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Preventing Elder Suicide Cheat Sheet by

How Physicians Can Help Prevent Elder Suicide
elder     physicians     prevent     suicide

Introd­uction

Patients' severe functional limita­tions, disabi­lity, increasing dependence on others, and the fear of becoming a burden are signif­icant risk factors for elder suicide. Physicians must make efforts to ascertain their older patients' mental status and potential suicide ideation.

Specific Goals of suicide prevention

There are three specific goals of suicide preven­tion:
1) Interr­upting indivi­duals' specific plans to take their lives,
2) Rreducing the risks that affect particular indivi­duals, and
3) Rreducing the overall number of suicides.

Strategies

Physicians can help by implem­enting the following strate­gies:
Addressing suicide risks in the direct care of patients,
Modifying the practice of their medical groups,
Joining public health efforts to reduce suicid­es,and
Advocating for changes in public policy.

Risk Factors:

Psychi­atric illnes­s—most commonly major depres­sion; but bipolar disorder and PTSD are also high risk;
Substance abuse including prescr­iption medica­tions as well as alcohol and/or illegal drugs;
Access to Weapons;
Chronic physical illness, especially illnesses that are permanent, disabling, and/or terminal;
Chronic severe pain;
Recent onset of dementia;
Grief;
Being a victim of ongoing violence;
Social isolation;
Homele­ssness;
Lack of engaging, satisf­ying, and/or meaningful activi­ties;
Experience of discri­min­ation, especially for LGBT indivi­duals;
Prior suicide attempts (although 60% of suicide decedents have never previously attempted suicide);
Family or spousal history of suicide; and
History of childhood trauma or being bullied.
 

Preventive Interv­entions

Demo­ral­izing Health Condit­ions: A major contri­bution physicians can make to suicide prevention is effective treatment of health conditions that result in demora­liz­ation. Partic­ularly important are conditions that cause severe functional limita­tions and/or are terminal. Disability and growing dependency frequently breed hopele­ssness and fear of becoming a useless burden, which are signif­icant risk factors for suicide. Providing effective treatment for such physical health conditions is a preventive interv­ention. However, many older patients fear death less than disabi­lity. It may be more important to address disability than acute disease.

Treating pain: Effective pain management is critical for many at-risk patients. But drugs for pain, partic­ularly opiates and benzod­iaz­epines, carry signif­icant risks of addiction, accidental overdoses, and falls—the major cause of premature disability and death in old age. And they can be used for suicide.

When possible, physicians should use altern­atives to depressant and addictive drugs, including nonpha­rma­col­ogical interv­entions such as biofee­dback, physical therapy, routine exercise, and pain-f­ocused cognitive behavioral therapy, as well as relatively safe medica­tions such as Cymbalta, Lyrica, or prescr­iption NSAIDs.

Scre­eni­ng: Identi­fying major depression or substance abuse is exceed­ingly difficult. Even primary care physicians who pay attention to their patients' moods and look for signs of substance abuse will probably miss people at risk

Useful screens include the Patient Health Questi­onnaire (PHQ-9) and General Anxiety Disorder-7 (GAD-7) among others, which can be completed by patients, their aides, or relatives prior to seeing the primary care provider.

Beha­vioral treatment: Treatment for depres­sion, substance abuse, or other behavioral disorders can be effective and reduce related suicide risks. Sometimes primary care physicians can provide effective treatment themse­lves, but often it is preferable to refer patients to mental health profes­sio­nals.

Upstream factors: In addition to treatment, it can be useful for physicians to talk with their patients about "­ups­tre­am" contri­butors to suicide risk including social isolation, family estran­gement, inactivity and boredom, bereav­ement, and/or lack of a sense of self-w­orth, meaning, or purpose.

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