Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-07T14:49:49.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicidal behavior and assisted suicide in dementia

Published online by Cambridge University Press:  16 April 2015

Brian M. Draper
Brian M. Draper*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
*
Correspondence should be addressed to: Brian M. Draper, Director, Academic Department for Old Age Psychiatry, Euroa Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia. Phone: 61-2-9382 3753; Fax 61-2-9382 3762. Email: b.draper@unsw.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Concerns about suicide risk in people with dementia have been increasing in recent years along with a discourse about rational suicide and assisted suicide.

Methods:

A systematic narrative literature review of suicidal behavior and assisted suicide in persons with dementia.

Results:

Most studies that have examined the spectrum of suicidal ideation, attempted suicide and suicide in dementia have methodological limitations but the overall suicide risk does not appear to be increased. When suicidal behavior does occur, common themes include the presence of psychiatric comorbidity, mainly depression; occurrence early in the dementia course with preserved insight and capacity; and an increased risk in younger people. The emerging discourse on rational and assisted suicide has been spurred by early and pre-symptomatic diagnosis and poses a number of ethical challenges for clinicians including the role of proxy decision-makers.

Conclusions:

Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.

Keywords

suicidedementiaeuthanasia
Type
Review Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 10: Psychosocial and Ethical Aspects of Dementia , October 2015 , pp. 1601 - 1611
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alfonso, C. A. and Cohen, M. A. (1994). HIV-dementia and suicide. General Hospital Psychiatry, 16, 45–46.CrossRefGoogle ScholarPubMed
Almqvist, E. W., Bloch, M., Brinkman, R., Craufurd, D. and Hayden, M. R. (1999). A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalisation after predictive testing for Huntington's disease. American Journal of Human Genetics, 64, 1293–1304.CrossRefGoogle ScholarPubMed
Ayalon, L., Mackin, S., Arean, P. A., Chen, H. and Herr, E. C. M. (2007). The role of cognitive functioning and distress in suicidal ideation in older adults. Journal of the American Geriatrics Society, 55, 1090–1094.CrossRefGoogle ScholarPubMed
Baliko, L., Csala, B. and Czopf, J. (2004). Suicide in Hungarian Huntington's disease patients. Neuroepidemiology, 23, 258–260.CrossRefGoogle ScholarPubMed
Ballard, C., Bannister, C., Solis, M., Oyebode, F. and Wilcock, G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135–144.CrossRefGoogle ScholarPubMed
Barak, Y. and Aizenberg, D. (2002). Suicide amongst Alzheimer's disease patients: a 10-year survey. Dementia and Geriatric Cognitive Disorders, 14, 101–103.CrossRefGoogle Scholar
Batchelor, I. R. C. and Napier, M. B. (1953). Attempted suicide in old age. British Medical Journal, 2, 1186–1190.CrossRefGoogle ScholarPubMed
Battin, M. P. (1984). The concept of rational suicide. In Shneidman, E. S. (ed.), Death: Current Perspectives. Palo Alto, CA: Mayfield Publishing.Google Scholar
Booij, S. J., Engberts, D. P., Tibbens, A. A. D. and Roos, R. A. (2013). Euthanasia and physician-assisted suicide in Huntington's disease in The Netherlands. International Psychogeriatrics, 25, 339–340.CrossRefGoogle ScholarPubMed
