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Suicide follow-up severely lacking in older adults

Older adults admitted to the ED with suicidal ideation or attempt were less likely to receive mental health evaluations or referral resources postdischarge, according to recent findings.

“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. In 2015 in the U.S., there were almost 8,000 suicide deaths among adults aged 65 years and older, amounting to an estimated $17 million in medical costs and $813 million in lost work costs,” Sarah A. Arias, PhD, of Brown University, and colleagues wrote. “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.”

To assess disparities in treatment of older adults at risk for suicide, researchers conducted a retrospective chart review of 800 charts among 200 older adults and 600 adults aged younger than 60 years who screened positively for suicidal ideation in the past 2 weeks.

Fewer older adults had a chief complaint of psychiatric behavior (53% vs. 70%) or self-harm behavior (26% vs. 36%), compared with younger adults.

Fewer older adults reported suicide attempt in the past 2 weeks (17% vs. 23%), despite having greater documentation of current suicidal ideation (93% vs. 79%), compared with younger adults.

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%).

“Improved suicide screening in the ED has led to improved detection of suicide risk, but 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,” the researchers wrote. “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, in addition to improvements in suicide interventions directed at reducing morbidity and mortality.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.