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Trends in suicide by drowning in the elderly in England and Wales 1979-2001
- Author:
- SALIB Emad
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.175-181.
- Publisher:
- Wiley
Suicide by drowning increases with age but its rates vary between countries and among communities. Drowning suicide rates in some of the available studies may have been over reported or under reported because of misclassification. This study presents data on the time trends, age/sex mortality rates from death by drowning in the elderly in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined. Counts of suicide due to drowning and submersion [ICD 9 codes; E954] and undetermined injury deaths [E984] (WHO, 1977), reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS). There has been a gradual reduction in suicide by drowning in men and women by more than a third the observed count in 1979 (p < 0.01). However, this decline was less evident in the elderly particularly those over the age of 75. Elderly drownings appear to attract more verdicts of suicide compared to younger age groups (Odds Ratio 4.3 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (Odds Ratio 1.5 95% CI 1.1-1.6). The high rate of open verdicts in elderly drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Therefore combining suicide and all undetermined deaths in drowning as a matter of course, in nationally collected statistics, may result in grossly exaggerated rates and misleading trends in suicidal drowning. Suicide by drowning is probably not amenable to prevention and although the elderly are often thought to benefit more from suicide prevention than younger adults, the study findings seem to suggest that this is not likely to be the case in drowning.
Measuring Alzheimer's disease progression with transition probabilities in the Taiwanese population
- Authors:
- FUH Jong-Ling, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.266-270.
- Publisher:
- Wiley
The transition probability of Alzheimer's disease (AD) is defined as the likelihood that the disease progresses from one stage to another in a given time period. The purpose was to estimate the separate stage-to-stage and stage-to-death transition probabilities for Taiwanese patients with AD and to evaluate the hazard ratios of age, sex, behavioral symptoms, and medications on disease progression. The authors examined data (severity of dementia, hallucinations or delusions, use of cholinesterase inhibitors [CEIs], survival) in 365 patients with probable AD at baseline and at follow-Gup (mean ± SD 29 ± 17 months, range 3-109 months). Modified survival analysis revealed that transition probabilities of Taiwanese patients were similar to those of Western patients. The probability of dementia remaining at the same stage was higher in patients taking CEIs than in other. Men had a higher probability of dying in the mild stage. Transition probabilities can be used to measure AD progression. CEIs used to treat AD might alter the disease course.
Reasons of informal caregivers for institutionalising dementia patients previously living at home: the Pixel study
- Authors:
- THOMAS Philippe, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(2), February 2004, pp.127-135.
- Publisher:
- Wiley
This is a study of the problems and requirements of the main caregiver providing home care for dementia patients that have resulted in the patient being institutionalised. Self-administered questionnaire of 48 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the geriatrician. Data were collected from 109 questionnaires concerning 75 females with dementia (84.7 ± 6.7 years) and 34 demented males (80.8 ± 7.4 years). In two-thirds of cases the main caregiver was a female, aged 61.1 ± 12.1 years. Cognitive disorders were not the main reasons for institutionalising patients. The most frequent caregiver complaint at the time of institutionalisation was incontinence, followed by withdrawal. The caregiver's main problem resulting in institutionalisation was dependence, with behavioural disorders in second place. A treatment with anticholinesterase for dementia was associated with a live-in carer being provided for 20 months longer than in the case of patients not receiving this treatment. Statistical analysis revealed 6 groups of separate caregiver-patient situations. On the one hand there were those patients who appeared to be easy for the caregiver to cope with: those with no problems, docile patients and passive patients not opposing care. In these cases the caregiver was most often young and male, or not directly related to the patient. On the other hand there were 3 other groups: patients with inappropriate motor behaviours, violent/agitated patients and unmotivated patients who opposed care. These patients lived with an elderly caregiver who had been looking after the patient for several years. Caregivers' requirements are for help with coping with and preventing dependence. The caregiver suffers terribly from a lack of relief, particularly when young. It is necessary to change the focus of home care for dementia patients towards preventing loss of autonomy and its consequences and to allow for periods of relief for home caregivers.
Validity of the Telephone Interview for Cognitive Status (TICS) in post-stroke subjects
- Authors:
- BARBER Mark, STOTT David J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.75-79.
- Publisher:
- Wiley
Cognitive impairment and dementia are very common after stroke. Telephone screening has potential advantages for clinical follow-up and population-based research in this group. We wished to test the validity of the Telephone Interview for Cognitive Status (TICS) for cognitive testing in post-stroke subjects. Cognitive function in stroke outpatients was assessed using the R-CAMCOG (a modification of the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly, for use in stroke subjects) along with the TICS and a modified version, the TICSm. The tests were administered in random order. A cut-off point of 33 on the R-CAMCOG was used to define post-stroke dementia. Sixty-four patients with a median age of 72 years were assessed. The Pearson correlation coefficients between the R-CAMCOG and the TICS and TICSm were 0.833 and 0.855 (both p <0.001) respectively. Twenty-four (38%) patients met R-CAMCOG criteria for post-stroke dementia. The area under the ROC curve for both the TICS and TICSm was 0.94. Using a cut-off of 28 or less on the TICS produced a sensitivity of 88% and a specificity of 85% for the diagnosis of post-stroke dementia. For the TICSm a cut-off of 20 or lower produced a sensitivity of 92% and a specificity of 80%. The TICS and TICSm telephone questionnaires are practicable and valid methods of assessing cognitive function in community outpatients following stroke. Scores of 28 and 20 respectively carry good sensitivity and specificity for the diagnosis of post-stroke dementia.
