Page 37 - Demo

FEATURE
• 13% were in situations they experienced as untenable, like financial ruin or guilt.
• 10% were depressed following worsening of their health, or of a disability.
• 6% had either dementia or another psychiatric illness; in three quarters of these people depression symptoms were present.
Conversely, protective factors may include family and social support systems, involvement in activities, financial security, good mental health,
and effective coping mechanisms.17 Little research has examined the effectiveness of interventions
to reduce the risk of suicide in later life.7 Ideally, strategies for suicide prevention need to be ‘whole of life,’ given the distal risk factors, and, as no
single prevention strategy is likely to be successful alone, a multi-faceted, multi-layered approach is required.6 This should include optimal detection
and management of depression and of high risk individuals, as available evidence indicates that this can reduce suicidal behaviour. A frail elder’s ability to devise and carry out a suicide plan should also not be underestimated.8
Better identification and treatment of depression
in elderly people is a priority, given its importance in late-life suicide.2,7,8,16 Identifying and diagnosing depression in elderly people can be challenging due to communication difficulties caused by hearing
or cognitive impairment, other comorbidities with physical symptoms similar to those of depression, and a reluctance to discuss their feelings or
seek help from a health professional.19 Once diagnosed, lifestyle changes should be encouraged, acknowledging that these can be challenging
to initiate in individuals with depression.20 These changes include increasing physical activity to the extent that is possible, and increasing engagement in pleasurable activities and social interactions. Pharmacotherapy and/or psychotherapy will generally be required. The selective serotonin- reuptake inhibitors (SSRIs) are considered first-
line pharmacotherapy. Cognitive behavioural therapy focuses on identifying and reframing negative, dysfunctional thoughts while increasing participation in pleasurable and social activities.20
Apart from depression, clinicians should also
be vigilant for physical illness, pain, functional impairment and social disconnectedness. Encouraging social connectedness is important.7 Suicide and its prevention are complex, without easy solutions. A raised awareness amongst pharmacists is a good starting point. They can
also support elderly individuals and their doctors through the identification and referral of depression, optimal management of physical conditions and improvement of pain control.21
Figure 1. Rate of suicide deaths in Australia per 100,000 population, by age group and sex, 2015.3
40 30 20 10
0
Male Female
(a) Age-specific death rate. Deaths per 100,000 of estimated mid-year population for each age group.
References
1. Elderly suicide alarming. Aust Nursing & midwifery journal 2015;22(9):17.
2. Van Orden K, Conwell Y. Suicides in late life. Curr Psychiatry Rep 2011;13(3):234–41.
3. Australian Bureau of Statistics 2015. Causes of death, Australia, 2013. Cat. no. 3303.0. Canberra: ABS.
4. Australian Institute of Health and Welfare. Harrison JE, Henley G. 2014. Suicide and hospitalised self-harm
in Australia: trends and analysis. Injury research and statistics series no. 93. Cat. no. INJCAT 169. Canberra: AIHW.
5. Shah A, Bhat R. The relationship between elderly suicide rates and mental health funding, service provision and national policy: a cross-national study. Int Psychogeriatr 2008;20(3):605–15.
6. Draper BM. Suicidal behaviour and suicide prevention in later life. Maturitas 2014;79(2):179–83.
7. Conwell Y. Suicide later in life: challenges and priorities for prevention. Am J Prev Med 2014;47(3 Suppl 2):S244–50.
8. Salvatore T. Suicide risk in homebound elderly individuals. What home care clinicians need to know. Home Healthc Now 2015;33(9):476–81.
9. O’Connell H, Chin AV, Cunningham C, et al. Recent developments: suicide in older people. BMJ 2004;329(7471):895–9.
10. Jeste DV, Palmer BW. A call for a new positive psychiatry of ageing. Br J Psychiatry 2013;202:81–3.
11. Manthorpe J, Iliffe S. Suicide in later life: public health and practitioner perspectives. Int J Geriatr Psychiatry 2010;25(12):1230–8.
12. Sachs-Ericsson N, Van Orden K, Zarit S. Suicide and aging: special issue of Aging & Mental Health. Aging Ment Health 2016;20(2):110–2.
13. Ho RC, Ho EC, Tai BC, et al. Elderly suicide with and without a history of suicidal behavior: implications for suicide prevention and management. Arch Suicide Res 2014;18(4):363–75.
14. Draper B, Kolves K, De Leo D, et al. The impact of patient suicide and sudden death on health care professionals. Gen Hosp Psychiatry 2014;36(6):721–5.
15. Australian Institute of Health and Welfare, 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.
16. Cheung G, Merry S, Sundram F. Late-life suicide: Insight on motives and contributors derived from suicide notes. J Affect Disord 2015;185:17–23.
17. Zanni GR, Wick JY. Understanding suicide in the elderly. Consult Pharm 2010;25(2):93–102.
18. Snowdon J. Suicide in late life. Reviews in Clin Geriartr 2001;11: 253–360.
19. Canadian Agency for Drugs and Technologies in Health. Diagnosing, screening, and monitoring depression in the elderly: a review of guidelines. Ottawa (ON), 2015.
20. Taylor WD. Clinical practice. Depression in the elderly. N Engl J Med 2014;371(13):1228–36.
21. Iliffe S, Manthorpe J. The prevention of suicide in later life: a task for GPs? Br J Gen Pract 2005;55(513):261–2.
Australian Pharmacist
January 2017 I ©Pharmaceutical Society of Australia Ltd. 35
Age
Rate (a)
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
85+