Brodaty, H.et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.CrossRefGoogle ScholarPubMed
Carney, S. S., Rich, C. L., Burke, P. A. and Fowler, R. C. (1994). Suicide over 60: the San Diego study. Journal of the American Geriatrics Society, 42, 174–180.CrossRefGoogle ScholarPubMed
Carpenter, B. and Dave, J. (2004). Disclosing a dementia diagnosis; a review of opinion and practice. Gerontologist, 44, 149–158.CrossRefGoogle ScholarPubMed
Chan, J., Draper, B. and Banerjee, S. (2007). Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. International Journal of Geriatric Psychiatry, 22, 720–732.CrossRefGoogle ScholarPubMed
Conwell, Y., Duberstein, P. R. and Caine, E. D. (2002). Risk factors for suicide in later life. Biological Psychiatry, 52, 193–204.CrossRefGoogle ScholarPubMed
Conwell, Y., Pearson, J. and DeRenzo, E. G. (1996). Indirect self-destructive behaviour among elderly patients in nursing homes. A research agenda. American Journal of Geriatric Psychiatry, 4, 152–163.CrossRefGoogle ScholarPubMed
Cooley, D. R. (2007). A Kantian moral duty for the soon-to-be-demented to commit suicide. American Journal of Bioethics, 7, 37–44.CrossRefGoogle ScholarPubMed
Davis, D. S. (2013). Alzheimer disease and pre-emptive suicide. Journal of Medical Ethics, http://dx.doi.org/10.1136/medethics-2012-101022CrossRefGoogle Scholar
Degrazia, D. (1999). Advance directives, dementia, and the “someone else problem”. Bioethics, 13, 373–375.CrossRefGoogle ScholarPubMed
de Boer, M. E., Droes, R. M., Jonker, C., Eefsting, J. A. and Hertogh, C. M. P. M. (2010). Advance directives for euthanasia in dementia: do law-based opportunities lead to more euthanasia? Health Policy, 98, 256–262.CrossRefGoogle ScholarPubMed
de Jonghe-Rouleau, A. P., Pot, A. M. and de Jonghe, J. F. M. (2005). Self-injurious behavior in nursing home residents with dementia. International Journal of Geriatric Psychiatry, 20, 651–657.CrossRefGoogle ScholarPubMed
De Leo, D. (1996). Dementia, insight, and suicidal behavior. Crisis, 17, 147–148.CrossRefGoogle ScholarPubMed
De Leo, D.et al. (2002). Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. Journal of Affective Disorders, 72, 291–295.CrossRefGoogle ScholarPubMed
Dening, K. H., Jones, L. and Sampson, E. L. (2013). Preferences for end-of-life care: a nominal group study of people with dementia and their family carers. Palliative Medicine, 27, 409–417.CrossRefGoogle Scholar
Di Maio, L., Squitieri, F., Napolitano, G., Campanella, G., Trofatter, J. A. and Conneally, P. M. (1993). Suicide risk in Huntington's disease. Journal of Medical Genetics, 30, 293–295.CrossRefGoogle ScholarPubMed
Draper, B. (1994). Suicidal behaviour in the elderly International Journal of Geriatric Psychiatry, 9, 655–661.CrossRefGoogle Scholar
Draper, B. (1996). Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577–587.3.0.CO;2-V>CrossRefGoogle Scholar
Draper, B. (2010). Suicidal behaviour. In (Abou-Saleh, M., Katona, C. and Kumar, A. (eds.), Principles and Practice of Geriatric Psychiatry, 3rdedn. (pp. 559–564). Chichester, UK: Wiley-Blackwell.CrossRefGoogle Scholar
Draper, B. (2014). Rational suicide and dementia. Journal of the Royal College of Physicians of Edinburgh, 44, 130–131.CrossRefGoogle ScholarPubMed
Draper, B., Brodaty, H. and Low, L.-F. (2003a). Self-destructive behaviour in dementia. In (Vellas, B., Fitten, L. J. and Winblad, B. et al. (eds.), Research and Practice in Alzheimer's Disease, vol 8, Severe Dementia, (pp.94–99). Paris: Serdi Publisher.Google Scholar
