Efficacy of Periosteal Stimulation for Chronic Pain Associated With Advanced Knee Osteoarthritis: A Randomized,Controlled Clinical Trial

Background

Because of morbidity associated with painful knee osteoarthritis (OA) and commonly prescribed analgesics, patients often pursue complementary and alternative modalities (eg, acupuncture). Clinical trials have demonstrated modest therapeutic efficacy of traditional Chinese acupuncture for knee OA pain, and patients with advanced disease have largely been excluded. We have previously demonstrated preliminary short-term tolerability and efficacy of periosteal stimulation therapy (PST) (ie, electrical stimulation of the periosteum facilitated by acupuncture needles) for older adults with advanced knee OA.

Objective

This study evaluated the sustained efficacy of PST and boosters for treating chronic pain with advanced knee OA.

Methods

One hundred ninety participants age >50 years with Kellgren-Lawrence grade 3 or 4 knee OA and chronic pain were randomized to (1) PST (once a week for 10 weeks) followed by PST boosters for 6 months (once every 2 weeks 2 times, then once a month), (2) control PST (ie, periosteal needles and brief electrical stimulation of control points) once a week for 10 weeks, or (3) PST for 10 weeks followed by control PST boosters for 6 months. Change in the Western Ontario and McMaster Universities Osteoarthritis Index pain score immediately after the 10-week intervention and at 6-month follow-up (9 months after baseline) was the primary outcome. OMERACT-OARSI (Outcome Measures in Rheumatology Clinical Trials–Osteoarthritis Research Society International) criteria also were evaluated. Secondary measures of outcome included (1) physical performance (Short Physical Performance Battery, gait speed, Timed Up and Go, and timed stair climb); (2) psychological factors (depressive symptoms measured with the Center for Epidemiologic Studies–Depression scale, coping measured with the catastrophizing subscale of the Coping Strategies Questionnaire, and self-efficacy measured with the Arthritis Self-Efficacy Scale); (3) health-related quality of life measured with the Medical Outcomes Study 36-Item Short-Form Health Survey; (4) rescue pain medication use tracked with diaries; and (5) health care utilization and interim physical activity were monitored via monthly telephone calls.

Results

After adjustment for pain at baseline, the PST and control booster did not differ from controls at 10 weeks (difference, 1.3; 95% CI, −0.10 to 2.8; P = 0.0683) or 9 months (difference, 1.1; 95% CI, −0.32 to 2.6; P = 0.13). The PST and PST booster group had similar improvement compared with controls at 10 weeks (baseline adjusted difference, 1.1; 95% CI, −0.34 to 2.5; P = 0.1369) but significantly more improvement at 9 months (baseline adjusted difference, 1.5; 95% CI, 0.069 to 3.0; P = 0.0401). Baseline depressive symptoms, low self-efficacy, higher difficulty performing daily activities, and greater knee stiffness predicted a lower likelihood of response.

Conclusion

PST plus PST boosters in patients age >50 with advanced knee OA were well-tolerated and modestly reduced pain. ClinicalTrials.gov identifier: NCT00865046.     

Moving to Maintain Function in Knee Osteoarthritis: Evidence From the Osteoarthritis Initiative

Dunlop DD, Semanik P, Song J, Sharma L, Nevitt M, Mysiw J, Chang RW, for the Osteoarthritis Initiative Investigators. Moving to maintain function in knee osteoarthritis: evidence from the Osteoarthritis Initiative.

Objectives

To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA).

Design

Prospective cohort study of knee OA development and progression with 1-year follow-up.

Setting

Community.

Participants

Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45-79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up.

Interventions

Not applicable.

Main Outcome Measure

A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile.

Results

Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes.

Conclusions

These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.     

Effect of Comorbid Knee and Hip Osteoarthritis on Longitudinal Clinical and Health Care Use Outcomes in Older Adults With New Visits for Back Pain

Objective

To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use.