Nursing home suicides: a psychological autopsy study
- Authors:
- SOUMINEN Kirsi, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1095-1101.
- Publisher:
- Wiley
Older adults comprise a fifth of all suicides. Elders are the fastest growing part of the population, thus the number of persons needing nursing home care will increase dramatically in the near future. Little information has been available about suicides in nursing homes. The present study described all suicides among older adults in nursing homes in Finland during a 12-month period emphasizing the factors that have been found to be associated with suicide in the general elderly population. Drawing on data from a psychological autopsy study of all suicides (n=1397) in Finland during one year, all suicides committed by patients in nursing homes were identified. Retrospective DSM-IV consensus diagnoses were assigned. Twelve elderly (aged 60 years or more) nursing home residents who died by suicide, 0.9% of all suicides, were identified. The primary finding of the present study was that nursing home residents who died by suicide had suffered from highly comorbid somatopsychiatric disorders. One or more diagnoses on Axis I were made for all who died by suicide in nursing home. Depressive syndrome was diagnosed in three-quarters of subjects. Only a third of these were identified to have suffered from depressive symptoms before their death. Early recognition and adequate treatment of both somatic diseases and mental disorders, particularly depression, as well as early recognition of suicide risk among nursing home residents, are needed in order to prevent suicide.
Gender in elderly suicide: analysis of coroners inquests of 200 cases of elderly suicide in Cheshire 1989-2001
- Authors:
- SALIB Emad, GREEN Laura
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1082-1087.
- Publisher:
- Wiley
The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable. Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989-2001. The Coroner's office covers the whole county of Cheshire (population 1 000 000). Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2-0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2-1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively.
Recent trends in elderly suicide rates in a multi-ethnic Asian city
- Authors:
- KUA Eee-Heok, KO Soo-Meng, NG Tze-Pin
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.533-536.
- Publisher:
- Wiley
There are a few reports on the trends of elderly suicide rates in western countries but none from Asian countries. This article describe the trends of elderly suicide rates of Chinese, Malays and Indians in Singapore from 1991 to 2000. Overall, the suicide rates for the elderly showed a decline from 40.1 per 100,000 in 1990 to 17.8 per 100,000 in 2000, with the most pronounced decline occurring from 1995 to 2000. The suicide rate for elderly Chinese was at a peak of 52 per 100,000 in 1995 and declined to 20 per 100,000 in 2000. The rates for elderly Malays were consistently low at 2.2 per 100,000 for the 10 years; for elderly Indians the rates were between the other two ethnic groups. In the 10-year period, the elderly suicide rates in Singapore declined markedly, especially for elderly Chinese.
Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria: results of the Leipzig Longitudinal Study of the Aged (LEILA75+)
- Authors:
- TURNER Stuart W., et al
- Journal article citation:
- British Journal of Psychiatry, 182(5), May 2003, pp.444-448.
- Publisher:
- Cambridge University Press
Although mild cognitive impairment is associated with an increased risk of developing dementia, there has been little work on its incidence and prevalence. The aim of this article was to report age-specific prevalence, incidence and predictive validities for four diagnostic concepts of mild cognitive impairment. A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study. Prevalence rates ranged from 3% to 20%, depending on the concept applied. The annual incidence rates applying different case definitions varied from 8 to 77 per 1000 person-years. Rates of conversion to dementia over 2.6 years ranged from 23% to 47%. Mild cognitive impairment is frequent in older people. Prevalence, incidence and predictive validities are highly dependent on the diagnostic criteria applied.
Would older people use psychological services?
- Authors:
- AREAN Patricia A., et al
- Journal article citation:
- Gerontologist, 42(3), June 2002, pp.392-398.
- Publisher:
- Oxford University Press
This article examines older patient preferences for psychological services, including the types of services they would be interested in and who should provide them. Seventy-nine percent of the sample surveyed said they would use any of the psychological services which were presented to them. Seventy-two percent preferred to talk to their primary care provider, and 46% of the sample indicated that they would also speak with a mental health worker or nurse about their problems. Few older people said they would attend group psychotherapy, but 69% said they would attend psychoeducational classes. Implications: Our findings suggest that older adults would be amenable to psychosocial services, particularly individual services and psychoeducational programming.
A prevalence study of suicide ideation among older adults in Hong Kong SAR
- Authors:
- YIP Paul S. F., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1056-1062.
- Publisher:
- Wiley
The objective of this paper is to ascertain estimates of the prevalence, and associated risk factors for, suicidal ideation among community-dwelling older adults in Hong Kong. The study was conducted as part of the General Household Survey (GHS), using face to face interviews of ethnic Chinese people aged 60 or above living in the community. Elders living in institutions or elderly homes were excluded from the study. Six percent of the sample was found to have ever had suicide ideation. The results showed that poor physical health, including poor vision, hearing problems, and a greater number of diseases; and poor mental health, especially in the form of depression, are predictors of suicidal ideation in the elderly population. Also, statistical analysis by linking individual factors to depression showed that financial and relationship problems are significant risk factors as well. Older adults who engaged in active coping, that is, those who actively seek to manage or control the negative events in their lives, fare better with lower levels of suicidal ideation than those who use passive coping styles. The prevalence of suicidal ideation is similar among elders in Hong Kong and western countries. Factors that contribute to risk for suicidal ideation span physical and mental health, social, and psychological domains. Although the association of suicidal ideation to self-destructive acts remains to be determined, these findings indicate a variety of potential foci for late life suicide prevention efforts.