Draper, B., Brodaty, H., Low, L.-F. and Richards, V. (2003b). Prediction of mortality in nursing home residents: impact of self-destructive behaviours International Psychogeriatrics, 15, 187–196.CrossRefGoogle Scholar
Draper, B., Brodaty, H., Low, L.-F., Richards, V., Paton, H. and Lie, D. (2002). Self destructive behaviours in nursing home residents. Journal of the American Geriatrics Society, 50, 354–358.CrossRefGoogle ScholarPubMed
Draper, B., Kõlves, K., De Leo, D. and Snowdon, J. (2014). The impact of patient suicide and sudden death on health care professionals. General Hospital Psychiatry, 36, 721–725.CrossRefGoogle ScholarPubMed
Draper, B., Maccuspie-Moore, C. and Brodaty, H. (1998). Suicidal ideation and the “wish to die” in dementia patients: the role of depression. Age and Ageing, 27, 503–507.CrossRefGoogle Scholar
Draper, B., Peisah, C., Snowdon, J. and Brodaty, H. (2010). Early dementia diagnosis and the risk of suicide and euthanasia. Alzheimers & Dementia, 6, 75–82.CrossRefGoogle ScholarPubMed
Erlangsen, A., Zarit, S. H. and Conwell, Y. (2008). Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. American Journal of Geriatric Psychiatry, 16, 220–228.CrossRefGoogle ScholarPubMed
Farrer, L. A. (1986). Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. American Journal of Medical Genetics, 24, 305–311.CrossRefGoogle ScholarPubMed
Forsell, Y., Jorm, A. F. and Winblad, B. (1997). Suicidal thoughts and associated factors in an elderly population. Acta Psychiatrica Scandinavica, 95, 108–111.CrossRefGoogle Scholar
Foy, R.et al. (2007). The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia. BMC Health Services Research, 19, 207.CrossRefGoogle Scholar
Harris, E. C. and Barraclough, B. (1997). Suicide as an outcome for mental disorders. British Journal of Psychiatry, 170, 205–228.CrossRefGoogle ScholarPubMed
Harwood, D. G. and Sultzer, D. L. (2002). “Life is not worth living”: hopelessness in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 15, 38–43.CrossRefGoogle ScholarPubMed
Haw, C., Harwood, D. and Hawton, K. (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21, 440–453.CrossRefGoogle ScholarPubMed
Hayden, M. R. (2003). Predictive testing for Huntington's disease: a universal model? Lancet Neurology, 2, 141–142.CrossRefGoogle ScholarPubMed
Hertogh, C. M. P. M. (2005). End-of-life care and medical decision making in patients with dementia. In Burns, A. (ed.), Standards in Dementia Care – European Dementia Consensus Network (EDCON). (pp. 339–354). London/New York: Taylor & Francis.CrossRefGoogle Scholar
Hertogh, C. M. P. M. (2009). The role of advance euthanasia directives as an aid to communication and shared decision-making in dementia. Journal of Medical Ethics, 35, 100–103.CrossRefGoogle ScholarPubMed
Hsiao, J. J., Kaiser, N., Fong, S. S. and Mendez, M. F. (2013). Suicidal behavior and loss of future self in semantic dementia. Cognitive & Behavioral Neurology, 26, 85–92.CrossRefGoogle ScholarPubMed
Hubers, A. A., Reedeker, N., Giltay, E. J., Roos, R. A. C., van Duijn, E. and van der Mast, R. C. (2012). Suicidality in Huntington's disease. Journal of Affective Disorders, 136, 550–557.CrossRefGoogle ScholarPubMed
Ito, T.et al. (2002). A study of suicidal cases of vascular dementia. Seishin Igaku, 44, 1295–1303.Google Scholar
Jorm, A. F., Henderson, A. S., Scott, R., Korten, A. E., Christensen, H. and Mackinnon, A. J. (1995). Factors associated with the wish to die in elderly people. Age and Ageing, 24, 389–392.CrossRefGoogle ScholarPubMed
Komiti, A.et al. (2001). Suicidal behaviour in people with HIV/AIDS – a review. Australian and New Zealand Journal of Psychiatry, 35, 747–757.CrossRefGoogle ScholarPubMed