Decrease of Muscle Strength Is Associated With Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results From the Cohort Hip and Cohort Knee Study

Objective

To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity.

Design

A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders.

Setting

A rehabilitation and rheumatology center.

Participants

Subjects (N=146) with early symptomatic knee OA from the CHECK study.

Interventions

Not applicable.

Main Outcome Measures

Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test.

Results

A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=−1.12, B=−5.83, and B=−1.25, respectively). Proprioception and laxity did not moderate this association.

Conclusions

In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations.     

Hospitalizations of Older Patients with Human Immunodeficiency Virus in the United States

Background

Older adults represent a growing percentage of the United States (US) population living with human immunodeficiency virus (HIV). The Emergency Department plays an integral role in the identification and initial evaluation and treatment of patients with HIV.

Objective

We sought to estimate the number of hospitalizations of older adults (age ≥ 50 years) with HIV in the United States from 2000 to 2006 and compare features of this population to younger adults with HIV. Clinical and demographic characteristics of the younger cohort (19–49 years) and two older cohorts (ages 50–64 and ≥65 years) were examined and compared.

Methods

Data from the Nationwide Inpatient Sample was used to compare the three groups of HIV-positive patients. Comparisons between the most common discharge diagnoses and primary procedures were also made.

Results

Older adults with HIV constitute almost one quarter of the hospitalizations of adults with HIV. Older adults with HIV were more likely to be male, have a significantly higher average hospital charge, and have a longer length of stay than younger adults with HIV. Pneumonia and fluid and electrolyte disorders were common diagnoses among all three age cohorts.

Conclusions

Older HIV patients were more likely to die during hospitalization compared with younger adults with HIV and older adults without HIV. Admissions for older HIV patients almost doubled during the study period and future studies should examine whether this is due to aging of the current HIV population or new infections.     

Comparison of Mirror,Raw Video,and Real-Time Visual Biofeedback for Training Toe-Out Gait in Individuals With Knee Osteoarthritis

Objective

To compare performance error and perceived difficulty during toe-out gait modification in people with knee osteoarthritis (OA) across 3 different types of visual feedback: mirror, raw video, and real-time biofeedback of toe-out angle.

Design

Repeated-measures, within-subject trial.

Setting

University motion analysis laboratory.

Participants

Individuals with knee OA (N=20; 11 women; mean age, 65.4±9.8y) participated in this study. Seven participants had mild knee OA, 9 had moderate knee OA, and 4 had severe knee OA.

Interventions

Participants were trained to walk on a treadmill while matching a target indicating a 10° increase in stance phase toe-out compared with toe-out angle measured during self-selected walking. The target was provided visually via the 3 types of feedback listed above and were presented in a random order.

Main Outcome Measures

Kinematic data were collected and used to calculate the difference between the target angle and the actual performed angle for each condition (toe-out performance error). Difficulty was assessed using a numerical rating scale (0–10) provided verbally by participants.

Results

Toe-out performance error was significantly less when using the real-time biofeedback method than when using the other 2 methods (P=.025; mean difference vs mirror=2.05°; mean difference vs raw video=1.51°). Perceived difficulty was not statistically different between the groups (P=.51).

Conclusions

Although statistically significant, the 2° difference in toe-out gait performance error may not necessitate the large economic and personnel costs of real-time biofeedback as a means to modify movement in clinical or research settings.     

Kinematics and muscle activity of the head,lumbar and knee joints during 180° turning and sitting down task in older adults

Background

The “180° turning and sitting down task” is a very conscious movement that requires focusing on turning at the exact moment, and very few studies address on this topic in older adults. The purpose of the study was to compare kinematics and electromyography of the head, lumbar and knee joints during 180°turning in older and young adults.

Methods

Twenty older adults and 20 younger adults were assessed. A 16-channel telemetry electromyography system with electrogoniometers and an inclinometer were used to record the head, lumbar and knee joint kinematic and electromyography data during the 180° turning. This movement had been further divided into 4 phases (braking, mid-stance, swing, and terminal loading) for analysis.

