Suicidal behavior and assisted suicide in dementia

Abstract

Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.

Suicide among nursing home residents in Australia: A national population‐based retrospective analysis of medico‐legal death investigation information

“…This could indicate that dementia was under‐diagnosed or under‐detected in this cohort of suicide deaths, as it is also estimated to be in the general population, although this is probably less likely in a nursing home setting. However, this finding is consistent with studies reporting low suicide risk among people with dementia, suggesting that dementia patients may be unable to formulate intent or implement the means to suicide due to their cognitive impairment . A large proportion of residents had at least 1 (86.5%) physical health diagnosis, often with multiple comorbidities and physical impairments.…”

Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia

“…While people living with dementia may still have a lot of things to enjoy, research also shows that they may experience burdensome symptoms as the disease progresses. 9,10 Such thoughts may trigger formal requests for physician-assisted suicide or euthanasia, to be carried out either early in the disease trajectory (while still competent) or later when decisional capacity has been lost. [5][6][7] Others have found that anticipated experiences of patients living with dementia are often more negative than their actual experiences.…”

“…8 Nonetheless, increased awareness of the challenges of living with dementia can result in some diagnosed people seriously contemplating a hastened death. 9,10 Such thoughts may trigger formal requests for physician-assisted suicide or euthanasia, to be carried out either early in the disease trajectory (while still competent) or later when decisional capacity has been lost. In The Netherlands, where the law on assisted death imposes no limit on life expectancy, physicians can provide assistance in dying at both the early and late stages of dementia, provided that the legal requirements are met.…”

The survival and characteristics of older people with and without dementia who are hospitalised following intentional self-harm

“…A recent review of suicidal behaviour in dementia noted that the overall quality of studies examining self-harm was poor and from the available studies it was unclear if dementia increased the risk of self-harm (Draper, 2015). The hospitalisation rate for self-harm for individuals with dementia aged 60 years and older was double the rate for individuals without dementia.…”

“…Prior anecdotal evidence suggested that individuals with dementia who self-harm also experience comorbid mental health conditions (Draper, 2015). Prior anecdotal evidence suggested that individuals with dementia who self-harm also experience comorbid mental health conditions (Draper, 2015).…”