Differences in suicide between the old and the oldest old

OBJECTIVES: The purpose of our study is to examine suicide trends among the old (65-79 years) and oldest old (80+ years). METHODS: All persons aged 50 or older who committed suicide in Denmark during 1972-1998 are included in the analysis. Suicide trends are analyzed by sex, age, civil status, and methods. Age, period, and cohort effects are examined graphically. RESULTS: In all, 17,729 persons (10,479 men and 7,250 women) committed suicide. During the study period, the suicide trends among the middle-aged and the old adults decreased. The trend among the oldest old, by contrast, remained stable. Marriage ceases to have a preventive effect among the oldest old. The oldest old tend to use more determined suicide methods. DISCUSSION: Distinct differences in suicide mortality between the old and the oldest old were found. The suicide trend of the oldest old does not reflect the recent improvements found in their overall mortality. Interestingly, it seems that the preventive effect of marriage seems to be ceasing with increasing age.     

Predictors of mortality for the oldest old. A 4-year follow-up of community-based elderly in Sweden

The aim of this study is to investigate predictors for mortality in two age groups, 75-84 years old and 85 years and older. Interviews were carried out on 161 community-based persons aged 75-84 and 260 persons aged 85 and over. Predictors for mortality 4 years later were analyzed using logistic regression. Different models to predict mortality were found for the two age groups. Gender and IADL (Instrumental Activities of Daily Living) were found to be significant for the older group while ADL (Primary Activities of Daily Living), mobility and life satisfaction were significant for the younger group. Eliminating variables based on the nurse's evaluations did not change the model for the 85+ age group; in the 75-84 age group the nurse's assessment of ADL was replaced by a self-reported IADL index. Results confirm the heterogeneity of the elderly population and the importance of ADL and subjective measures for predicting mortality.     

Depression and suicide in the elderly]

The suicidal behavior in 155 patients older than 60 years is analyzed. Patients were treated for endogenous, neurotic, or reactive depression. Differences between diagnostic categories and sex are discussed in detail. Motivation and recent causes of suicidal behavior are analyzed. Psychopathological symptoms correlating with suicidal behavior in endogenous depression in the elderly are depicted. The social environment of and the therapeutic approach to suicidal elderly patients are discussed. The problem of rational suicide and the demand for voluntary death are mentioned.     

老年人的抑郁症及自杀的防治

老年期抑郁症是指首次发病于老年期,以持久的抑郁心境为主要表现,情绪低落、焦虑、迟滞及诸多躯体不适主诉为主。这些精神障碍不能归因于躯体疾病或脑器质性病变,且具有缓解和复发倾向,部分患者预后不良。抑郁症是老年期最常见的功能性精神障碍之一。65岁以上发生抑郁症者,据国外统计占总人口的7％～10％,老年人患有躯体疾病时,     

Predictors of falling in elderly hospital patients

A prospective study was conducted to determine whether a brief clinical assessment conducted soon after admission can accurately identify older people who fall while staying in an acute hospital. Eighty-eight non-bedfast patients aged 80-99 years took part in the study. Within 3 days of admission, these patients were assessed for the following measures: impaired orientation on the MMSE, psychoactive medication use, evidence of stroke, and impaired ability on the Get-Up-and-Go-test. The major presenting condition for each patient was also recorded. Patients were then followed up to determine whether they fell while in hospital. Impaired orientation on the MMSE, evidence of previous cerebrovascular accident, and major presenting conditions of falls and confusion were significantly associated with falls while in hospital. There was also a trend indicating that psychoactive medication use was elevated in the fallers. In contrast, there was no difference in the proportion of fallers and non-fallers who had impaired ability in the Get-Up-and-Go-test. Of the 15 patients who fell, 13 had two or more risk factors, and after controlling for possible confounding factors of age, sex and length of stay, the presence of two-plus risk factors remained strongly and significantly associated with falls (adjusted OR = 13.43; 95% CI = 1.91 - 94.40). The findings indicate that a simple screening protocol can accurately identify patients at risk of falling while in hospital.     

