Suicide Risk

The risk of suicide demonstrates the need for early geriatric psychiatric assessments and vigorous treatment protocols. Suicidal feelings are high among individuals aged 85 years or over with mental disorders, with 30% believing "life was not worth living'' and 10% having thought of taking their own life (Skoog et al., 1996). Among women who felt life was not worth living, the three-year mortality rate was three times that of women without these feelings (43% vs. 14%, respectively). Several studies have shown that recognition of depression among the elderly who attempt or complete suicide is inadequate (Duckworth et al., 1996; Suominen et al., 2004). Only 4% of the elderly who had attempted suicide had been diagnosed with a mood disorder before the attempt, despite having physician contact within the previous year (Suominen et al., 2004). Among elderly depression patients who had committed suicide, 80% of patients had no psychiatric referral, and 87% were untreated (Duckworth et al., 1996). Correlates of suicide include poor perceived health, poor sleep quality, and lack of a confidant (Turvey et al., 2002). There is also a strong association with deliberate self-poisoning using benzodiazepine in the elderly (Ticehurst et al., 2002).

In the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), use of a multifaceted care management model in primary care was shown to significantly reduce rates of suicidal ideation compared with usual care among elderly patients with depression (Bruce et al., 2004). In addition, a survey of prescribing trends showed a decrease in the rate of suicide associated with prescriptions for antidepressants, antipsychotics, antimanic drugs and analgesics, and an increase with prescriptions for barbiturates, hypnotics, and sedatives (Shah et al., 2001).

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