PracticeUpdate Conference Series European Congress of Psychiatry 2019

it. Ideators were more likely to be male, to require carer support and to have substance-related disorders. Attempters were often widowed, had trauma- and stressor-related disorders, suffered from diseases of the eye and lacked social connectedness; in addition, attempters were more likely to be female and to be without carer support. The researchers stated in their abstract that these results support “risk profiles that can be utilized in inpatient settings to identify older adults at risk of suicide ide- ation and attempts.” They comment that “post-discharge programs can focus on a variety of risk factors, such as depression, substance abuse, trauma-related disor- ders, factors associated with decline in vision and psychosocial problems.” They also emphasized that social connected- ness and carer support are particularly important psychosocial factors. In a comment on the study for Elsevier’s PracticeUpdate , Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, explained that the findings are primarily relevant to psychiatrists, as primary care physicians should not be the first line of care among older adults with psychiatric conditions requiring residen- tial placement. In their poster, the investigators con- cluded that, “elderly patients treated for mood disorders were at a fairly high risk of mortality over a 3-year follow-up period. While comorbid mental and phys- ical illnesses generally contributed to an elevated risk, diagnoses of hypertension and hyperlipidemia were shown to be negatively associated with the mortality risk. Early detection, better control, and risk prevention for physical and mental illnesses are important to improve prog- nosis of mood disorder in elderly patients.” Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, commented on the study for Elsevier’s PraticeUpdate . He pointed out that, “what’s especially con- cerning about the findings of this survival analysis is that the study group of elderly patients with mood disorders were being Interestingly, having a diagnosis of hyper- tension or hyperlipidemia was associated with a lower risk of mortality.

“As noted by the authors, rates of suicide among older adults are among the high- est of any group in Australia, a pattern which is also occurring in the United States” he continued. “One finding that should serve to affect who primary care physicians screen for suicidality was that that the males in this study were more likely to report suicidal ideation and women were more likely to attempt sui- cide. This is opposite of the patterns for all other age groups.”

Nevertheless, he noted, “there are val- uable findings that can contribute to the care of the older adult in the primary care settings. Inadequate caregiver support and lack of social interaction contribute to isolation, despair and hopelessness in this population. The findings regarding the negative impact of declining vision are also noteworthy. For many elderly patients, physiological aging is not grace- ful but is marked by numerous functional losses. Decline or loss of vision after a lifetime of sight is both a functional and symbolic loss.

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" It could be very valuable to follow this study with a multivariate analysis of which factors other than comorbid physical conditions were predictive of increased mortality risk. "

symptoms. And the severe complications which can accompany these conditions can deflect attention away from consist- ent management of mood disorders in the elderly (and others). “It could be very valuable to follow this study with a multivariate analysis of which factors other than comorbid physical conditions were predictive of increased mortality risk,” he suggested. “The pres- ence of a solid social support system, provision of an established routine, and creating a living environment low in emo- tional upheaval are all associated with improved quality of life among elderly with psychiatric disorders.”

treated and still had an elevated mortality risk. Epidemiologic research has consist- ently established that the presence of a major psychiatric disorder is predictive of not only poorer quality of life but a signifi- cantly shortened lifespan. “The dynamics of having a psychiatric disorder and life-challenging comorbid condition in late life can get quite compli- cated quickly,” he explained. “First, mood disorders are characterized by symptoms that can interfere with adherence and cooperation with medical care, including indecisiveness, anhedonia, pessimism, etc. In contrast, worsening of medical conditions such as dementia, diabetes and renal disease exacerbate psychiatric

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EPA 2019 • PRACTICEUPDATE CONFERENCE SERIES 13