Predictors of prose recall in adulthood and old age

One group of young adults and three groups of older adults (young-old, old, old-old) were examined in immediate recall of random and organizable words, and immediate and delayed recall of prose passages. Results showed that all groups of older adults recalled less from the prose passages and the word recall tasks than the younger adults, although there were no performance differences among the three older samples. As well, all age groups showed a similar increase in recall of organizable words compared with random words, and all age groups showed parallel forgetting curves in prose recall. These results suggest that all age groups utilized the organizational support to the same extent, and that forgetting rate was not influenced by age. Regression analyses showed that recall of random and organizable words, education, vocabulary and age all contributed to prose recall performance. Most important, the importance of markers of strategy use (word recall tasks) for prose recall decreased from early to late adulthood, whereas the importance of a semantic memory marker (vocabulary) showed the opposite pattern.     

Predictors of morale among Korean immigrant elderly in the USA

This study assesses the morale and its salient predictors among Korean immigrant elderly living alone or with a spouse only. Face-to-face interviews with 131 Korean immigrant elderly reveal relatively low morale, as measured by the modified Philadelphia Geriatric Center Morale Scale. Correlation analysis of morale with 14 independent variables shows that education, health, number of companions, number of confidants, intimacy with children, independent living skills, and preference between Korea and the USA as a place to live are significant zero-order correlates of morale. Multiple regression analysis of the 14 variables identifies 4 as significant predictors of morale: health, intimacy with children, education, and preference between Korea and the USA as a place to live.     

Historical aspects of suicide in the old age (author's transl)]

Beginning with a very different attitude of the antiquity taken up to suicide, which was normally not regarded as a self-murdering but as a voluntary departing this life and as such as a philosophically based act of liberty especially by members of the stoic system who not seldom commited suicide themselves, another estimation is discussed which was exercised by the Pythagoreans and the members of the Aristotele's doctrine. They rejected suicide as immoral. The suicide in the old age was regarded under the different aspects of old age and his positive and negative evaluation. As predecessor of the absolute refusal of suicide in the Christian era can be mentioned Cicero, who had regarded suicide in a special paper on the old age as the desertion without order of the commander-in-chief. However with the renaissance this attitude against the suicide changed and now the first time in the Christian era the possibility was discussed that very dangerously ill patients could end their pains by suicide. In the time of enlightenment more and more people thought, that very much cases of suicide were committed in severe illness. Especially suicide in the old age was regarded more and more as a psychiatric problem. There were new aspects contributed by medical statistics which could shown clearly the increase of tendency to suicide in the higher age of men. Today the question is vividly discussed if suicide in the old age is more the result of special environmental factors in the sense of isolation or economic instability or is produced by pathological processes in the brain such as cerebral sclerosis.     

Prophylaxis of suicide in old age (author's transl)

The author reports on sociopsychiatric care of old alone living peoples during Christmas-time and the end of year. This help of living was given under the primary aspects of suicide prevention. Nevertheless the conception of the arrangement is important for geropsychiatric prevention at all. The author gives informations about effects of this type of care. After the two weeks living in the hospital and getting special care the most of the old people looks from an active point of view to their biological and social conditions of aging, and better than before they can manage their life.     

Predictors of mortality in the prospective Dubbo study of Australian elderly

Background: A prospective study in non-institutionalised Australian elderly 60 years and over commenced in Dubbo, NSW in 1988. Aim: To examine clinical and socio-demographic predictors of all-causes mortality Methods: The data were derived from a community-based sample comprising 1236 men and 1569 women followed for a median period of 62 months. Results: Two hundred and thirty five men (19%) and 184 women (12%) died, 46% of male and 53% of female deaths respectively related to cardiovascular disease. In a proportional hazards model, the significant predictors of mortality were: older age, being married (relative risk [RR]=0.71 for men, 0.74 for women), current smoking for men (RR=3.11), taking more than three alcoholic drinks per day for men (RR=0.37), prior coronary heart disease for men (RR=1.36), severe hypertension for women (RR=1.99), use of anti-hypertensive medication for men (RR=1.74), diabetes for men (RR=1.62), poor-fair self-rated health for women (RR=1.74) and physical disability for men (RR=1.72). Serum cholesterol was associated with mortality in a ‘J-shaped’ relationship in men and in a reciprocal relationship in women. Blood pressure predicted mortality in an incremental fashion below 75 years, but in older subjects lower pressure was associated with excess mortality. Conclusion: Some predictors of mortality in the well elderly have been identified and a more extended period of follow-up will possibly resolve contradictory findings in some areas.     

