Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department
Department of Emergency Medicine
Emergency Medicine | Geriatrics | Mental and Social Health | Psychiatry and Psychology
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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Citation: J Am Geriatr Soc. 2017 Oct;65(10):2272-2277. doi: 10.1111/jgs.15011. Epub 2017 Jul 28. Link to article on publisher's site
suicide, emergency department, older adult, mental health evaluation, treatment
Arias, Sarah A.; Boudreaux, Edwin D.; Segal, Daniel L.; Miller, Ivan; Camargo, Carlos A. Jr; and Betz, Marian E., "Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department" (2017). Emergency Medicine Publications and Presentations. 83.