Suicide Risk Jumps Soon After Dementia Diagnosis

Pauline Anderson

March 22, 2021

Older patients recently diagnosed with dementia are at a significantly increased risk for suicide compared to their peers without dementia.

Investigators found that individuals who were diagnosed with dementia had a 54% increased risk for suicide within the first year after diagnosis. The risk was particularly high among those aged 74 years and younger.

Dr Timothy Schmutte

These findings have implications for screening by clinicians, said study investigator Timothy Schmutte, PsyD, assistant professor, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

"Providers need to be very attentive about doing a well-rounded assessment, not only of patients' mental health needs but also their needs for additional supports and services," Schmutte told Medscape Medical News.

The findings were presented at the American Association for Geriatric Psychiatry (AAGP) 2021.

"Jarring" Diagnosis

Using Medicare claims linked to the National Death Index, the researchers collected data on adults aged 65 years and older who received a dementia diagnosis within the previous year. Types of dementia were classified as Alzheimer's, vascular, Lewy bodies, frontotemporal, or unspecified.

Among the 2,667,987 participants, 62.2% were women, 82.5% were non-Hispanic Whites, and 46.5% were aged 85 years and older.

The study used a "very strict and narrow" definition of suicide based on ICD-codes that determine intentional self-injury/suicide, said Schmutte.

Results showed a suicide rate among the participants of 26.42 per 100,000 person-years. Relative to the general population, the overall standardized mortality ratio (SMR) for suicide was 1.54 (95% CI, 1.42 – 1.65).

The risk was "most pronounced" in the 65- to 74-year age group (SMR, 3.43; 95% CI, 2.96 – 3.89), followed by those aged 75 to 84 years, said Schmutte. The risk was less for those aged 85 and older, possibly because they died from other causes or weren't cognitively or physically able to carry out a suicide plan, he noted.

About half of the suicide deaths occurred within 90 days of the dementia diagnosis. The risk "seems to be most accentuated" during that period, Schmutte said.

Receiving a diagnosis of dementia can be "jarring and jolting" and can cause despair for some patients, especially because there are few effective treatments, he said.

He added that some previous research shows that dementia is the most feared diagnosis ― even more so than cancer.

Psychiatric Illness, FTD, Guns

A history of psychiatric illness increased suicide risk, "but the risk is still there even without a known history of mental illness," said Schmutte.

The risk was particularly high for frontotemporal dementia (FTD). "That makes sense because the frontal lobe is the part of brain primarily affected in that kind of dementia, so insight, impulse control, and judgment are most impaired," Schmutte said.

Most of the suicides among the participants (63%) were completed using a firearm.

It is estimated that about half of all American adults aged 65 years and older have a firearm in their home. Of these, about 25% "don't store them safely," Schmutte said.

This underscores the need to screen patients recently diagnosed with dementia for the presence of firearms. "Maybe another family member needs to store the guns, just to get them out of the house, to prevent not just suicides but accidental deaths," Schmutte added.

The suicide rate in the United States for those aged 45 to 64 years has "plateaued" in recent years, but the rate continues to climb among those aged 65 and older, he said.

Possible Risk Factors?

Commenting on the study for Medscape Medical News, Rajesh R. Tampi, MD, chairman of the Department of Psychiatry and Behavioral Sciences and chief of the Section for Geriatric Psychiatry, Cleveland Clinic, Cleveland, Ohio, said he can only speculate as to why persons younger than 75 have the highest suicide risk among those newly diagnosed with dementia.

"It may be that they're more capable of accessing guns and physically able to carry out the act," said Tampi, who is also professor of psychiatry at Northeast Ohio Medical University, Rootstown, Ohio, and co-president of the AAGP.

Other risk factors could include living in a rural area or being recently diagnosed with a mental or substance use disorder or a chronic pain condition, he added.

He speculated that younger seniors with such risk factors could be more despondent upon being given a dementia diagnosis because they may have less access to healthcare if they live in an isolated area, or they may have less inhibition if they're using substances.

Tampi also noted that the age of onset of FTD is less compared with other types of dementia.

American Association for Geriatric Psychiatry (AAGP) 2021: Abstract NR14. Presented March 18, 2021.

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