Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department

Abstract

Background/Objective We described characteristics and treatment received for older (≥60 years) versus younger (<60 years) adult emergency department (ED) patients with suicide risk. Design Retrospective chart review. Setting An ED with universal screening for suicide risk. Participants Eligible charts included a random sample of adults (≥18 years) who screened positive for suicidal ideation (SI) in past 2 weeks and/or a suicide attempt (SA) within the past 6 months. Visit dates were from 5/2014 to 9/2016. Results A total of 800 charts were reviewed, with oversampling of older adults. Of the 200 older adults sampled, fewer older adults compared to younger adults (n=600) had a chief complaint involving psychiatric behavior (53% vs. 70%) or self-harm behavior (26% vs. 36%). Although more older adults (93%) had documentation of current SI compared to younger adults (79%), fewer older adults (17%) reported SA in the past two weeks compared to younger adults (23%). Of those with a positive suicide screen who were discharged home, less than half of older adults received a mental health evaluation during their visit (42%, 95%CI 34–52) compared to 66% (95%CI 61–70) of younger adults who met the same criteria. Similarly, fewer older than younger adult patients with current SI/SA received referral resources (34%; 95%CI 26–43; versus 60%; 95%CI 55–65). Conclusions Significantly fewer suicidal older adult patients who were discharged home received a mental health evaluation when compared to similar younger adults. These findings highlight an important area for improvement in the treatment of older adults at risk for suicide.

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