Page 36 - Demo

FEATURE
PROFESSOR GREGORY PETERSON MPS
is Deputy Dean (Research), Faculty of Health and Co- Director, Health Services Innovation Tasmania, School of Medicine, University of Tasmania and a community pharmacist.
• male gender
• depression or other
mental illness
• social isolation – living alone/few
social supports
• recent death of a loved one
• serious physical illness and disability
• chronic pain
• previous suicide
attempt
• alcohol misuse.
AGED CARE
Suicide in elderly people
BY PROFESSOR GREGORY PETERSON MPS
Three Australians aged 75 and older kill themselves every week. If the base age is reduced to 70, the number is closer to four per week. Furthermore, these figures are likely to represent under-reporting.1
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Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd.
“While mental disorders are common in later life and closely associated with suicide, only a small proportion of older adults in need of mental healthcare receive adequate management.”
‘Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age.’2
In 2015, 3,027 people died from intentional self- harm in Australia.3 It was the thirteenth leading cause of death.
Deaths from suicide occur among males at a rate three times greater than that for females. The age- specific death rate is highest among males 85 years and over (Figure 1). The most common method of suicide in elderly people was hanging.1 The next most common method of suicide was firearms, then gas, poison, drowning and jumping from buildings. The major drug groups implicated in poisoning cases were benzodiazepines, antidepressants, opioids and paracetamol.4
In most countries around the world, suicide rates are higher for both men and women in later life than for younger age groups, and they peak in old age.2,5–9 Suicide attempts are also much more likely to result in death in the elderly compared with the general population.9 With the number of older people with mental illness expected to triple over the next 25 years,10 suicides in the elderly are an important public health concern.2,10–13 While the potentially devastating effect of a suicide on relatives and friends is clear, the suicide of an elderly patient can also have a profound impact on their health professionals.14
Suicide risk in elderly people often remains undetected.13 Effective prevention programs require an ability to predict those older people at risk of suicidal ideation. However, suicidal behaviours across all ages are complex and there is usually no single cause or stressor which is sufficient to explain
either fatal or non-fatal suicidal behaviour.
Most commonly, several risk factors from systemic, societal, community, relationship and individual domains act cumulatively to increase an individual’s vulnerability to suicidal behaviour (Box 1).15 Multiple factors increase suicide risk ranging from distal early and mid-life issues such as child abuse, parental death, substance misuse and traumatic life experiences to proximal precipitants in late life such as social isolation and health-related concerns.6 The
circumstances leading up to suicidal behaviour in older people frequently involve declining health, chronic pain, impairment in daily living activities, threats to physical and financial autonomy, social isolation, lack of social support, grief, depression and hopelessness.14 Being divorced, widowed or single increases the risk.9
Depression
Most, but not all, older people who die by suicide have a diagnosable mental disorder at the time of death; most commonly, this is severe depression2,9,11,16 and could be a first episode of major depression.6 While mental disorders are common in later life
and closely associated with suicide, only a small proportion of older adults in need of mental healthcare receive adequate management.7 In fact, the increased risk of suicide in elderly people may partly be because of the high prevalence of untreated and/or unrecognised depression.17
The following conclusions came from an analysis of coroners’ records for 210 older people who committed suicide in Sydney.18
• 25% were depressed in response to losses, including bereavement.
• 24% wanted to end their physical suffering (from cancer or degenerative neurological disease, such as motor neurone disease), or to relieve a perceived burden on others. Nearly two thirds of this group were also depressed.
• 18% had a depressive illness without obvious external cause.
Box 1. Risk factors for suicide in older individuals
15,16