Findings

There were significant differences in the joint displacement and muscular activity among the different phases. Comparison between groups showed that the older adults group had less lateral lumbar flexion, less knee flexion and lower velocity of the head and knee flexion compared to young adults during turning. The electromyography data of the left biceps femoris, left gastrocnemius and left erector spinae muscles in the older adults group showed significantly higher levels than in the young adults.

Interpretation

Older adults need to adjust velocities of moving joints and increase the extensor synergy muscles of the back and the stance leg to provide posture stability. Kinematics and neuromuscular modulations of the head, lumbar and knee are required according to the various phases of the turn movements and change with aging.     

Lower limb muscle moments and power during recovery from forward loss of balance in male and female single and multiple steppers

Background

Studying recovery responses to loss of balance may help to explain why older adults are susceptible to falls. The purpose of the present study was to assess whether male and female older adults, that use a single or multiple step recovery strategy, differ in the proportion of lower limb strength used and power produced during the stepping phase of balance recovery.

Methods

Eighty-four community-dwelling older adults (47 men, 37 women) participated in the study. Isometric strength of the ankle, knee and hip joint flexors and extensors was assessed using a dynamometer. Loss of balance was induced by releasing participants from a static forward lean (4 trials at each of 3 forward lean angles). Participants were instructed to recover with a single step and were subsequently classified as using a single or multiple step recovery strategy for each trial.

Findings

(1) Females were weaker than males and the proportion of females that were able to recover with a single step were lower than for males at each lean magnitude. (2) Multiple compared to single steppers used a significantly higher proportion of their hip extension strength and produced less knee and ankle joint peak power during stepping, at the intermediate lean angle.

Interpretation

Strength deficits in female compared to male participants may explain why a lower proportion of female participants were able to recover with a single step. The inability to generate sufficient power in the stepping limb appears to be a limiting factor in single step recovery from forward loss of balance.     

Young and older adults use different strategies to perform a standing turning task

Background

Falls are the leading cause of death in adults over 65 years of age. Falls during turning are likely to result in costly and debilitating hip fractures. Two-thirds of adults who fracture a hip will never regain their previous level of independence. The purpose of this study, therefore, was to examine performance of turning in place in young and older adults.

Methods

Ten young (mean age = 25 years) and 10 community-dwelling older adults (mean age = 75 years) performed a standing turning task under two conditions: feet constrained and feet unconstrained. Dependent measures were rotational range of motion of the head-on-trunk, trunk-on-pelvis, pelvis and feet; trunk flexion/extension and knee flexion; and center of pressure range and center of mass range in both the anterior–posterior and medial–lateral directions.

Findings

In both conditions, older adults used less head-on-trunk but more trunk-on-pelvis rotation than the young adults. In the constrained condition, older adults also used more trunk extension and knee flexion than the young adults. In the unconstrained condition, more of the older adults moved their feet (60% vs. 30% of young adults). These differences in segmental motion resulted in greater center of mass movement for the older adults in the constrained but not the unconstrained foot condition.

Interpretations

Older adults show changes in segmental spinal range of motion associated with postural instability while turning in place. Foot movements play an essential role in compensating for these changes and maintaining postural stability.     

Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Background

Compared to matched controls, knee osteoarthritis patients walk with altered, kinematics, kinetics and muscle activity. Studies of osteoarthritis patient gait have focused on individual measures, and findings from these studies differ due to differences in patient levels of disability and age. Therefore, aims of this study were to examine kinematic, kinetic and muscle co-contraction gait variables within a single osteoarthritis patient group, and to determine if alterations in these variables are related to pain, symptom and function measures.

Methods

Thirty asymptomatic controls and 54 patients with radiographic evidence of knee osteoarthritis participated. Self-perceived measures of pain and symptoms, and gait (knee joint angles, moments and muscle co-contraction) were analysed and compared.

