Suicide in the elderly: the limits of paternalism

The woman who wanted electroconvulsive therapy and do-not-resuscitate status. Questions of competence on a medical-psychiatry unit

A case involving an elderly woman suffering concurrently from serious psychiatric and medical illnesses is presented. Ethical considerations concerning her treatment on a medical-psychiatry unit are discussed with special attention to her requests for both electroconvulsive therapy (ECT) and do-not-resuscitate (DNR) status. The compatibility of simultaneous requests for ECT and DNR is examined on three levels. The effect of depression upon competence to request and refuse treatment is analyzed. This case illustrates a conflict between medical and psychiatric treatment goals and ethical traditions which will become more common as psychiatrists treat older and more medically ill patients.

Cohort, age, and period effects in the analysis of U.S. suicide patterns: 1933-1978

This study employed multiple classification analysis to examine the impact of age, period, and cohort effects on U.S. white male suicide rates between 1933 and 1978. Previous studies of cohort effects with regard to suicide behavior have been descriptive in nature, and have failed to consider the interaction of the three effects. Drawing on a study of pulmonary tuberculosis mortality by W.M. Mason and Smith (1985), the work specified seven models. The Shazam ordinary-least-squares computer package was employed to estimate the logit coefficients for the seven models. Period effects were found to be weaker than age and cohort effects for explaining shifts in white male suicide patterns. In this study all of the three effects were measured indirectly, and this fact limits the validity of the findings. Causal analysis, which directly measures at least one of the effects, would have improved the robustness of the findings.

Suicide among psychiatric inpatients of older ages

The problem of suicide at older ages is considerable. To date, there are virtually no data on how older psychiatric inpatients differ from other similar groups on background/treatment variables related to suicide, “traditional” aging suicidal variables, and standard psychometric tests sensitive to suicide. Four inpatient groups were identified based on age (< 40 yr. or > 54 yr.) and current suicidal behavior (suicidal, nonsuicidal but depressed) and compared on these variables. Older suicidal inpatients were different from the other groups of inpatients on very few variables. Older suicidal patients were given a diagnosis of depression, made more suicidal gestures, had suicidal ideation (except for younger suicidal group), had operative physical problems (except for older nonsuicidal group), and tended not to act-out relative to other groups. On the psychometric measures, age, and not suicidal problems, was largely responsible for any differences between older suicidal patients and the other groups. Many traditional aging suicidal variables did not differentiate among the groups.