August 23, 2017
A new study published in the Journal of the American Geriatrics Society found that many suicidal older adults discharged home did not receive a follow-up mental health evaluation compared with younger adults.
Study author Sarah A Aria, PhD, Brown University (Providence, RI), and coauthors sought to investigate treatment received by older adults (≥60 years old) vs younger adults (< 60 years old) who were admitted to the emergency department with suicide risk using retrospective chart review.
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The motivation for this study, said authors, was based on “a recent report by the [WHO] found that suicide rates in men greater than 70 years old are higher than in any other demographic group worldwide…. Suicide is disproportionate among older adults as they constitute about 14.5% of the U.S. population but complete about 18% of all suicides, reflecting a greatly elevated risk in later life” (2017; doi:10.1111/jgs.15011).
Individuals eligible for study review included a random sample of adults over the age of 18 years who had positively screened for suicide ideation in the pas 2 weeks and/or a suicide attempt within the previous 6 months (from May 2014 to September 2016).
Eight hundred charts were reviewed—200 older adults’ charts and 600 younger adults’ charts. Fewer older adults than younger adults had a chief complaint involving psychiatric behavior (53% vs 70%) or self-harm behavior (26% vs 36%). A higher number of older adults (93%) had documentation of current suicide ideation compared to younger adults (79%), but fewer older adults (17%) reported a suicide attempt in the past 2 weeks compared to younger adults (23%).
Less than half of older adults who screened positively for suicidal ideation and were discharged received a mental health evaluation during their visit (42%). Evaluation was more common in younger adults who screened positively and were discharged (66%).
Older adults with current suicidal ideation or attempt were less likely to receive referral resources, compared with younger adults with current suicidal ideation or attempt (34% vs 60%).
Researchers concluded: “There appear to be meaningful disparities in the use of best practice approaches, like mental health evaluations, for older, at-risk patients for suicide. This is particularly concerning as suicide rates peak among older men…. Future research directed at examining suicide risk factors associated with the older adult population, in addition to provider attitudes toward older adult patients with mental health issues is a critical step for improving responses to suicide risk detection.”—Amanda Del Signore