Managing suicide risk in late life: access to firearms as a public health risk.

OBJECTIVE: The authors assessed the prevalence of gun availability for elderly patients to determine whether gun availability is related to the presence of suicidal or depressive symptoms. METHODS: This is a cross-sectional epidemiologic survey of firearm availability and safety practices. A random sample of older adults with a scheduled primary-care clinic appointment was selected and screened with the General Health Questionnaire and questions about suicidality and alcohol use. Participants were also asked about the availability of firearms in their home and about safe gun practices. RESULTS: Of 1,023 patients screened, 285 (27.9%) reported having some type of firearm in the home, and 202 (19.7%) reported having a handgun in the home. Patients with suicidal ideation or high levels of depression or psychological distress were not significantly more or less likely to have a gun in the home than those without these emotional stressors. The strongest predictors of firearm availability were being male and being married. CONCLUSIONS: These preliminary data suggest that a significant proportion of elderly people have firearms available to them in their homes. Those patients with emotional distress did not differ from those without distress with respect to having firearms available to them. These data strongly suggest the need for screening for firearm availability and education about the safe storage of firearms as a potential means of prevention of suicide among elderly patients suffering from emotional distress or suicidal ideation.     

Risk factors for suicide among older adults with cancer

Objective: To determine whether the increased risk of suicide for individuals with cancer may be explained by functional limitations, lack of social support, or other factors.Method: In this population-based case-control study, interviews of primary informants for suicides in the state of North Carolina were compared to interviews with participants in the Piedmont Health Study of the Elderly to estimate adjusted odds ratios for suicide and self-reported, physician diagnosed cancer, heart attack, stroke, and hip fracture.Results: Adjusting for all other factors, there was a statistically significant association of suicide and cancer (odds ratio [OR] 2.62, 95% confidence interval [CI] CI 1.84–3.73), but not heart attack, hip fracture, or stroke. The risk of suicide was also elevated for men vs. women (OR 17.15, CI 10.88–27.02), whites vs. blacks (OR 9.70, CI 6.07–15.50), and individuals with stressful life events (OR 2.75, CI 1.97–3.86) or limitations of instrumental (OR 2.93, CI 2.03–4.22) but not physical activities of daily living. Suicide cases were not more likely to be short of breath or poor sleep quality. Suicide was statistically significantly less likely for study participants who were married with spouse living vs. other (OR 0.61, CI 0.43–0.88) or who had one or more indicators of social support (OR 0.27, CI 0.19–0.39).Conclusion: After adjustment for other risk factors, suicide was strongly associated with cancer but not with other disabling, potentially fatal conditions.     

Alcohol effects on cognitive change in middle-aged and older adults

Objectives: This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups.

Methods: Data (1998–2005) from n?=?571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45–64, young-old: 65–75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities).

Results: Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status.

Discussion: In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.     

中老年人群肌肉减少症与抑郁症状的相关性研究

目的 探讨肌肉减少症与抑郁症状之间的关系。方法 收集 2011 年中国健康与养老追 踪调查（CHARLS）项目中 5 600 名中老年人（年龄≥ 45 岁）的一般资料、血清肌酐和胱抑素 C 比值（serum creatinine to cystatin C ratio,CCR）、相对肌力（RMS）、流行病学研究中心抑郁量表（CESD-10）评分。采用 多因素 Logistic 回归模型分析 CCR 和 RMS 与抑郁症状之间的关系,采用限制性立方样条分析中老年人 群肌肉减少症与抑郁症状的剂量 - 反应关系。结果 5 600 名中老年人的年龄（59.70±9.39）岁;男性占 48.6%（2 721/5 600）;抑郁症患者占 26.5%（1 484/5 600）。多因素 Logistic 回归分析结果显示,与 CCR 水平 最低组（Q1）相比,Q4 组患抑郁风险降低 39%（OR=0.61,95%CI=0.51～0.73）;RMS 水平最高组（T4）与水平 最低组（T1）相比,患抑郁症状风险降低 58%（OR=0.42,95%CI=0.35～0.51）。限制性立方样条函数分析 结果显示,CCR 水平和 RMS 水平和抑郁症状发生风险呈负相关。结论 中老年人群的肌肉水平会影响 抑郁症状,肌肉减少症和抑郁症患者的抑郁症状密切相关。     

Memory self-appraisal in middle-aged and older adults with the apolipoprotein E-4 allele.