Predictors of mammography use in the past year among elderly women

Thirty-two personal characteristics were examined as potential predictors of mammography use in the past year in a geriatric clinic. Interviews assessed demographic, health status, health service utilization, health belief, and psychological and social variables (n = 242, mean age = 76 years). Four variables were independently associated with mammography use in logistic regression analysis: age, historical mammography use, perceived severity, and perceived barriers. The inverse relationship between age and mammography use in the past year was not modified by health status, functional status, and the other independently predictive variables. The authors conclude that geriatrics specialty care does not eliminate the age-associated decline in mammography use that has been previously described. The factors associated with mammography use in this sample were similar to those that have been described in younger populations of women. Variables examined because of specific gerontologic considerations were not independently associated with mammography use in the past year.     

Social psychological aspects of suicide in the old age (author's transl)]

Referring to Emile Durkheim's classical appraoch the normative aspects of suicide are emphasized, regarding suicidal behavior not as a purely individual phenomenon but as always co-determined by the normative expectations of a person's social environment. Starting from the dramatic increase of suicide rates with age combined with a marked decrease in non-letal suicide attempts it is argued that normally suicide-inhibiting social norms become less effective as a person appraoches old age, thus weakening the appellative motivation components of suicidal behavior and strengthening evasive strivings. Results of 2 representative studies are reported which tend to support these as well as a number of more specific hypotheses. Moreover, some aspects in the attitude to younger persons to suicidal acts of old people seem even compatible with the assumption of latent suicide-facilitating expectations.     

Predictors of physical activity in community-dwelling elderly white women

OBJECTIVE: To describe patterns of physical activity and to determine factors associated with engaging in regular exercise, especially walking, in elderly white women. DESIGN: Cross-sectional study of 9,442 independently living elderly white women aged 65 years and over participating in the Study of Osteoporotic Fractures. MEASUREMENTS AND MAIN RESULTS: We studied the association between lifestyle habits, social factors, health status and self-reported physical activity (assessed by modified Paffenbarger scale) during the past twelve months. Walking was the most common form of exercise: 4,837 (51%) women reported doing so a mean of 12 (SD = 10) blocks per day, 3.9 (SD = 2.9) times per week. Other common activities were gardening (35%), swimming (16%), and bicycling (13%). Less than a third of women reported engaging in medium- or high-intensity exercise in the past year. In a multivariate age-adjusted analysis, factors independently (P < .01) associated with walking for exercise included greater than high school education (52% vs 48%), history of physical activity for exercise at ages 30 years (51% vs 46%) and 50 years (51% vs 45%), and stronger social network (51% vs 47%). Women who were current smokers, obese, or depressed were less likely to take walks for exercise. Marital status, self-reported arthritis, current estrogen use, and a history of falls in the past year were not independently associated with taking walks for exercise. CONCLUSIONS: In this healthy cohort, walking for exercise is associated with other positive health behaviors. Given the mounting evidence about the health benefits of walking, and since many of these community dwelling women can and do walk for exercise, but rarely engage in other common prescribed physical activities, clinicians might best focus their efforts on encouraging walking.     

