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Key Points
Risk of suicide was increased in older adults who were using prescribed sleep medications. |
Concomitant use of anxiolytics and antidepressants was associated with heightened risk of suicide in older adults. |
There is a need of careful monitoring of older adults prescribed psychoactive medication to reduce risk of suicide. |
Introduction
Suicide rates are the highest in the oldest population [1]. Older adults who die by suicide are often depressed, or have other psychiatric morbidities [2, 3]. Therefore, treatment of depression and other psychiatric conditions is a major suicide prevention strategy in this age group.
Psychoactive medications are widely prescribed to older adults to treat behavioural and psychological symptoms associated with increased risk of suicidal behaviour [4, 5–6]. Among older adults aged 75+ in Sweden, about four out of ten are prescribed psycholeptic medications (antipsychotics, hypnotics or anxiolytics) and about one-fifth are on antidepressants [7]. Psychoactive medications are commonly used for suicide [8, 9]. Further, emergency department visits for self-harm involving prescribed medications are significantly more common in older adults [10]. Yet, some research has shown that antidepressants and lithium, may be protective of suicidal behaviour [11, 12]. Taken together, psychoactive medications play an important role for the mental health and risk of suicidal behaviour among older people.
Surprisingly, only a few pharmacoepidemiological studies have investigated how the use of psychoactive medications may impact the risk of suicide in older adults [11, 13, 14, 15–16]. None of these were conducted in the 75+ segment of the general population. Findings from research that includes “younger old” adults are not appropriate to extrapolate to the “older old” adult population (75+) as use patterns, treatment response and side effects of psychoactive medications differ with age due to higher levels of comorbidities and age-related physiological changes [17].
A better understanding of psychoactive medication use is advocated to prevent late-life suicide. Such knowledge will help to inform healthcare practitioners for a better monitoring of their older patients at risk and to contribute to improvement of the quality and safety of prescribing for a particularly sensitive and vulnerable age group with high consumption of psychoactive medications.
The availability of high-quality national registers in Sweden with full population coverage offers unique opportunities to examine with real-world big data how the use of...