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Healthcare professionals should be alert to the possible threat of suicide among elderly patients with chronic illness, particularly those with multiple illnesses, symptoms of depression, or other risk factors for suicide.

Patient Safety Monitor Alert, June 17, 2004

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Healthcare professionals should be alert to the possible threat of suicide among elderly patients with chronic illness, particularly those with multiple illnesses, symptoms of depression, or other risk factors for suicide. A new study reveals that seizure disorder, congestive heart failure, and chronic lung disease are independently associated with an increased risk of suicide among elderly people. The study appears in the June 14 issue of The Archives of Internal Medicine.

Suicide is the 11th leading cause of death in the United States and is particularly common among the elderly. It's also the most widely reported sentinel event, consisting of 374 of the 2,455 (15%) sentinel events reported to the JCAHO since 1995.

Warning signs of a patient's suicidal thinking may include:

>> any mention of dying, disappearing, jumping, or other types of self-harm

>> a recent loss, such as through death, loss of health, a divorce, separation, or a broken relationship

>> a change in sleep patterns or eating habits

>> low self-esteem

>> no hope about the future

David N. Juurlink, MD, PhD, of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, and colleagues examined the relationship between treatment for several illnesses and the risk of suicide in elderly patients.

The researchers examined the prescription records of all Ontario residents 66 years and older who committed suicide between January 1, 1992 and December 31, 2000. For each resident who committed suicide, the researchers also looked at their prescription records for age, sex, residential area, and income to determine the presence or absence of 17 illnesses potentially related to suicide.

Among the 1,329 elderly persons who committed suicide (1,012 men; 317 women), the most common methods involved firearms (28%), hanging (24%), and self-poisoning (21%). Depression, bipolar disorder (manic-depressive illness) and severe pain were associated with the largest increases in suicide risk. However, several other chronic illnesses including seizure disorder, congestive heart failure, and chronic lung disease, were also associated with an increased risk for suicide.

The researchers also found that treatment for multiple illnesses was strongly related to an increased risk of suicide, and that most of the patients who committed suicide visited a physician in the month before death, about half of them during the preceding week. This new study is among only a few that have examined the association between suicide and specific illnesses.

"Our findings have important implications for prevention because most elderly patients who commit suicide visit a physician shortly beforehand, and many of them have clinically recognizable features of depression at the time," the authors write.

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