OBJECTIVE: Because subjective memory complaints may indicate subtle functional brain abnormalities, the authors studied the influence of the major genetic risk for Alzheimer's disease, the apolipoprotein E-4 (APOE-4) allele, on self-reports of memory performance in middle-aged and older adults. METHOD: Subjective and objective assessments of memory performance were compared in relation to the presence or absence of the APOE-4 allele in 39 cognitively intact persons with mild memory complaints. RESULTS: Subjects with the APOE-4 allele had lower scores on objective verbal memory and on the subjective memory measure for retrospective functioning. Among the subjects in the age range where APOE-4 has its greatest influence on the risk of Alzheimer's disease (55-74 years), the APOE-4 group had lower scores on the subjective memory measure for frequency of forgetting. Moreover, the standardized difference in retrospective functioning scores between the two genetic risk groups increased when the mid-age-range group was examined rather than the whole study group. CONCLUSIONS: The APOE-4 allele is associated with increased subjective memory impairment in middle-aged and older adults. Longitudinal studies of age-related memory loss should include genetic risk and subjective memory measures as potential predictors of decline.     

Race and vascular depression risk in community-dwelling older adults.

OBJECTIVE: Authors examined racial differences in cerebrovascular risk factors (CVRFs) and overall depressive symptomatology. METHODS: The authors applied a correlational design using a depression inventory, the Center for Epidemiological Studies Depression scale (CES-D) and self-report CVRF data from black and white community-dwelling elderly subjects (N=362). RESULTS: Black subjects were more likely than whites to screen positive for depression, but there were no race differences in CVRFs. Across races, greater rates of CVRFs were associated with higher scores on the CES-D. CVRFs and lower education level were independent predictors of positive depression screening on the CES-D. CONCLUSIONS: CVRFs were associated with depression in black and white elderly subjects. Future research should examine race differences within vascular depression, utilizing broader measures of CVRFs.     

Associations between subclinical depressive symptoms and reduced brain volume in middle-aged to older adults

Objectives: The associations between subclinical depressive symptoms, as well specific symptom subscales, on brain structure in aging are not completely elucidated. This study investigated the extent to which depressive symptoms were related to brain volumes in fronto-limbic structures in a sample of middle-aged to older adults.

Method: Eighty participants underwent structural neuroimaging and completed the Beck Depression Inventory, 2nd Edition (BDI-II), which comprises separate affective, cognitive, and somatic subscales. Gray matter volumes were extracted from the caudal and rostral anterior cingulate, posterior cingulate, hippocampus, and amygdala. Hierarchical regression models examined the relationship between brain volumes and (i) total depressive symptoms and (ii) BDI-II subscales were conducted.

Results: After adjusting for total intracranial volume, race, and age, higher total depressive symptoms were associated with smaller hippocampal volume (p = 0.005). For the symptom subscales, after controlling for the abovementioned covariates and the influence of the other symptom subscales, more somatic symptoms were related to smaller posterior cingulate (p = 0.025) and hippocampal (p < 0.001) volumes. In contrast, the affective and cognitive subscales were not associated with brain volumes in any regions of interest.

Conclusion: Our data showed that greater symptomatology was associated with smaller volume in limbic brain regions. These findings provide evidence for preclinical biological markers of major depression and specifically advance knowledge of the relationship between subclinical depressive symptoms and brain volume. Importantly, we observed variations by specific depressive symptom subscales, suggesting a symptom-differential relationship between subclinical depression and brain volume alterations in middle-aged and older individuals.     

