Henry O'Connell

Recent developments: Suicide in older people

Elderly people have a higher risk of completed suicide than any other age group worldwide.1 Despite this, suicide in elderly people receives relatively little attention, with public health measures, medical research, and media attention focusing on younger age groups.2 We outline the epidemiology and causal factors associated with suicidal behaviour in elderly people and summarise the current measures for prevention and management of this neglected phenomenon. We searched Medline and the Cochrane database for original research and review articles on suicide in elderly people using the search terms “suicide”, “elderly”, and “older”. From time immemorial, suicidal feelings and hopelessness have been considered part of ageing and understandable in the context of being elderly and having physical disabilities. The Ancient Greeks tolerated these attitudes in the extreme and gave elderly people the option of assisted suicide if they could plead convincingly that they had no useful role in society. Such practices were based on the assumption that once an individual had reached a certain age then they no longer had any meaningful purpose in life and would be better off dead. Although not as extreme, ageist beliefs in modern, especially industrialised, societies are based on similar assumptions. Sigmund Freud echoed such views, while suffering from incurable cancer of the palate: > It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear. The burden of suicide is often calculated in economic terms and, specifically, loss of productivity. Despite lower rates of completed suicide in younger age groups, the absolute number of younger people dying as a result of suicide is higher than that for older people because of the current demographic structure of many societies.1 Younger …

Alcohol use disorders in elderly people—redefining an age old problem in old age

Alcohol use disorders in elderly people are common and associated with considerable morbidity. The ageing of populations worldwide means that the absolute number of older people with alcohol use disorders is on the increase, and health services need to improve their provision of age appropriate screening and treatment methods and services Media attention and public health initiatives related to alcohol use disorders tend to focus on younger age groups.1–3 However, alcohol use disorders are common among elderly people and are associated with notable health problems.2 Furthermore, in elderly people they are often underdetected and misdiagnosed4 as screening instruments and diagnostic criteria are geared towards younger people.5 The ageing of populations worldwide means that the absolute number of elderly people with alcohol use disorders is on the increase,6 and a real danger exists that a “silent epidemic” may be evolving. We searched PubMed for research papers and review articles in the area of alcohol use disorders in elderly people. The prevalence of alcohol use disorders in elderly people is generally accepted to be lower than in younger people, but rates may be underestimated because of underdetection and misdiagnosis, the reasons for which are many and varied.7 The cross sectional nature of prevalence studies also means that a cohort effect cannot be ruled out. For example, the drinking habits of Americans from the 1920s may differ substantially from those from the era after the second world war because of the effects of prohibition.8 Most prevalence studies have been carried out in North America, and results may not be generalisable to other cultures.7 Rates of alcohol use disorders also vary depending on the restrictiveness of diagnostic criteria used, with higher rates for “excessive alcohol consumption” and “alcohol abuse” than “alcohol dependence syndrome.” For …

Vascular biomarkers of cognitive performance in a community-based elderly population: the Dublin Healthy Ageing study

BACKGROUND population studies suggest that cardiovascular risk factors may be associated with cognitive impairment. Epidemiological studies evaluating individual markers of vascular disease as risk factors for cognitive dysfunction have yielded inconsistent results. Homocysteine has emerged as a marker consistently associated with poorer outcomes. Existing studies have largely examined individual vascular risks in isolation and have tended to ignore patient psychological status. OBJECTIVE to investigate the association between markers of vascular disease and cognition in a community-dwelling non-demented elderly population while adjusting for vascular and non-vascular confounds. DESIGN cross-sectional community based assessment. PARTICIPANTS 466 subjects with mean age 75.45 (s.d., 6.06) years. 208 (44.6%) were male. RESULTS higher levels of homocysteine were consistently associated with poorer performance in tests assessing visual memory and verbal recall. No other vascular biomarker was found to be associated with cognitive performance. Factors such as alcohol use, tea intake, life satisfaction, hypertension and smoking were positively correlated with global cognitive performance. Negative correlations existed between cognitive performance and depression, past history of stroke, intake of fruit and use of psychotropic medication. CONCLUSIONS homocysteine was the only vascular biomarker associated with poorer function in a number of domains on neuropsychological testing, independent of vascular and non-vascular confounds. Other psychosocial factors may need to be taken into account as potential confounds in future studies investigating cognition.

Loneliness and vascular biomarkers: the Dublin Healthy Ageing Study

Loneliness has been associated with poor physical health and a link has been suggested between the presence of loneliness, cardiovascular health and inflammatory markers.

Recent alcohol intake and suicidality — a neuropsychological perspective

BackgroundAlcohol use disorders and suicidal behaviours are among the most prevalent and damaging of all psychiatric phenomena in Ireland and worldwide. Furthermore, alcohol use both chronic and acute has long been identified as a potent risk factor for suicidal behaviour.AimsIn this paper, the authors review the observational and experimental evidence for the acute neuropsychological effects of alcohol intake on suicidal ideation and behaviour.MethodsA selective review of the literature was conducted, using the PubMed database. Search terms employed included ‘alcohol’, ‘suicide’, ‘binge’ and ‘acute alcohol intake’.ResultsCognitive mechanisms implicated include alcohol-induced deficits in attention-allocation, prospective cognition, autobiographical memory and disinhibition. Emotional mechanisms include alcohol-induced dysphoria, depression and aggression.ConclusionsThis paper serves to highlight the importance of identifying and tackling acute alcohol intake and binge drinking as a risk factor for suicidal behaviour.

Alcohol use in Ireland - can we hold our drink?

Alcohol use and related harm is now a major public health problem in Ireland. The statistics do not make for pleasant reading. Annual per capita consumption increased by 41% between 1989 and 1999 to 11 litres of pure alcohol per head of population, the second highest level in Europe, and 1.9 litres higher than the EU average. A more telling statistic, estimated alcohol consumption per adult (defined as 15 years and over), was 15.2 litres in the year 2000, the third highest level in the EU and the 12th highest in the world. The dramatic rate of increase in alcohol consumption in Ireland over the past decade, in a time when the vast majority of EU countries have seen a reduction in levels of alcohol consumption, means that Ireland is soon likely to top the EU drinking table.

Psychiatric consultation to elderly medical inpatients in a general hospital

OBJECTIVES To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time. METHOD One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously. RESULTS In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms. CONCLUSIONS Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.

Documentation of alcohol, cigarette and cannabis use by psychiatric and general practice trainees.

Alcohol misuse and the consumption of cigarettes and cannabis are associated with well-established impairments in physical and psychological health. Excessive consumption of these substances in Ireland now poses a major public health problem. Per capita consumption of alcohol in Ireland increased by 41% between 1989 and 1999, the highest such increase among EU countries, leaving Ireland with the second highest alcohol consumption levels of all EU countries. Tobacco smoke remains the leading preventable cause of death and disability in Ireland. While statistics on cannabis use are less clear, a recent UN study found Ireland to have the highest levels of cannabis use in the 23 countries of Western Europe.