Unexpected Suicidality in an Older Individual in an Emergency Department

Topic: Risk, prevention and care in population studies

On supplementary questioning, he revealed multiple recent social stressors, including the 1-year anniversary of his partner's death and an impending eviction from his home with the loss of his beloved garden. Twenty-five percent of these visits were by older adults, and total and mental health-related ED visits by older adults are increasing,6 but there could be as many as 13 million individuals in the ED with SI per year, based on an estimated prevalence of SI in all individuals in the ED of up to 11%,7 and some figures suggest that up to 20% of older individuals in the ED have depression.8 Almost half of individuals who commit suicide visit an ED in the year before their death, often for nonpsychiatric reasons, and they are more likely to have multiple recent ED visits than those who die by other causes.9 Most EDs rely on targeted SI questioning triggered by clinician concern, but some have begun standard screening of all patients, in part because of Joint Commission patient safety goals related to suicide prevention. Suicide prevention for older adults poses unique challenges because older suicidal individuals are more likely to employ advance planning and less likely to directly ask for help,3 with a suicide attempt to completion ratio in older adults of approximately 4:1, compared with up to 200:1 in young adults.3 SI in older adults is also more likely to stem from chronic medical or social issues than abrupt crises,3 so there may be a longer period available for intervention.

Key findings

• On supplementary questioning, he revealed multiple recent social stressors, including the 1-year anniversary of his partner's death and an impending eviction from his home with the loss of his beloved garden.
• Twenty-five percent of these visits were by older adults, and total and mental health-related ED visits by older adults are increasing,6 but there could be as many as 13 million individuals in the ED with SI per year, based on an estimated prevalence of SI in all individuals in the ED of up to 11%,7 and some figures suggest that up to 20% of older individuals in the ED have depression.8 Almost half of individuals who commit suicide visit an ED in the year before their death, often for nonpsychiatric reasons, and they are more likely to have multiple recent ED visits than those who die by other causes.9 Most EDs rely on targeted SI questioning triggered by clinician concern, but some have begun standard screening of all patients, in part because of Joint Commission patient safety goals related to suicide prevention.
• Suicide prevention for older adults poses unique challenges because older suicidal individuals are more likely to employ advance planning and less likely to directly ask for help,3 with a suicide attempt to completion ratio in older adults of approximately 4:1, compared with up to 200:1 in young adults.3 SI in older adults is also more likely to stem from chronic medical or social issues than abrupt crises,3 so there may be a longer period available for intervention.

Why it matters

This case report describes an older individual with suicidal ideation in the emergency department and discusses challenges in suicide prevention for older adults. It does not address treating, curing, or preventing Alzheimer's disease.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.1111/jgs.12290
• PubMed: 23772739
• Original source →
• Free full text: Journal of the American Geriatrics Society →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{betz2013-23772739,
  author  = {Betz, Marian E. and Schwartz, Robert S. and Boudreaux, Edwin D.},
  title   = {{Unexpected Suicidality in an Older Individual in an Emergency Department}},
  journal = {Journal of the American Geriatrics Society},
  year    = {2013},
  doi     = {10.1111/jgs.12290},
  pmid    = {23772739},
  url     = {https://doi.org/10.1111/jgs.12290}
}

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