October 06, 2016
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Older adults screened less often for suicidal behaviors than younger adults

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A review of emergency department practice found that 68% of adults older than 85 years were screened for suicidal behaviors compared with 81% of younger patients, according to findings published in the Journal of the American Geriatrics Society.

“Rates of screening for self-harm, suicidal ideation or suicide attempts — although high overall because of the sites’ protocols for universal screening — decreased significantly with age, as did the prevalence of positive screens among those asked,” Marian E. Betz, MD, MPH, in the Department of Emergency Medicine at the University of Colorado School of Medicine, and colleagues wrote. “Although the explanation for these findings is unclear, it was hypothesized that at least part of the decline was related to greater prevalence of conditions precluding questioning (eg, dementia, severe confusion) in older adults.”

Previous research has shown clinicians underdiagnose depression and suicidal ideation in older adults, the researchers wrote. To examine the prevalence of suicidal behaviors in older adults, Betz and colleagues performed a retrospective review between 2011 and 2014 of eight emergency departments (EDs) in seven states, each with protocols for nurses to screen every patient for suicide risk. The researchers assessed demographic characteristics, then documented screening for self-harm, suicidal ideation (SI) or suicide attempts (SA).

Of 142,534 visits, 23.3% were for patients older than 60 years. Documented screening for self-harm, SI or SA declined with age, from 81% in younger-aged patients to 68% in patients aged 85 years or older. The prevalence of positive results for each screen also declined with age, with peaks in young-age and middle-age (9%) and reaching the lowest point after 75 years (1.2%).

The researchers concluded that these findings support the need for more detailed examination of suicide risk in older adults.

“These results suggest the need for enhanced screening protocols (with provider training) and possibly modified screening questions for use with older adults,” the researchers wrote. “With persistently high rates of suicide among older adults and a growing older adult population, there is an urgent need to improve the identification of suicide risk in older adults in EDs, as well as in outpatient and nonclinical settings.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.