Lebret, S., Perret-Vaille, E., Mulliez, A., Gerbaud, L. and Jalenques, I. (2006). Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 1052–1059.CrossRefGoogle ScholarPubMed
Lim, W. S., Rubin, E. H., Coats, M. and Morris, J. C. (2005). Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Disease and Associated Disorders, 19, 214–219.CrossRefGoogle ScholarPubMed
Low, L.-F., Draper, B. and Brodaty, H. (2004). The relationship between self-destructive behaviour and nursing home environment. Aging and Mental Health, 8, 29–33.CrossRefGoogle ScholarPubMed
Margo, G. M. and Finkel, J. A. (1990). Early dementia as a risk factor for suicide. Hospital and Community Psychiatry, 41, 676–678.Google ScholarPubMed
Nelson, F. L. and Farberow, N. L. (1982). The development of an indirect self-destructive behavior scale for use with chronically ill medical patients. International Journal of Social Psychiatry, 28, 5–13.CrossRefGoogle ScholarPubMed
O’Neal, P., Robins, E. and Schmidt, E. H. (1956). A psychiatric study of attempted suicide in persons over sixty years of age. AMA Archives of Neurology and Psychiatry, 75, 275–284.CrossRefGoogle ScholarPubMed
Osvath, P., Kovacs, A., Voros, V. and Fekete, S. (2005). Risk factors of attempted suicide in the elderly: the role of cognitive impairment. A case-control study of old psychiatric in-patients. International Journal of Psychiatry in Clinical Practice, 9, 221–225.CrossRefGoogle Scholar
Paulsen, J. S., Hoth, K. F., Nehl, C. and Stierman, L. (2005). Critical periods of suicide risk in Huntington's disease. American Journal of Psychiatry, 162, 725–731.CrossRefGoogle ScholarPubMed
Peisah, C., Snowdon, J., Gorrie, C., Kril, J. and Rodriguez, M. (2007). Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide. Journal of Affective Disorders, 99, 127–132.CrossRefGoogle ScholarPubMed
Pierce, D. (1987). Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 2, 105–110.CrossRefGoogle Scholar
Pierce, D. W. (1996). Repeated deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 11, 983–986.3.0.CO;2-C>CrossRefGoogle Scholar
Post, S. G. (1997). Physician-assisted suicide in Alzheimer's disease. Journal of the American Geriatrics Society, 45, 647–651.CrossRefGoogle ScholarPubMed
Prado, C. G. (1998). The Last Choice: Preemptive Suicide in Advanced Age. Greenwich, CT: Greenwood.Google Scholar
Prado-Jean, A.et al. (2010). Specific psychological and behavioral symptoms of depression in patients with dementia. International Journal of Geriatric Psychiatry, 25, 1065–1072.CrossRefGoogle ScholarPubMed
Pratchett, T. (2010). My case for a euthanasia tribunal. The Guardian. Available at: http://www.guardian.co.uk/society/2010/feb/02/terry-pratchett-assisted-suicide-tribunal; accessed 24 December 2012.Google Scholar
Purandare, N., Oude Voshaar, R. C., Rodway, C., Bickley, H., Burns, A. and Kapur, N. (2009). Suicide in dementia: 9-year national clinical survey in England and Wales. British Journal of Psychiatry, 194, 175–180.CrossRefGoogle ScholarPubMed
Rabins, P. V. (2007). Can suicide be a rational and ethical act in persons with early or pre-dementia. American Journal of Bioethics, 7, 47–49.CrossRefGoogle ScholarPubMed
Rao, R., Dening, T., Brayne, C. and Huppert, F. A. (1997). Suicidal thinking in community residents over eighty. International Journal of Geriatric Psychiatry, 12, 337–343.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Raue, P. J., Meyers, B. S., Rowe, J. L., Heo, M. and Bruce, M. L. (2007). Suicidal ideation among elderly homecare patients. International Journal of Geriatric Psychiatry, 22, 32–37.CrossRefGoogle ScholarPubMed
