Addressing High Elder Suicide Rates: A Call to Action

Addressing High Elder Suicide Rates: A Call to Action
Hayley Kytta, PharmD, Allina Health

Background: Suicide is a serious public health issue that has increased in prevalence throughout the last decade. There have been many initiatives focused on reducing the suicide rate among teens and young adults. However, suicidal ideation among the elderly is often overlooked, as highlighted in a recent article from the Senior Care Pharmacist. points out.Suicide rates are particularly high among older men. According to the National Institute of Health, men 65 years of age and older had a suicide rate higher than any age group in 2017 (31/100,000 persons), which is significantly higher than the overall national rate (22.4/100,000 persons) and much higher than the rate for older women (5/100,000 persons). The suicide rate for men increases with age and is highest for men 85 years of age and older (39.2/100,000 persons). The COVID-19 pandemic has exacerbated known risk factors for suicidal ideation, including isolation, and it is expected to worsen this already alarming problem. With effective training, pharmacists can play an active role in identifying suicidal ideation among older adults. However, suicide prevention training varies widely among pharmacy professionals.

Evidence and Discussion: Pharmacists are well-positioned to be gatekeepers for suicide prevention. This is especially true for individuals that work in senior care or community pharmacies. A study of 680,000 Medicare beneficiaries by Berenbrok et. al found that beneficiaries visited community pharmacies approximately twice as frequently as they visited primary care offices. Studies have also shown that pharmacy personnel frequently interact with patients who display warning signs of suicidal ideation. A study of over 500 community pharmacy staff in North Carolina by Carpenter et. al found that 21.6% had been asked about lethal medication doses by patients or encountered patients requesting a lethal dose of medication. Additionally, the authors noted that one out of three student pharmacists report that they have experienced concerning statements related to suicide while at work. Due to these concerns, more suicide prevention (SP) training programs for pharmacy employees have been developed. A scoping review by [authors] of SP training programs for pharmacists and student pharmacists published online in the American Journal of Pharmaceutical Education (AJPE) found evidence of growing interest in SP training in the pharmacy profession. A previous review in 2018 identified 16 training programs, four of which targeted student pharmacists. Between January 2018 and December 2020, seven additional programs were identified; five of which were geared towards student pharmacists. The authors of the review recommend that SP training for pharmacy professionals address the following areas: 1) identify warning signs for suicide; 2) communicate with individuals to assess risk of suicide; 3) refer patients to appropriate resources; and 4) counsel about which medications may increase the risk of suicidal ideation.

Clinical Impact: High rates of suicidal ideation, particularly among older adults, is an alarming public health trend. Due to the accessibility of and knowledge regarding the role of medication in causing and managing suicidal ideation, pharmacists are uniquely positioned to help address this crisis. Pharmacy educators and employers should implement SP training experiences that are specific to the profession and address all four recommended competencies as supported by [authors] in APJE. This training will help empower more pharmacy personnel to intervene when concerns for suicidal ideation arise.

References

  1. National Institute of Mental Health. Suicide Statistics. NCHS Data Brief No. 362. https://www.nimh.nih.gov/health/statistics/ suicide.shtml#part_154969. Published April 2020. Accessed February 2, 2021. 
  2. Burechson K, Salvatore T. Elder Suicide: What senior care pharmacists need to know. Sr Care Pharm. 2021;36(11):568-572. doi:10.4140/TCP.n.2021.568
  3. Stover AN, Lavigne JE, Carpenter DM. A scoping review of suicide prevention training programs for pharmacists and student pharmacists [published online Jan 10, 2022]. Am J Pharm Educ. doi:10.5688/ajpe8917
  4. Berenbrok LA, Gabriel N, Coley KC, Hernandez I. Evaluation of frequency of encounters with primary care physicians vs visits to community pharmacies among medicare beneficiaries. JAMA Netw Open. 2020;3(7):e209132. doi:10.1001/jamanetworkopen.2020.9132
  5. Carpenter DM, Lavigne JE, Colmenares EW, Falbo K, & Mosley SL. Community pharmacy staff interactions with patients who have risk factors or warning signs of suicide. Res Soc Adm Pharm. 2020;16(3):349-359.