Recent research on suicide in the elderly

Pearson, Jane L.

doi:10.1007/s11920-002-0014-9

Cited by 19 publications

(12 citation statements)

References 52 publications

(40 reference statements)

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“…More likely, the psychic pain associated with anxiety symptoms leads to greater suicidal ideation. Given that the elderly have the highest rate of completed suicide of any age group [14], clinicians need to closely evaluate elderly patients with anxious depression for suicidal ideation.…”

Section: Correlates Of Anxious Depressionmentioning

confidence: 99%

Comorbidity of depression and anxiety in the elderly

Lenze

2003

Curr Psychiatry Rep

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Elderly patients with depression commonly suffer from concurrent symptoms of anxiety or comorbid anxiety disorders. Such comorbidity is associated with a more severe presentation of depressive illness, including greater suicidality. Additionally, most antidepressant treatment studies of elderly individuals with depression have found poorer treatment outcomes in those with comorbid anxiety, for example, delayed or diminished response and increased likelihood of dropout from treatment. In terms of treatment of anxious depression, there is evidence that tricyclic antidepressants and serotonin reuptake inhibitors are not different from each other in terms of efficacy or tolerability. Rather than the specific choice of antidepressant medication, it appears that quality of clinical management has the greatest impact on likelihood of remission in anxious depressed elderly individuals. Co-prescription of benzodiazepines is sometimes warranted for severe anxiety, but increases the risk of cognitive or motor impairment. Psychotherapy, including cognitive-behavioral therapy and interpersonal therapy, which are efficacious for late-life depression in general, should also be considered for treatment alone or in combination with appropriate medication. Future research areas are also addressed in this paper.

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Section: Correlates Of Anxious Depressionmentioning

confidence: 99%

Comorbidity of depression and anxiety in the elderly

Lenze

2003

Curr Psychiatry Rep

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“…The elderly frequently need an intervention with a rapid onset, as they can present with high depression severity (e.g., agitation, psychosis), present a greater risk of suicide [16][17][18], are more prone to suffer from the physical consequences of depression (e.g., dehydration, malnutrition, weight loss) [19] and respond more slowly to antidepressants [8,20].…”

Section: Ect Efficacy In the Elderlymentioning

confidence: 99%

Neuromodulation Therapies for Geriatric Depression

Gálvez

Alonzo

et al. 2015

Curr Psychiatry Rep

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Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

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“…Such a hypothesis, however, cannot be tested in a psychological autopsy that utilizes exclusively proxy data. Among older adults, there are between two and four suicide attempts for every completed suicide compared with estimates of 8:1 and 20:1 in younger people 28. Older adults are more determined in their efforts to die by suicide 29.…”

Section: Introductionmentioning

confidence: 99%

A multidimensional risk factor model for suicide attempts in later life

Chan¹,

Chiu²,

Lam³

et al. 2014

NDT

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BackgroundElderly suicide is a public health problem worldwide, and the risk factors are multidimensional. Chronic mental health problems, personality traits, stressful life events, comorbid medical conditions, social isolation, unemployment, and poverty are associated with higher risk for suicide in later life. There was a relative paucity of data on the neurobiological markers of elderly suicide.ObjectiveThis study examines the conjoint roles of cerebrovascular risk factors (CVRFs) and other established biopsychosocial risk factors in older adults who had made a recent suicide attempt.DesignA cross-sectional, case-controlled study.SettingA tertiary care setting in a public sector and a community setting.Subjects and methodsCases (N=77) were nondemented Chinese adults aged ≥65 years, enrolled in a regional psychogeriatric service following a suicide attempt; comparison subjects (N=99) were community-dwelling nondemented older adults with no lifetime history of suicide. Measures of sociodemographic profile, life events, suicidal behavior, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I psychopathology, personality traits, functional status, physical health, CVRFs, and executive cognitive functions were administered.ResultsWeighted sum of CVRF score was significantly higher in older women who had made a recent suicide attempt (mean: 10.56; standard deviation [SD]: 5.46) than comparison subjects (mean: 7.24; SD: 4.04) (t=3.52, P=0.001; df=99). Logistic regression showed that CVRF score (Exp[B]: 1.289, P=0.033), DSM-IV depressive disorders (current) (Exp[B]: 348, P<0.001), number of life events in the past 12 weeks (Exp[B]: 10.4; P<0.001), and being married (Exp[B]: 12.2, P<0.048) significantly increased odds for suicide attempt status in older women (Nagelkerke R2: 0.844). Association of CVRF score and suicide attempt status was not observed in older men for whom number of life events in the past 12 weeks (Exp[B]: 9.164; P<0.001), higher neuroticism (Exp[B]: 1.028; P=0.048), and impaired performance on a Modified Card Sorting Test (Exp[B]: 0.646; P=0.032) significantly increased odds for suicide attempt status in a logistic regression model (Nagelkerke R2: 0.611).ConclusionRisk factors for cerebrovascular diseases may be associated with higher risk for attempted suicide in older women, but not in older men. Older men and women have distinct risk factor profiles that may inform targeted intervention and prevention strategies.

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Recent research on suicide in the elderly

Cited by 19 publications

References 52 publications

Comorbidity of depression and anxiety in the elderly

Comorbidity of depression and anxiety in the elderly

Neuromodulation Therapies for Geriatric Depression

A multidimensional risk factor model for suicide attempts in later life

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