A retrospective case series of suicide attempts leading to hospice admission

Abstract

Objective This investigation sought to systematically identify and characterize a cohort of patients treated in hospice for life-limiting injuries sustained in a suicide attempt that was not immediately lethal. Method We developed a case series of all completed suicides in a large, community-based hospice, from 2004 through 2010. Clinical documentation and county medical examiner reports were used to identify those deaths that resulted from a suicide attempt made prior to hospice admission. Cases were characterized in terms of basic demographic variables, the temporal sequence of events in the transition from hospital care to hospice, the mechanism of injury and medical complications, the presence of mental illness, and family involvement in decision making. Results Out of a total of 20,887 hospice deaths during the study period, 8 deaths resulted from an incomplete suicide attempt made prior to hospice admission. Subjects were nearly all male (6/8), and 46 years old on average; substantially younger than the general hospice population. Drug overdose was the most common method of suicide (5/8), and irreversible anoxic brain injury was the main medical complication. The majority of subjects (6/8) had evidence of serious mental illness. Most cases were complicated by estranged family relationships; however, family members were involved in end-of-life decision making for nearly all patients. Significance of results Whereas a failed suicide attempt leading to hospice appears to be a relatively rare event, patients in this population appear unique in several regards. Further study may serve to better characterize this group and prepare hospice agencies and clinicians for caring for this unique population.

Hospice and palliative social workers' experiences with clients at risk of suicide

“…For particularly distressed individuals, these symptoms may include thoughts of suicide (also referred to as “suicidal ideation”), suicide attempts, or death by suicide. While the incidence of suicide and the prevalence of related thoughts and behaviors among seriously ill patients and their families is unknown (Fairman et al, 2014), documented accounts of such occurrences suggest that this issue warrants concern (Adelman et al, 2014; Fairman & Irwin, 2013; Fairman et al, 2014; O'Dwyer et al, 2015). The growing acceptance of physician-assisted suicide (sometimes referred to as “physician aid in dying”), as evidenced in the United States by an increasing number of states legalizing the practice (Clodfelter & Adashi, 2016), further underscores its importance.…”

Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children

“…3,8 While families are among the main sources of social support that help promote stability or intervene in SMI exacerbations, 55 it is also possible that parents may be a source of stress and conflict for adult children with SMI. 56 Almost one in five family members of individuals with SMI report being recipients of interpersonal violence, 57,58 and it is possible that individuals with the most severe SMI may be estranged from their families, 59 information that we were unable to capture using these data.…”

Managing an intentional overdose in a hospice

“…Out of 20 887 hospice deaths, they identified 8 in which a suicide attempt led to hospice admission. 2 The use of naloxone for patients with respiratory depression secondary to opioids at the end of life can be complex due to its short half-life and the risk of inducing acute withdrawal. Patient safety alerts issued by NHS England in November 2014 and October 2015 highlight the potential to cause intense pain and distress, as well as possible fatal cardiac complications.…”