Frailty in geriatric veterans indicates risk for suicide attempt, death

Among veterans aged 65 years or older, frailty was positively associated with risk for suicide attempts and negatively associated with risk for suicide death, according to data published in JAMA Psychiatry.

“Prior studies on late-life suicide have lacked breadth and depth to comprehensively examine how frailty influences suicide risk,” Randall L. Kuffel, BS, an epidemiology staff research associate in the department of psychiatry in the San Francisco VA Health Care System in California, and colleagues wrote. “Most studies have focused on individual risk factors, such as depression or pain alone, or have used a limited form of physical and psychiatric multimorbidity to assess suicide risk. However, frailty, captured through an accumulation of deficits, can integrate a wider range of health factors, the accumulation of which may be indicative of reduced cognitive reserve and reduced emotional resilience.”

Kuffel and colleagues identified 2,858,876 veterans aged 65 years or older who received care from the Veterans Health Administration from October 2011 to September 2013. They followed patients through 2017 to evaluate frailty on a five-level index that accounted for 31 variables in five domains, which were morbidity, functional status, cognition and mood, sensory loss and other conditions common among older adults.

The researchers evaluated the associations between frailty score — categorized as non-frailty, prefrailty, mild frailty, moderate frailty and severe frailty — and nonfatal suicide attempt and suicide death.

In total, 8,955 (0.3%) participants attempted suicide during follow-up.

Overall frailty risks

Compared with veterans with non-frailty, the risk for suicide attempt was greater among veterans with prefrailty (adjusted HR = 1.34; 95% CI, 1.27-1.42), mild frailty (aHR = 1.44; 95% CI, 1.35-1.54), moderate frailty (aHR = 1.48; 95% CI, 1.36-1.6) and severe frailty (aHR = 1.42; 95% CI, 1.29-1.56) when adjusting for substance use disorders and PTSD.

Conversely, the risk for suicide death was greatest among veterans with prefrailty (aHR = 1.2; 95% CI, 1.12-1.28) and mild frailty (aHR = 1.12; 95% CI, 1.03-1.22) compared with veterans with non-frailty. There were no significant differences in risk for suicide death between veterans with moderate or severe frailty and veterans with non-frailty.

Individual frailty components

Assessment of the 31 frailty variables revealed the risk for suicide attempt was higher among veterans with lung disease (aHR = 1.11; 95% CI, 1.06-1.17), use of durable medical equipment and resources (aHR = 1.14; 95% CI, 1.03-1.25), chronic pain (aHR = 1.22; 95% CI, 1.15-1.29), anxiety (aHR = 1.36; 95% CI, 1.28-1.45), depression (aHR = 1.78; 95% CI, 1.67-1.87) and bipolar disorder (aHR = 2.69; 95% CI, 2.54-2.86).

The risk for suicide attempt was lower among veterans with no dementia diagnosis (aHR = 0.79; 95% CI, 0.73-0.85), incontinence (aHR = 0.84; 95% CI, 0.76-0.92), heart failure (aHR = 0.86; 95% CI, 0.8-0.93) and diagnosis of failure to thrive (aHR = 0.66; 95% CI, 0.51-0.87).

“Future studies may replicate our findings and investigate potential underlying mechanisms to better understand the role of frailty as a factor associated with late-life suicide and a candidate for intervention and prevention effort,” Kuffel and colleagues wrote.