Pain as a risk factor for suicidal behavior in older adults: A systematic review

IntroductionDelirium is commonly missed in older adults presenting to the emergency department (ED). Although current recommendations for active screening of delirium in the ED, this might not be feasible or practical. Identifying patients at high risk for prevalent and incident delirium in the ED will help to improve the screening process and to build interventions. There is currently scattered synthesis of evidence on risk factors associated with delirium in the ED. To address this gap, we are conducting a systematic review to describe the risk factors (patient vulnerability factors and precipitating factors) for delirium in the ED.Methods and analysisA literature search was performed from inception to March 2020 in Ovid EBM Reviews, Ovid EMBASE, Ovid MEDLINE, Scopus and Web of Science. We will include original research studies that report a quantitative relationship between at least one risk factor and delirium in the ED setting. Two investigators will use eligibility criteria from this protocol to independently screen titles and abstracts, and select studies based on full-text review of potentially eligible studies. After arriving at a final set of included studies, two investigators will extract data using a standardised data collection form. If appropriate, data regarding each risk factor will be pooled through a random-effect meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to evaluate the overall quality of evidence.Ethics and disseminationTo our knowledge, this will be the first systematic review evaluating risk factors for prevalent and incident delirium specifically related to the ED setting. Results of this study will aid in the identification of older adults at risk for delirium in the ED. We aim to publish the results of this systematic review in a peer-reviewed journal with good visibility for the fields of emergency medicine and geriatrics.PROSPERO registration numberCDR42020175261

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A systematic review of association between pain and suicidal behavior in elderly people

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2070 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S174-S174

Author(s):

J. Santos ◽

S. Martins ◽

L.F. Azevedo ◽

L. Fernandes

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Risk Factor ◽

Elderly People ◽

Suicidal Behavior ◽

Suicidal Behaviour ◽

Suicide Ideation ◽

Late Life ◽

Psychological Pain ◽

Competing Interest

IntroductionSuicide rates worldwide are highest in elderly people compared to younger ages. The recognition of risk factors for late life suicide may be crucial, since one in four attempts is consummated. In this context, pain has been identified as a major event raising the probability for suicide in elders although very little research has examined this association.ObjectiveTo conduct a systematic review to examine whether pain is a risk factor for suicidal behaviour (suicide ideation/attempt/suicide) in elderly people.MethodsThe Cochrane Collaboration's guidelines and PRISMA statement were used. The electronic databases considered were MEDLINE, ISI Web of Knowledge, Scopus and PsycARTICLES. Search terms were “pain”, “suicide*” and “elderly”. Studies that assessed the relation between pain and suicidal behavior among people aged ≥ 60 years were included.ResultsOf the 2655 references founded, only 41 articles met the inclusion criteria. Most of the quantitative studies concluded that there is a relationship between pain and late life suicidal ideation, in particular severe and chronic pain. Physical or psychological pain was also reported as the cause of attempting suicide in two studies and was considered an important risk factor for committed suicide in eight of them.ConclusionThe results suggest that pain is a risk factor for suicidal behaviour in elderly people, especially suffering from severe and chronic pain, which are in accordance with previous reviews in this field. Future studies are needed to clarify this association and highlight about the importance of pain in suicide prevention initiatives for elders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people

International Psychogeriatrics ◽

10.1017/s1041610217001430 ◽

2017 ◽

Vol 29 (11) ◽

pp. 1801-1824 ◽

Cited By ~ 32

Author(s):

Chukwudi Okolie ◽

Michael Dennis ◽

Emily Simon Thomas ◽

Ann John

Keyword(s):

Systematic Review ◽

Older Adults ◽

Primary Care ◽

Suicidal Ideation ◽

Older People ◽

Suicidal Behavior ◽

Depression Screening ◽

Controlled Trials ◽

Cochrane Central Register ◽

Suicide Attempted

ABSTRACTBackground:Older people have a high risk of suicide but research in this area has been largely neglected. Unlike for younger age groups, it remains unclear what strategies for prevention exist for older adults. This systematic review assesses the effectiveness of interventions to prevent suicidal behavior and reduce suicidal ideation in this age group.Methods:MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant publications from their dates of inception until 1 April 2016. Studies included in this review report effectiveness data about interventions delivered to older adults to prevent suicidal behavior (suicide, attempted suicide, and self-harm without suicidal intent) or reduce suicidal ideation. A narrative synthesis approach was used to analyze data and present findings.Results:Twenty one studies met the criteria for inclusion in the study. Most programs addressed risk predictors, specifically depression. Effective interventions were multifaceted primary care-based depression screening and management programs; treatment interventions (pharmacotherapy and psychotherapy); telephone counseling for vulnerable older adults; and community-based programs incorporating education, gatekeeper training, depression screening, group activities, and referral for treatment. Most of the studies were of low quality apart from the primary care-based randomized controlled trials.Conclusions:Multifaceted interventions directed at primary care physicians and populations, and at-risk elderly individuals in the community may be effective at preventing suicidal behavior and reducing suicidal ideation in older adults. However, more high quality trials are needed to demonstrate successful interventions.

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