Suicide risk warning for older patients

A Queensland coroner warns doctors to look for signs of suicide risk among seriously ill older patients

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A coroner has called for GPs to be alert to signs of suicide risk among seriously ill elderly patients after a 75-year-old man set fire to himself at a nursing home.

The patient died in hospital after suffering burns to 65% of his body in the smoking room of a care facility in January 2014. He had been found alight soon after returning from radiotherapy and chemotherapy treatment.

The death was originally thought to have been an accident, but after hearing expert evidence Queensland Deputy Coroner John Lock recorded a finding of suicide.

He recommended the state’s health department, “in partnership with the aged care sector and the general practitioner sector”, carry out routine screening and assessment of elderly persons diagnosed with, and being treated for, significant physical conditions.

The coroner found the patient “took his own life when he set his clothing alight in such a manner to ensure a rapid spread of fire across his clothing”.

“This was probably in the context of a deterioration in his physical wellbeing due to treatment for bladder cancer,” he said.

Mr Lock said the case pointed to a need for GPs and specialist-care providers to be educated regarding suicide risk in such patients, and for more resources to address it.

“Whilst suicide rates are disproportionally high in the elderly … they are correspondingly less likely to be recognised, or effectively treated, in those elderly persons who come into contact with services,” Mr Lock said.

He noted research indicating physical diseases were predictors of suicide in older adults, as well as the view of the patient’s oncologist, Dr Keiron Bigby, that it was “a real psychosocial issue”.

Dr Bigby told an inquest into the death that he had had concerns about the patient’s ability to tolerate his cancer treatment, but he believed the combination of radiotherapy and chemotherapy would add some benefit and there was some potential of a cure.

He said depression and anxiety would not be unusual in patients undergoing such treatment, but his oncology department had no welfare worker, one overworked social worker and a shared psychologist.

“In my own experience it is of real concern there appears to be increasing numbers of elderly people who are taking their own lives in the context of deteriorating physical conditions, almost always on their own, without warning and often violently,” Mr Lock said.

“Not all are suffering from clinical depression, or if they are, this is undiagnosed.

“Notably suicidal behaviour amongst older persons is often undertaken with greater intent, and greater lethality than amongst younger cohorts,” he said.

“Elderly persons are less likely to discuss their plans prior to the death and are more likely to choose more lethal methods, which means they are less likely to survive a suicide attempt.”