老年非瓣膜性心房颤动住院患者缺血性脑卒中的预测因素

目的探讨老年非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)住院患者缺血性脑卒中(ischemic stroke,IS)的预测因素。方法选择2013年1月～2017年6月福建医科大学附属协和医院住院的老年NVAF患者314例,根据是否合并IS分为NVAF组239例,NVAF+IS组75例。多因素logistic回归分析老年NVAF住院患者发生IS的影响因素,ROC曲线下面积(AUC)探讨各影响因素的预测价值。结果 NVAF+IS组年龄、收缩压、高血压、外周血管疾病、CHADS_2、CHA_2DS_2-VASc、左心房内径、左心房内径指数、左心室质量和左心室质量指数明显高于NVAF组,估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)明显低于NVAF组,差异有统计学意义(P0.05,P0.01)。多因素logistic回归分析显示,eGFR、左心房内径、左心房内径指数、左心室质量、左心室质量指数是老年NVAF住院患者发生IS的独立危险因素(P 0.05,P 0.01)。CHADS_2、CHA_2DS_2-VASc、左心房内径指数及eGFR预测老年NVAF住院患者发生IS的AUC分别为0.541、0.525、0.577、0.577,CHADS_2+左心房内径指数+eGFR的AUC分别高于CHADS_2、CHADS_2+左心房内径指数、CHADS_2+eGFR的AUC(0.621 vs 0.541、0.585、0.588,P0.05);CHA_2DS_2-VASc+左心房内径指数+eGFR的AUC分别高于CHA_2DS_2-VASc、CHA_2DS_2-VASc+左心房内径指数、CHA_2DS_2-VASc+eGFR的AUC(0.626 vs0.525、0.586、0.591,P0.05)。结论 CHADS_2、CHA_2DS_2-VASc分别联合eGFR和左心房内径指数对老年NVAF住院患者发生IS的预测能力分别高于CHADS_2、CHA_2DS_2-VASc。     

Predictors of perioperative mortality after coronary artery bypass grafting in the elderly

BACKGROUND: Coronary artery bypass grafting (CABG) is associated with higher operative risk in the elderly compared to younger patients. The aim of this study was to evaluate risk factors for perioperative mortality after CABG in the elderly. METHODS: We investigated 325 consecutive patients aged 75 or over undergoing isolated CABG at our institution. We analyzed the patients' characteristics and perioperative outcome. Patients were divided into survivors and non-survivors; risk factors and complications were compared. Based on this, we performed a multivariate logistic regression analysis to determine independent risk factors for perioperative mortality. RESULTS: Non-survivors of CABG more often suffered from concomitant extracardiac atherosclerosis (non-survivors, 62.2 %; survivors, 40.6 %; p = 0.013) as well as from renal insufficiency preoperatively (non-survivors, 35.1 %; survivors 8.0 %; p < 0.0001). A trend towards higher incidences of impaired left ventricular function (non-survivors, 37.8 %; survivors, 29.9 %; p = 0.105) and a history of recent myocardial infarction (non-survivors, 29.7 %; survivors, 17.0 %; p = 0.061) were found in non-survivors compared to survivors. Furthermore, non-survivors more often underwent CABG with cardiopulmonary bypass (CPB non-survivors, 96.1 %; survivors 70.6 %; p = 0.0005). Multivariate logistic regression analysis revealed that preoperatively impaired renal function (OR: 2.857, p < 0.0001), use of CPB (OR: 5.952, p = 0.0175), extracardiac atherosclerosis (OR: 1.581, p = 0.0228), and recent myocardial infarction (OR: 1.574, p = 0.0405) were independent risk factors for perioperative mortality. Comparison of patients undergoing CABG with or without CPB reveals that patients operated without CPB had a higher preoperative risk than patients undergoing CABG with CPB. CONCLUSION: These results show that besides impaired renal function, extracardiac atherosclerosis, and history of recent myocardial infarction, the use of CPB is a major risk factor for CABG in the elderly. Perioperative mortality and morbidity can be significantly reduced if CPB is avoided.     

长沙市农村社区老年人群自杀率的流行病学调查

目的　掌握农村社区老年人群自杀率的第一手资料 ,为预防农村老年人自杀提供依据。　方法　采取分层整群抽样方法 ,以长沙近郊浏阳市和望城县的 8个乡 (镇 )的全部 14 5个行政村1996～ 2 0 0 0年自杀死亡的老年人为调查对象 ,调查农村老年人自杀率 ,对自杀者的性别、年龄、地区等差异运用 χ2 检验和 (或 )u检验方法进行统计学推断。　结果　 (1) 5年平均标化自杀率 10 3 18/10万 ,男性 116 38/ 10万、女性 90 73/ 10万 ,性别差异无显著性 (P >0 0 5 ) ;(2 )自杀死亡占农村老年人群意外死亡的 6 7 6 8% ,为意外死亡的第一位死因 ;(3)望城县历年的老年人群自杀率呈直线上升趋势 (P <0 0 0 5 )。　结论　农村老年人群是自杀的高危人群之一 ,自杀为其意外死亡的首位死因