg W, Becher K, Heppner HJ, Wicklein S, Sieber C. Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr 2005; 38:182-9. [PMID: 15965792 DOI: 10.1007/s00391-005-0309-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 04/08/2005] [Indexed: 11/27/2022]
Abstract
Although morbidity and mortality of acute poisoning are increased in elderly compared to younger patients, little has been published on this topics in the last years (Medline search). To investigate the influence of age on the clinical course of acute poisoning with different toxic agents, a longitudinal retrospective study at the Toxicological Intensive Care Unit (ICU) of the 2nd Department of Internal Medicine (Klinikum Nürnberg, Germany) was performed.A total of 5883 patients treated at our toxicological ICU were enrolled into the study, including all patients of the years 1982, 1992, and 1997. These three years were selected to investigate possible time-dependent changes of intoxication characteristics and quality of therapy at our ICU over a time span of 15 years. For each patient the following data were obtained from a standardized toxicological record: age, gender, toxic agents responsible for acute poisoning, and length of stay at the toxicological ICU. For a subgroup of 3740 patients, the cause of acute poisoning and the clinical outcome was also recorded. As compared with younger patients, mean length of stay at the ICU, indicating a more serious course of acute poisoning, was prolonged in elderly and, i. e., in very old patients (p <0.001). However, this prolongation of time at the ICU was only observed in elderly patients poisoned with drugs or with mixed poisoning including drugs, while mean length of stay was not prolonged in elderly patients poisoned with alcohol, with illegal drugs, chemicals, animal/plant poison, or other toxic agents. Patients with the highest risk of dying in the ICU after acute poisoning were elderly patients attempting suicide with drugs. Mortality in 3740 patients with acute poisoning was 0.24%, while it was 2.17% in the 184 patients being 65 years old or older. Thus, mortality was 9-fold higher in the elderly. Mean length of stay at the ICU decreased significantly from 1982 to 1992 and to 1997 (p <0.001) indicating an improvement of the therapeutical ICU management of acute poisoning and/or less dangerous toxic agents (i. e. less barbiturates). The age-dependent increase of the length of stay at the ICU until very old age (> 80 years) was most pronounced in 1982 and also declined markedly until 1997.Age, suicide attempt, and ingestion of (multiple) drugs seem to be risk factors for a higher mortality and a prolonged stay in the ICU after acute poisoning. Although in general the clinical course after poisoning has more complications and an impaired prognosis in old age, each category of toxic agents (drugs, alcohol, chemicals, etc.) has its own special "risk profile" for elderly patients. However, due to advances in modern ICU medicine the general prognosis of acute poisoning is good in old and even in oldest old patients.
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Affiliation(s)
- W Mühlberg
- Institute for Biomedicine of Aging, University of Erlangen-Nürnberg, 2nd Department of Internal Medicine Klinikum Nürnberg, Heimerichstr. 58, 90419 Nürnberg, Germany.
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23
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Zeppegno P, Manzetti E, Valsesia R, Siliquini R, Ammirata G, De Donatis O, Usai C, Torre E. Differences in suicide behaviour in the elderly: a study in two provinces of Northern Italy. Int J Geriatr Psychiatry 2005; 20:769-75. [PMID: 16035130 DOI: 10.1002/gps.1354] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND to investigate the suicide phenomenon among the elderly (people aged 65 and over) in the Italian provinces of Novara and Verbania, in the time span between January 1990 and December 2000, in order to evaluate if the characteristics of the suicide behaviour correlate to the place of living with particular attention to the psychosocial factors. METHODS the information was collected from the Republic Procuration of the two provinces. Frequencies and contingency tables were evaluated to compare the data found in the two provinces. Standardised Mortality Ratios (SMRs) with their confidential intervals (95% confidence intervals) were calculated in comparison with the average suicide rates in North West Italy in the same period and in the same age group. RESULTS One hundred and eighty-four suicides were committed from the elderly, with an average rate of 14.07 per 100 000 inhabitants in Novara and 25.56 in Verbania. The most common methods used to commit suicide were hanging and jumping from height. The factors chiefly related to suicide were mental disease, followed by organic illness. The analysis of SMRs point out that the incidence of suicide in the province of Verbania is higher than in North West Italy while in Novara it is lower. CONCLUSION the evaluation of the suicide risk in the elderly in a diagnostic and preventive framework must take into consideration the psychosocial factors that vary with the place of living.
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Affiliation(s)
- P Zeppegno
- Psychiatric Clinic, Department of Medical Science, School of Medicine, University of Eastern Piedmont, Amedeo Avogadro, Novara, Italy.
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Abstract
This exploratory study compares elderly suicides with (n=13) and without (n=72) family member suicide. Previous episodes of suicidal behavior were more common among suicides who lost first-degree relatives by suicide (100% vs. 65%, p = .009). Six persons had lost an offspring by suicide prior to their own deaths. Substance use disorder was more prevalent among those with offspring suicide than those without (100% vs. 25%, p = .000). While informants reported that offspring suicides played a central role in the suicide of the elderly study case, sibbling suicides were not considered precipitating factors.
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Affiliation(s)
- Margda Waern
- Section of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska Academy, Göteborg University, Sweden.
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Byard RW, Hanson KA, Gilbert JD. Suicide methods in the elderly in South Australia 1981-2000. ACTA ACUST UNITED AC 2004; 11:71-4. [PMID: 15261001 DOI: 10.1016/j.jcfm.2003.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
The files of the Forensic Science Centre in Adelaide, Australia were examined over a 20-year period from 1981 to 2000 for cases of suicide in individuals aged 65 years and over. A total of 445 cases were found (13.8% of all suicides) with an age range of 65-94 years (average= 73.5 years). All cases had undergone full autopsies and police investigation. There were significantly more male than female victims; M:F = 330:115 (p < 0.001). Hangings accounted for the highest proportion of cases (107/445; 24%) followed by gunshot wounds (96/445; 21.6%), drug toxicity (82/435; 18.9%), drowning (66/445; 14.8%), and carbon monoxide toxicity (52/445; 11.7%). A miscellaneous group accounted for 42 of 445 cases (9.2%). No significant changes occurred in either the total suicide rate or in the rates in males and females, except for drowning deaths in males, which showed a significant decrease over time (p < 0.01). Female victims tended to avoid violent methods such as gunshot wounds in favour of drug overdose. Gunshot wound deaths were far less common than published data from other countries would indicate, with relative increases in deaths due to hanging, drug toxicity, drowning and carbon monoxide toxicity. An awareness of the considerable variability that occurs among populations in suicide methods and rates is important in determining local requirements for suicide prevention campaigns.
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Affiliation(s)
- R W Byard
- Forensic Science Centre, 21 Divett Place, Adelaide, SA 5000, Australia.
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Scribante L, Blumenthal R, Saayman G, Roos JL. A retrospective review of 1018 suicide cases from the capital city of South Africa for the period 1997-2000. Am J Forensic Med Pathol 2004; 25:52-5. [PMID: 15075690 DOI: 10.1097/01.paf.0000113862.03302.1d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Scribante
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa.
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