Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department

OBJECTIVES: To estimate the prevalence of self-harm, suicidal ideation (SI), and suicide attempts (SA) in older adults in the emergency department (ED), including differences according to age, sex, and race and ethnicity. DESIGN: Quasi-experimental, multiphase, eight-center study with prospective review of consecutive charts during enrollment shifts (November 2011-December 2014). SETTING: Eight EDs in seven states, all with protocols for nurses to screen every patient for suicide risk (universal screening). PARTICIPANTS: Adults (\u3e/=18 years) registered in the ED. MEASUREMENTS: Demographic characteristics; documented screening for self-harm, SI, or SA; and positive self-harm, SI, or SA in those with screening performed. RESULTS: Of 142,534 visits, 23.3% were of individuals aged 60 and older. Documented screening for self-harm, SI, or SA declined with age, from approximately 81% in younger age groups to a low of 68% in those aged 85 and older. The prevalence of positive screens for self-harm, SI, or SA also declined with age, with peaks in young and middle-age (9.0%) and reaching the lowest point after the age of 75 (1.2%). CONCLUSION: Documented screening for suicide risk declined with age in this large sample of individuals in the ED. Although the reason for this finding is unclear, at least part of the decline may be related to increasing rates of altered mentation or other individual-level barriers to screening in the older population. These findings support the need for more-detailed examination of the best methods for identifying-and treating-suicide risk in older adults