Rosenberg, P. and Rosse, R. (2003). Impulsive suicide attempts by a patient with alcoholic dementia. Psychosomatics, 44, 415.CrossRefGoogle ScholarPubMed
Rubin, E. H. and Kinscherf, D. A. (1989). Psychopathology of very mild dementia of the Alzheimer type. American Journal of Psychiatry, 146, 1017–1021.Google ScholarPubMed
Rubio, A., Vestner, A. L., Stewart, J. M., Forbes, N. T., Conwell, Y. and Cox, C. (2001). Suicide and Alzheimer's pathology in the elderly: a case-control study. Biological Psychiatry, 49, 137–145.CrossRefGoogle ScholarPubMed
Rurup, M. L., Pasman, H. R. and Onwuteaka-Philipsen, B. D. (2010). [Advance euthanasia directives in dementia rarely carried out. Qualitative study in physicians and patients]. [Dutch] Nederlands Tijdschrift voor Geneeskunde, 154, A1273.Google ScholarPubMed
Sabodash, V., Mendez, M. F., Fong, S. and Hsiao, J. J. (2013). Suicidal behaviour in dementia: a special risk in semantic dementia. American Journal of Alzheimer's Disease & Other Dementias, 28, 592–599.CrossRefGoogle ScholarPubMed
Schmid, H., Manjee, K. and Shah, T. (1994). On the distinction of suicide ideation versus attempt in elderly psychiatric inpatients. The Gerontologist, 34, 332–339.CrossRefGoogle ScholarPubMed
Sendbuehler, J. M. and Goldstein, S. (1977). Attempted suicide among the aged. Journal of the American Geriatrics Society, 25, 245–248.CrossRefGoogle ScholarPubMed
Seyfried, L. S., Kalesa, H. C., Ignacioa, R. V., Conwell, Y. and Valenstein, M. (2011). Predictors of suicide in patients with dementia. Alzheimer's & Dementia, 7, 567–573.CrossRefGoogle ScholarPubMed
Sharp, R. (2012). The dangers of euthanasia and dementia: how Kantian thinking might be used to support non-voluntary euthanasia in cases of extreme dementia. Bioethics, 26, 231–235.CrossRefGoogle ScholarPubMed
Snowdon, J. and Baume, P. (2002). A study of suicides of older people in Sydney. International Journal of Geriatric Psychiatry, 17, 261–269.CrossRefGoogle ScholarPubMed
Stewart, C., Peisah, C. and Draper, B. (2011). A test of mental capacity to request assisted suicide. Journal of Medical Ethics, 37, 34–39.CrossRefGoogle ScholarPubMed
Sveen, C. A. and Walby, F. A. (2008). Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide and Life-Threatening Behavior, 38, 13–29.CrossRefGoogle ScholarPubMed
Tariot, P. N.et al. (1995). The behavior rating scale for dementia of the consortium to establish a registry for Alzheimer's disease. American Journal of Psychiatry, 152, 1349–1357.Google ScholarPubMed
Tsai, C.-F., Tsai, S.-J., Yang, C.-H. and Hwang, J.-P. (2007). Chinese demented inpatients admitted following a suicide attempt: a case series. International Journal of Geriatric Psychiatry, 22, 1106–1109.CrossRefGoogle ScholarPubMed
Wedderburn, S.et al. (2013). Predictive testing for Huntington disease and other neurodegenerative disorders. Internal Medicine Journal, 43, 1272–1279.CrossRefGoogle ScholarPubMed
Wetzel, H. H.et al. (2011). Suicidal ideation in Huntington disease: the role of comorbidity. Psychiatry Research, 188, 372–376.CrossRefGoogle ScholarPubMed
Williams, N., Dunford, C., Knowles, A. and Warner, J. (2007). Public attitudes to life-sustaining treatments and euthanasia in dementia. International Journal of Geriatric Psychiatry, 22, 1229–1234.CrossRefGoogle ScholarPubMed
Zuidema, S. U., Verhey, F. R., Derksen, E. and Koopmans, R. T. C. M. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar