An overview of suicide in the U.S. Army is presented in two sections: (1) the epidemiology of U.S. Army suicides, based on biennium reports, and (2) the temporal aspects of those suicides compared with the data for the United States as a whole. A brief historical review documents some of the changes in contemporary military suicide rates compared to those of the past century. The cycles in the number of suicides by day of the week, day of the month, and the month of the year for the U.S. Army are computed and contrasted with those reported for the U.S. resident population.
D-A195MILITARY MEDICINE #lieC F-~p 815 [ 3 5-"" ' ORIGINAL ARTICLE:. Authors alone are responsible for opinions expressed in the contribution and for its clearance through their federal health agency, if required.
Approved for public release; distribution unlimited. 17. DISTRIBUTION STATEMENT (of the abstract entered In Block 20. It different trem RePOrt) 19. KEY WORDS (Continue an reverse side if ngcogay mid identify by. block n~mbet) C Suicide-U.S. Army-Psychiatry-ratio-epidemiology CD L4I. 3 AvTrnACT' MA11 sb-86110 It POBG-id"Mit? by block numee A third biennium of epidemiological data on suicide in the U.S. Army was comn-.0 piled with the same method as was used previously. The annual crude suicide rale Sper 100,000 soldiers-at-risk for 1981-82 was found to be 11.2, a drop of 0.4 points from where it stood in 1979-80. Sex-specific, race-specific, age-specific, grade-specific and marital statusspecific rates were studied and can be compared with the same indices in the previous three biennia. Demographic data and information on circumstances surrounding the suicidal act were also made available for comparison with-DD F0"gl 147 EDSonon o 9mov assossoLaE1 UNCLASSIFIED A75SECURITY CLASRFIAN 0 j A(~iU e~ge % ATIOW. 0 A 6 df * 1Jrninol-med f JaoLtif ction iAvall and/or 11st Special UNCLASSIFIED SECURITY CLASIFICATION Of THIS PAOIEwhfl Does Entered) % %..*..
Background Hospitalized older adults have significant geriatric deficits that may lead to poor outcomes. We conducted a randomized trial to investigate the effectiveness of providing clinicians with a real‐time geriatric assessment (GA) report in nonelectively hospitalized older patients with cancer. Subjects, Materials, and Methods We developed a web‐based software platform for administering a modified GA (Cancer 2005;104:1998–2005) to older (>70 years) nonelectively hospitalized patients with pathologically confirmed malignancy. Patients were randomized to have their GA report provided to their treating clinicians (Intervention arm) or not provided (Control arm). Results Our study included 135 patients, median age 76 years, 52% female, 75% white, 21% black, 79% greater than high school education, 59% married, and 17% living alone. All patients had at least one GA‐identified deficit, including physical function deficits (90%), cognitive impairment (22%), >5 comorbidities (28%), polypharmacy (>9 medications; 38%), weight loss ≥10% in the past 6 months (40%), anxiety (32%), or depression (30%). There was no difference between the Intervention (6%) and Control arms (9%) in the proportion of patients who were referred by their clinical team for an intervention to address a deficit (p = .53). Conclusion Many older nonelectively hospitalized patients with cancer have geriatric deficits that are amenable to evidence‐based interventions. Real‐time GA reports provided to the care team prior to discharge did not influence provider referral for such interventions. There is a need for systems‐level interventions to address deficits in this vulnerable patient population. Implications for Practice Geriatric deficits are common in hospitalized older adults with cancer and lead to poor outcomes. Addressing modifiable deficits represents an appealing way to improve outcomes. Widespread geriatrician consultation is impractical owing to resource and personnel constraints. This work tested whether prompt delivery of a mostly self‐administered, web‐based geriatric assessment report to clinicians improved referral rates for evidence‐informed interventions. It confirmed frequent geriatric deficits and high readmission rates in this population but found that real‐time geriatric assessment reporting did not influence provider referral for evidence‐informed interventions on geriatric assessment identified deficits. These findings highlight the need for systems‐level intervention to improve outcomes in this vulnerable patient population.
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