Suicide risk in first year after dementia diagnosis in older adults

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trader32176
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Suicide risk in first year after dementia diagnosis in older adults

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Suicide risk in first year after dementia diagnosis in older adults

5/25/21


https://alz-journals.onlinelibrary.wile ... /alz.12390

(This is an abbreviated version . for the full text , click the link above)



Abstract

Introduction


Receiving a diagnosis of Alzheimer's disease or related dementias (ADRD) can be a pivotal and stressful period. We examined the risk of suicide in the first year after ADRD diagnosis relative to the general geriatric population.

Methods


We identified a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years with newly diagnosed ADRD (n = 2,667,987) linked to the National Death Index.

Results

The suicide rate for the ADRD cohort was 26.42 per 100,000 person-years. The overall standardized mortality ratio (SMR) for suicide was 1.53 (95% confidence interval [CI] = 1.42, 1.65) with the highest risk among adults aged 65 to 74 years (SMR = 3.40, 95% CI = 2.94, 3.86) and the first 90 days after ADRD diagnosis. Rural residence and recent mental health, substance use, or chronic pain conditions were associated with increased suicide risk.

Discussion


Results highlight the importance of suicide risk screening and support at the time of newly diagnosed dementia, particularly for patients aged < 75 years.

1 INTRODUCTION

As people age, many fear developing Alzheimer's disease and related dementias (ADRD).1, 2 After being diagnosed with ADRD, feelings of loss, anger, and uncertainty are common and for some adults the experience is particularly traumatic.3, 4 Suicide risk increases with age and is highest among older adults in the United States and many regions of the world.5, 6 In 2018, the most recent year for which US national data were available, the suicide rate for adults aged 65+ years was 17.36 per 100,000, compared to 14.21 in the general population.5 At a time when the US suicide rate among older adults has acclerated7 and the number of older adults with ADRD is increasing,8 research is needed to quantify suicide risk in older adults with newly diagnosed dementia and to identify patient characteristics that place geriatric patients at increased short-term risk for suicide.

Prior reviews9, 10 concluded that the risk of suicide in patients with dementia appears to be equal to that of the age-matched general population, but noted that most studies had significant methodological limitations. Findings from large, cohort studies are mixed. A Danish cohort study11 observed a 3- to 10-fold increased risk of suicide in adults aged ≥ 50 years with dementia; however, the cohort was limited to persons diagnosed with dementia during hospitalization, thus representing a subsample of all dementia cases. A more recent Danish cohort study12 of persons aged ≥ 15 years found suicide rates were lower overall for ADRD, but did not include persons diagnosed in primary care where most cases are diagnosed.13 A Korean cohort study of memory clinic patients found no significant association with suicide risk compared to the age- and sex-matched population.14 Conversely, a separate Korean study of adults aged ≥ 60 years with newly diagnosed ADRD had an increased risk of suicide death in the first year after dementia diagnosis compared to propensity-score matches without dementia.15

One cohort study with US veterans aged ≥ 60 years with dementia found predictors of death by suicide included depression, anxiolytic use, and prior psychiatric hospitalization.16 However, depression was not a predictor of suicide death in a retrospective, cohort study of adults with dementia in the US state of Georgia.17 More research is needed given the paucity of nationally representative US data to examine variations in risk of suicide after dementia diagnosis and to identify which subgroups of patients are most at risk.

Suicide risk may be higher during the early stages of ADRD and then decreases during more advanced stages of the disease as individuals become less cognitively and functionally capable of acting on suicidal impulses.18 Suicide risk may also vary by dementia subtype with evidence that non-fatal suicidal behaviors and depression are more prevalent in frontotemporal and vascular dementia,19 whereas suicidal ideation may be highest for adults with Lewy body and vascular dementia.20

To our knowledge, we present the first US national study of suicide risk among adults aged ≥ 65 years during the first 12 months after a new dementia diagnosis. We followed a cohort of Medicare fee-for-services beneficiaries with a new diagnosis to examine risk of suicide within the first 12 months after the first observed clinical diagnosis of ADRD. Because suicidal ideation and deliberate self-harm are among the strongest predictors of suicide death,21 we also examined 12-month risk of non-fatal suicidal events. We analyzed risks by dementia subtype, sociodemographic and clinical characteristics, and recent health-care use. Standardized mortality ratios were calculated to quantify the excess risk of suicide death during the first year after dementia diagnosis.
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