No abstract

Many elderly people who commit suicide are not in close contact with primary care services; those who are may not be prescribed appropriate treatment, and few are referred for specialist care. Specialist services will fail to reduce suicide rates unless they embark upon programmes to increase public awareness of therapeutic possibilities and work more closely with primary care agencies to realise these possibilities.

SUMMARYThe article describes the social, physical and psychological features of 104 consecutive elderly suicides, using information obtained from coroners' inquests. An age and sex matched cohort of 51 accidental deaths was used as a control. The suicide cohort was significantly more depressed and in pain, had experienced more previous depressive episodes and suicide attempts, and were less confused compared to the control group. The study confirms the importance of recognized risk factors: 61% were living alone, with 9% complaining of loneliness. Only one individual, on available data, attended a day hospital or day centre. Physical illness was common, with at least 56% having ill health prior to death and 63% showing postmortem abnormalities. Twenty-two per cent revealed abnormal cerebral pathology. Depressive illness was prominent, with 79% exhibiting depressive symptoms prior to death. Only 12 individuals were taking antidepressants and only one was on lithium. Despite contact with primary care services, only 20% had been seen by psychiatrists within three months of death. The roles of alcohol, drugs, abnormal cerebral changes and personality factors are discussed along with considerations for prevention.

Despite the fact that suicide and its prevention continues to be a priority area for health care in the UK, suicide in the elderly remains a neglected subject receiving little interest and research attention. The Green Paper Our Healthier Nation (Secretary of State for Health, 1998) maintained the concept of setting targets for suicide reduction originally proposed in The Health of the Nation strategy. The new target proposes that by the year 2010 the death rate from suicide and undetermined injury will be reduced by at least a further sixth (17%) from the baseline of 1996. The setting of such targets has always been a contentious issue among many psychiatrists, who have concerns that they may be used as a quality measure of psychiatric services, especially as some consider that social influences predominate over health care issues. The subsequent debate has focused on targeting specific at-risk groups, notably severely mentally ill young men, Asian women and those who deliberately harm themselves.

Isoforms of the vitamin B₁₂ carrier protein transcobalamin (TC) might influence its cellular availability and contribute to the association between disrupted single-carbon metabolism and Alzheimer’s disease (AD). We therefore investigated the relationships between the TC 776C>G (Pro259Arg) genetic polymorphism, total serum cobalamin and holo-TC levels, and disease onset in 70 patients with clinically diagnosed AD and 74 healthy elderly controls. TC 776C>G polymorphism was also determined for 94 histopathologically confirmed AD patients and 107 controls. Serum holo-TC levels were significantly higher in TC 776C homozygotes (p = 0.04). Kaplan-Meier survival functions differed between homozygous genotypes (Cox’s F-Test F(42, 46) = 2.1; p = 0.008) and between 776C homozygotes and heterozygotes (Cox’s F test F(46, 108) = 1.7; p = 0.02). Proportionately fewer TC 776C homozygotes appear to develop AD at any given age, but this will require confirmation in a longitudinal study.