Sarah A Arias1, Edwin D Boudreaux2, Daniel L Segal3, Ivan Miller1, Carlos A Camargo4, Marian E Betz5. 1. Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA. 2. Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. 3. University of Colorado at Colorado Springs, Colorado Springs, CO, USA. 4. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 5. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Abstract
BACKGROUND/ OBJECTIVE: We described characteristics and treatment received for older (≥60 years) vs younger (<60 years) adult emergency department (ED) patients with suicide risk. DESIGN: Retrospective chart review. SETTING: An ED with universal screening for suicide risk. PARTICIPANTS: Eligible charts included a random sample of adults (≥18 years) who screened positive for suicidal ideation (SI) in past 2 weeks and/or a suicide attempt (SA) within the past 6 months. Visit dates were from May 2014 to September 2016. RESULTS: A total of 800 charts were reviewed, with oversampling of older adults. Of the 200 older adults sampled, fewer older adults compared to younger adults (n = 600) had a chief complaint involving psychiatric behavior (53% vs 70%) or self-harm behavior (26% vs 36%). Although a higher number of older adults (93%) had documentation of current SI compared to younger adults (79%), fewer older adults (17%) reported SA in the past 2 weeks compared to younger adults (23%). Of those with a positive suicide screen who were discharged home, less than half of older adults received a mental health evaluation during their visit (42%, 95% CI 34-52) compared to 66% (95% CI 61-70) of younger adults who met the same criteria. Similarly, fewer older, than younger, adult patients with current SI/SA received referral resources (34%; 95% CI 26-43; vs 60%; 95% CI 55-65). CONCLUSIONS: Significantly fewer suicidal older adult patients who were discharged home received a mental health evaluation when compared to similar younger adults. These findings highlight an important area for improvement in the treatment of older adults at risk for suicide.
BACKGROUND/ OBJECTIVE: We described characteristics and treatment received for older (≥60 years) vs younger (<60 years) adult emergency department (ED) patients with suicide risk. DESIGN: Retrospective chart review. SETTING: An ED with universal screening for suicide risk. PARTICIPANTS: Eligible charts included a random sample of adults (≥18 years) who screened positive for suicidal ideation (SI) in past 2 weeks and/or a suicide attempt (SA) within the past 6 months. Visit dates were from May 2014 to September 2016. RESULTS: A total of 800 charts were reviewed, with oversampling of older adults. Of the 200 older adults sampled, fewer older adults compared to younger adults (n = 600) had a chief complaint involving psychiatric behavior (53% vs 70%) or self-harm behavior (26% vs 36%). Although a higher number of older adults (93%) had documentation of current SI compared to younger adults (79%), fewer older adults (17%) reported SA in the past 2 weeks compared to younger adults (23%). Of those with a positive suicide screen who were discharged home, less than half of older adults received a mental health evaluation during their visit (42%, 95% CI 34-52) compared to 66% (95% CI 61-70) of younger adults who met the same criteria. Similarly, fewer older, than younger, adult patients with current SI/SA received referral resources (34%; 95% CI 26-43; vs 60%; 95% CI 55-65). CONCLUSIONS: Significantly fewer suicidal older adult patients who were discharged home received a mental health evaluation when compared to similar younger adults. These findings highlight an important area for improvement in the treatment of older adults at risk for suicide.
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