Findings

Osteoarthritis patients had greater self-perceived pain and symptoms on the questionnaires. Gait differences in the knee osteoarthritis patients were greater knee flexion at heel strike and during early stance along with reductions in the peak external knee extension moment in late stance. Co-contraction ratios highlighted greater lateral muscle activation in osteoarthritis patients, which were correlated with the magnitude of their adduction moments. Larger adduction moments were related to lower self-perceived pain and symptoms.

Interpretation

Osteoarthritis patients use predominantly lateral muscle activation during stance which may aid in stabilising the external knee adduction moment. Kinematic alterations in knee osteoarthritis patient gait occur without alterations in knee joint moments. Our results also suggest that adduction moments are lowered to reduce the patients’ pain and symptoms.     

Randomized Controlled Trial of the Effectiveness of Continuous Passive Motion After Total Knee Replacement

Objective

To determine the effects of using a continuous passive motion (CPM) device for individuals with poor range of motion (ROM) after a total knee replacement (TKR) admitted for postacute rehabilitation.

Design

Randomized controlled trial.

Setting

Inpatient rehabilitation facility (IRF).

Participants

Adults (N=141) after TKR with initial active knee flexion <75° on admission to the IRF.

Intervention

Two randomized groups: group 1 (n=71) received the conventional 3 hours of therapy per day, and group 2 (n=70) received the addition of daily CPM use for 2 hours throughout their length of stay.

Main Outcome Measures

The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores.

Results

All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group.

Conclusions

CPM does not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.     

Pain Management in Older Adults

Background

Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults.

Objective

To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment.

Methods

We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain.

Results

Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods.

Conclusion

An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults.     

Demographics,bystander CPR,and AED use in out-of-hospital pediatric arrests

Background

In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations.

Methods

We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were older than 1 year of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009 from an arrest presumed to be cardiac in nature. Hierarchical multivariable logistic regression analysis was used to estimate the associations between age, demographic factors, and AED use.

Results

129 patients were 1–8 years of age (younger children), 88 patients were 9–17 years of age (older children), and 19,338 patients were ≥18 years of age (adults). When compared to adults, younger children were less likely to be found in a shockable rhythm (young children 11.6%, adults 23.7%) and were less likely to have an AED used (young children 16.3%, adults 28.3%). Older children had a similar prevalence of shockable rhythms as adults (31.8%) and AED use (20.5%). A multivariable analysis demonstrated that, when compared to adults, younger children had decreased odds of having an AED used (OR 0.42, 95% CI 0.26–0.69), but there was no difference in AED use among older children and adults.

Conclusions

Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.     

Randomized Trial Investigating the Efficacy of Manual Lymphatic Drainage to Improve Early Outcome After Total Knee Arthroplasty

Objective

To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion.

Design

Prospective randomized controlled trial.

Setting

Private hospital and functional rehabilitation clinic.

Participants

Consecutive sample of patients (N=43; 53 knees) scheduled for TKA.

Intervention

MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy.

Main Outcome Measures

Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score.

Results

A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes.

Conclusions

MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.     

Depression Treatment Preferences After Acute Traumatic Spinal Cord Injury

Objective

To examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with spinal cord injury (SCI).

Design

Cross-sectional surveys.

Setting

Rehabilitation inpatient services.

Participants

Persons with traumatic SCI (N=183) undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Patient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey.

Results

Among inpatients with SCI (28% had Patient Health Questionnaire-9 score ≥10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try) followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%). All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling than nondepressed individuals. Subjects preferred treatment in a medical/rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and a history of antidepressant use were significantly more willing to take an antidepressant. Age ≥40 years was a significant predictor of willingness to receive individual counseling.

Conclusions

Treatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling, and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.     