Assessment of physical activity in middle-aged and older adults with schizophrenia

BACKGROUND: Regular physical activity (PA) decreases morbidity in the general population; yet, information about the amount and effects of PA in persons with schizophrenia is scant. To develop interventions to increase PA and to assess its potential benefits in this group, accurate measurement of PA is needed. The purpose of this study was to characterize PA and determine the test-retest reliability and concurrent validity of the Yale Physical Activity Scale (YPAS), a self-report measure, in persons with schizophrenia. METHODS: PA was assessed with the YPAS, a scale of motivational readiness for PA, and accelerometry in middle-aged and older persons with a diagnosis of schizophrenia (n=54) and in a comparison group with no known psychiatric diagnosis (n=27). RESULTS: On the YPAS measures, persons with schizophrenia reported on average 11 h per week of PA, whereas the non-psychiatric comparison group reported about 32 h per week. Only about 30% of schizophrenia subjects were classified as being regularly active relative to 62% of the comparison group on PA motivational stages of readiness. On the accelerometry measures, the schizophrenia group had lower levels of light activity than the comparison group, but there were no differences in moderate and vigorous activity or sedentary behavior. Only in the comparison group were there significant associations between YPAS and accelerometer variables. Several YPAS scores demonstrated high test-retest reliability in both groups, and concurrent validity was supported between the YPAS and PA motivational stages of readiness. CONCLUSIONS: We found that the YPAS is a reliable measure of PA in schizophrenia for some indices. Although the YPAS demonstrated concurrent validity with other self-report measures, it did not demonstrate concurrent validity when compared to PA measured by accelerometry in persons with schizophrenia. Use of multiple measures, both subjective and objective, is recommended when assessing PA in schizophrenia.     

Cardiovascular risk factors and cognitive decline in middle-aged adults

OBJECTIVE: To perform serial neuropsychological assessments to detect vascular risk factors for cognitive decline in the Atherosclerosis Risk in Communities cohort, a large biracial, multisite, longitudinal investigation of initially middle-aged individuals. METHODS: The authors administered cognitive assessments to 10,963 individuals (8,729 white individuals and 2,234 black individuals) on two occasions separated by 6 years. Subjects ranged in age at the first assessment from 47 to 70 years. The cognitive assessments included the delayed word recall (DWR) test, a 10-word delayed free recall task in which the learning phase included sentence generation with the study words, the digit symbol subtest (DSS) of the Wechsler Adult Intelligence Scale-Revised and the first-letter word fluency (WF) test using letters F, A, and S. RESULTS: In multivariate analyses (controlling for demographic factors), the presence of diabetes at baseline was associated with greater decline in scores on both the DSS and WF (p < 0.05), and the presence of hypertension at baseline was associated with greater decline on the DSS alone (p < 0.05). The association of diabetes with cognitive decline persisted when analysis was restricted to the 47- to 57-year-old subgroup. Smoking status, carotid intima-media wall thickness, and hyperlipidemia at baseline were not associated with change in cognitive test scores. CONCLUSIONS: Hypertension and diabetes mellitus were positively associated with cognitive decline over 6 years in this late middle-aged population. Interventions aimed at hypertension or diabetes that begin before age 60 might lessen the burden of cognitive impairment in later life.     

The availability of firearms and the use of firearms for suicide: a study of 20 countries

The availability of firearms in a country was measured by noting the percentage of homicides committed using a firearm. This measure of gun availability was found to be positively associated with the suicide rate using firearms and negatively associated with the suicide rate using all other methods. The implications of these findings for suicide prevention are discussed.     

Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS

OBJECTIVE: This study examined the prevalence and characteristics of suicidal ideation among middle-aged and older persons who have HIV infection or AIDS. METHODS: A total of 113 subjects older than age 45 who had HIV-AIDS were recruited from AIDS service organizations in Milwaukee, Wisconsin, and New York City. Participants completed confidential questionnaires covering suicidal ideation, emotional distress, quality of life, coping, and social support. RESULTS: Twenty-seven percent of respondents reported having thought about taking their own life in the previous week. Those who had thought about suicide reported greater levels of emotional distress and poorer health-related quality of life than those who had not considered suicide. They were also significantly more likely to use escape and avoidance strategies for coping with HIV infection and less likely to use positive-reappraisal coping. Those who had thought about suicide also were more likely to have disclosed their HIV status to the people close to them, and yet they perceived receiving significantly less social support from friends and family. With the exceptions of physical functioning and coping strategies, differences between those who had contemplated suicide and those who had not remained unchanged after controlling for symptoms of depression. CONCLUSIONS: Persons who are in midlife and older and are living with HIV-AIDS experience significant emotional distress and thoughts of suicide, suggesting a need for targeted interventions to improve mental health and prevent suicide.     

Cross-ethnic evaluation of psychotic symptom content in hospitalized middle-aged and older adults

OBJECTIVE: The objective of this study was to examine ethnic differences in the content of delusions and hallucinations among a tri-ethnic sample of adult psychiatric inpatients older than 40 years who were hospitalized with an acute psychotic episode. METHODS: A chart review of inpatient episodes for 133 middle-aged and older adult patients (31 African Americans, 50 Latinos, and 52 Euro-Americans) with a mean age of 50 years was performed at an acute behavioral medicine unit at a university hospital. All patients were diagnosed with a severe psychotic disorder. The content and frequency of psychotic symptoms were systematically reviewed using a structured checklist and comparisons across ethnic groups were made using chi(2) statistics. RESULTS: Ethnic group differences were found in the contents and subtypes of delusions and hallucinations. Significant ethnic differences were found in symptom content, consistent with findings from studies on younger samples of inpatients. Euro-Americans were nearly twice as likely as Latinos to report delusions of grandiosity. African Americans were more likely than Latinos to report general paranoid delusions of persecution. Latinos reported more culturally influenced contents than the other groups. CONCLUSION: Raising provider awareness of ethnic variation in symptom expression is a key step in the process of developing effective treatments for ethnically diverse middle-aged and older patient populations.     

Social networks and alcohol use among older adults: a comparison with middle-aged adults

Objectives: This study compared the association between social networks and alcohol consumption among middle-aged (MA) and older adults (OA) to better understand the nature of the relationship between those two factors among OA and MA.

Method: We examined Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Current drinkers aged over 50 were subdivided into two age groups: MA (50–64, n = 5214) and OA (65 and older, n = 3070). Each age group was stratified into drinking levels (low-risk vs. at-risk) based on alcohol consumption. The size and diversity of social networks were measured. Logistic regression models were used to examine age differences in the association between the social networks (size and diversity) and the probability of at-risk drinking among two age groups.

Results: A significant association between the social networks diversity and lower odds of at-risk drinking was found among MA and OA. However, the relationship between the diversity of social networks and the likelihood of at-risk drinking was weaker for OA than for MA. The association between social networks size and at-risk drinking was not significant among MA and OA.

Conclusion: The current study suggests that the association between social networks diversity and alcohol use among OA differs from the association among MA, and few social networks were associated with alcohol use among OA. In the future, research should consider an in-depth exploration of the nature of social networks and alcohol consumption by using longitudinal designs and advanced methods of exploring drinking networks.     

Reasons for living,meaning in life,and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults

Objectives: To investigate the roles of reasons for living (RFL) and meaning in life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA).

Method: Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning).

Results: RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α = .94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning.

Conclusion: These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.     

Understanding suicide among older adults: a review of psychological and sociological theories of suicide

Objectives: Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions.

Method: In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults.

Results: Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults.

Conclusion: To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.