Unexpected Suicidality in an Older Individual in an Emergency Department

Betz, Marian E.; Schwartz, Robert S.; Boudreaux, Edwin D.

doi:10.1111/jgs.12290

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Regardless, asking these questions as part of standard care for patients screening positive for active suicidal ideation or behavior may help reduce future suicide risk. Specifically, NSSI is recognized as a robust risk factor for future suicidal behavior in both adolescents and adults and reducing access to lethal means is a suicide prevention approach with strong empirical support . The rising rate of mental health patients seeking care in the ED further emphasizes the importance of ensuring that appropriate steps, such as a mental health evaluation, are taken for patients identified with suicide risk …”

Section: Methodsmentioning

confidence: 99%

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

Arias

Boudreaux

Segal

et al. 2017

J American Geriatrics Society

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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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Section: Methodsmentioning

confidence: 99%

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

Arias

Boudreaux

Segal

et al. 2017

J American Geriatrics Society

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“…Older adults are also frequently more reluctant to discuss mental health issues with healthcare professionals compared with younger adults. This might influence clinicians to discharge the patient without a mental-health assessment [12]. Outpatient follow-up has been shown to decrease suicidal behaviors [20].…”

Section: Discussionmentioning

confidence: 99%

“…Canadian data on ED visits for suicidal behaviors in older adults are, however, scarce. Signs and symptoms of depression in seniors are under- identified by emergency clinicians [12]. Depression often presents with more subtle signs and symptoms in older adults, including physical symptoms [6].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Older Adults Attending the Emergency Department for Suicidal Thoughts or Voluntary Intoxication: A Multicenter Retrospective Cohort Study

Boulet¹,

Gagnon²,

Nadeau³

et al. 2022

Cureus

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The objective of this article is to explore the characteristics of older adults visiting the ED for suicidal thoughts and/or voluntary intoxication. MethodsAll older adults (65 years or older) who visited one of the five University Hospital Center (CHU) of Quebec EDs in 2016 and who reported suicidal thoughts or intoxication in triage or received a relevant discharge diagnosis were included. ResultsA total of 478 ED visits were identified, of which 332 ED visits (n=279 patients) were included. The mean age was 72.6 (standard deviation 6.8) years old and 41.6% were female. Mood disorders (41.2%) and alcoholism (40.5%) were common. Nearly 30% of all ED visits (n=109) resulted in a referral for a mental health assessment. In the subsequent year (2017), 38.4% returned to the ED for suicidal ideations. There were 7.9% who attended the ED five times or more. ConclusionsED visits for suicidal thoughts and intoxication in older adults are common among men with known mood disorders or alcoholism. ED dispositions are variable, and access to a mental health assessment is not consistent.

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“…Although not widely in practice, ED‐based universal screening for suicide risk (questioning all individuals, regardless of reason for visit) does appear to be feasible when well implemented . In settings without universal screening, individuals with known psychiatric problems or substance abuse appear most likely to be questioned about suicide risk; although these groups are at high risk of suicide, they are not the only people at risk . An advantage of universal screening is that it is aimed at enhancing detection in individuals with more‐hidden risk factors, for whom providers may have a low clinical suspicion of suicide risk and therefore a lower likelihood of screening.…”

Section: Discussionmentioning

confidence: 99%

Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department

Betz

Arias

Segal

et al. 2016

J American Geriatrics Society

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Background/Objectives Depression, suicide ideation (SI) and suicide attempts (SA) are common among older adults, representing serious public health problems. Individuals with multiple comorbidities and frequent contact with hospital–based emergency departments (ED) may have elevated – but unrecognized – risk. To inform future interventions, we sought to estimate the prevalence of self-harm/SI/SA among older ED patients, including differences by age group, sex, and race/ethnicity. Design Quasi-experimental, multi-phase, 8-center study with prospective review of consecutive patient charts during enrollment shifts (November 2011–December 2014). Setting 8 EDs located in 7 states, all with protocols for nurses to screen every patient for suicide risk (“universal screening”). Participants Adult (≥18 years) registered ED patients. Measurements Patient demographics, documented screening for self-harm/SI/SA, positive self-harm/SI/SA among those with screening performed. Results Among a total of 142,534 patient visits, 23.3% were by patients aged ≥60 years. Documented screening for self-harm/SI/SA declined with age, from approximately 81% in younger age groups to a low of 68% among those aged ≥85 years. The prevalence of positive screens for self-harm/SI/SA also declined with age, with peaks among young and middle-aged adults (9.0%) and a nadir among patients aged ≥75 years (1.2%). Conclusion Documented screening for suicide risk declined with patient age in this large sample of ED patients. Although the explanation for this finding is unclear, we hypothesize that at least part of the decline is related to increasing rates of altered mentation or other patient-level barriers to screening in the older population. Our findings support the need for more detailed examination of the best methods for identifying – and treating – suicide risk among older adults.

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Unexpected Suicidality in an Older Individual in an Emergency Department

Cited by 6 publications

References 10 publications

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

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

Characteristics of Older Adults Attending the Emergency Department for Suicidal Thoughts or Voluntary Intoxication: A Multicenter Retrospective Cohort Study

Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department

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