A biomechanical analysis of trunk and pelvis motion during gait in subjects with knee osteoarthritis compared to control subjects

Background

Trunk lean over the stance limb during gait has been linked to a reduction in the knee adduction moment, which is associated with joint loading. We examined differences in knee adduction moments and frontal plane trunk lean during gait between subjects with knee osteoarthritis and a control group of healthy adults.

Methods

Gait analysis was performed on 80 subjects (40 osteoarthritis). To define lateral trunk lean two definitions were used. The line connecting the midpoint between two reference points on the pelvis and the midpoint between the acromion processes was projected onto the lab frontal plane and the pelvis frontal plane. Pelvic tilt was also measured in the frontal plane as the angle between the pelvic and lab coordinate systems. Angles were calculated across the stance phase of gait. We analyzed the data, (i) by extracting discrete parameters (mean and peak) waveform values, and (ii) using principal component analysis to extract shape and magnitude differences between the waveforms.

Findings

Osteoarthritis subjects had a higher knee adduction moment than the control group (α = 0.05). Although the discrete parameters for trunk lean did not show differences between groups, principal component analysis did detect characteristic waveform differences between the control and osteoarthritis groups.

Interpretation

A thorough biomechanical analysis revealed small differences in the pattern of motion of the pelvis and the trunk between subjects with knee osteoarthritis and control subjects; however these differences were only detectable using principal component analysis.     

Using Timed Up and Go and Usual Gait Speed to Predict Incident Disability in Daily Activities Among Community-Dwelling Adults Aged 65 and Older

Objectives

To compare the ability of Timed Up and Go (TUG) and usual gait speed (UGS) to predict incident disability completing basic activities of daily living (ADL) and instrumental ADL (IADL) in older adults free of disability at baseline, and to provide estimates for the probability of incident disability at different levels of baseline mobility performance.

Design

Data from the first 2 waves of The Irish Longitudinal Study on Ageing, a study assessing health, economic, and social aspects of ageing in adults aged ≥50 years.

Setting

A nationally representative, population-based sample of community-dwelling adults.

Participants

Participants aged ≥65 years who completed mobility tests during a health assessment, had no reported difficulty in ADL/IADL, and had a Mini-Mental State Examination score ≥24 were re-interviewed after 2 years (n=1664).

Interventions

Not applicable.

Main Outcome Measures

Participants completed the TUG and UGS at baseline and indicated difficulty in a number of basic ADL and IADL at follow-up.

Results

Receiver operating characteristic analysis indicated that TUG and UGS are acceptable tools to predict disability in ADL and IADL (area under the curve [AUC]=.65–.75) with no significant difference between them (P>.05). Both were excellent predictors of difficulty in higher-level functioning tasks such as preparing hot meals, taking medications, and managing money (AUC>.80). Predictive probabilities were obtained across a range of performance levels.

Conclusions

TUG and UGS have similar predictive ability in relation to incident disability in basic ADL and IADL. Predictive probabilities can be used to identify those most at risk and in need of particular services. Since improving physical function can prevent or delay dependence in ADL/IADL, TUG and UGS can also provide performance goals and feedback during exercise interventions.     

ED use by older adults attempting suicide

Objective

The objective of this study was to describe patterns of older adult patient visits to emergency departments (EDs) for self-harm and suicide-related injuries.

Methods

A retrospective, secondary data analysis of the Nationwide Emergency Department Sample was conducted. Nationally representative estimates of patient visits by older adults attempting suicide were calculated using available sampling weights. Population estimates were calculated using estimates from the US Census Bureau.

Results

Findings suggest that 22 444 ED patient visits were made by adults aged 65 years and older for suicide-related injuries, representing an estimated population rate of 63 ED patient visits per 100 000 adults aged 65 years and older, with nearly half of all visits involving substance use. Total ED and hospital charges exceeded $353.9 million.

Conclusions

Effort is needed to better integrate and deliver suicide screening and support services in the ED, while also connecting at-risk older adults with mental health services before and after the ED encounter.