Many common illnesses increase risk of suicide in elderly

14/06/2004

Certain common medical and psychiatric illnesses significantly increase the risk of suicide in the elderly, a new study from the Institute for Clinical Evaluative Science (ICES) shows. Although it’s known medical illness is a factor in suicide, few studies have examined which specific diseases are more likely to lead to suicide, and even less have focused on suicide and illness in the elderly.

ICES researchers investigated this issue by tracking all suicides between 1992 and 2000 committed by Ontarians 66 years of age and older. The prescription records of these individuals during the 6 months preceding their suicide were compared to those of living matched controls in a 1:4 ratio to determine the presence or absence of 17 illnesses potentially associated with suicide.

Results:

Over 1,300 elderly patients died of suicide during the study period.
The most common mechanisms to commit suicide involved firearms (28%), hanging (24%), and self-poisoning (21%).
Specific illnesses associated with suicide included heart failure, chronic obstructive lung disease, seizures, urinary incontinence, anxiety disorders, depression, psychotic disorders, bipolar disorder, moderate pain, and severe pain.
Treatment for multiple illnesses was strongly related to a higher risk of suicide.
Almost half the patients who committed suicide had visited a physician in the preceding week.

“These results have several important implications for the prevention of suicide in the elderly,” said lead author and ICES scientist Dr. David Juurlink.

“Physicians who care for patients with painful conditions should be alert to the potential for suicide as many patients may view it as a means of escape from suffering.

“In addition, most elderly patients who commit suicide visit a physician shortly beforehand and many of them have clinically recognizable features of depression at the time. Physicians, nurses and other healthcare professionals need to be aware of the possible threat of suicide in elderly patients with chronic illnesses, particularly in those with multiple illnesses, and symptoms of depression.”

The study, “Medical illness and the risk of suicide in the elderly”, is in the June 14, 2004 issue of the Archives of Internal Medicine.

Author affiliations: ICES (Drs. Juurlink, Szalai, Redelmeier, and Mr. Kopp); the Clinical Epidemiology and Healthcare Research Program (Drs. Juurlink and Redelmeier), Departments of Medicine (Drs. Juurlink and Redelmeier), Psychiatry (Dr. Herrmann), and Population Health Sciences (Dr. Szalai) at the University of Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.