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Suicide and assisted dying in dementia: what we know and what we need to know. A narrative literature review

  • J. Diehl-Schmid (a1) (a2), R. Jox (a1) (a3) (a4), S. Gauthier (a1) (a5), S. Belleville (a1) (a6), E. Racine (a1) (a7), C. Schüle (a1) (a8), G. Turecki (a1) (a9) and S. Richard-Devantoy (a1) (a9) (a10)...
Abstract
ABSTRACT Background:

Evidence-based data on prevalence and risk factors of suicidal intentions and behavior in dementia are as scarce as the data on assisted dying. The present literature review aimed on summarizing the current knowledge and provides a critical discussion of the results.

Methods:

A systematic narrative literature review was performed using Medline, Cochrane Library, EMBASE, PSYNDEX, PSYCINFO, Sowiport, and Social Sciences Citation Index literature.

Results:

Dementia as a whole does not appear to be a risk factor for suicide completion. Nonetheless some subgroups of patients with dementia apparently have an increased risk for suicidal behavior, such as patients with psychiatric comorbidities (particularly depression) and of younger age. Furthermore, a recent diagnosis of dementia, semantic dementia, and previous suicide attempts most probably elevate the risk for suicidal intentions and behavior. The impact of other potential risk factors, such as patient's cognitive impairment profile, behavioral disturbances, social isolation, or a biomarker based presymptomatic diagnosis has not yet been investigated. Assisted dying in dementia is rare but numbers seem to increase in regions where it is legally permitted.

Conclusion:

Most studies that had investigated the prevalence and risk factors for suicide in dementia had significant methodological limitations. Large prospective studies need to be conducted in order to evaluate risk factors for suicide and assisted suicide in patients with dementia and persons with very early or presymptomatic diagnoses of dementia. In clinical practice, known risk factors for suicide should be assessed in a standardized way so that appropriate action can be taken when necessary.

Copyright
Corresponding author
Correspondence should be addressed to: Prof. Dr. Janine Diehl-Schmid, Department of Psychiatry, Technische Universität München, Ismaninger Str.22, 81675 München, Germany. Phone: +49-89-41406488; Fax: +49-89-41404923. Email: janine.diehl-schmid@tum.de.
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A. Alberici , E. Cottini , M. Cossedu , B. Borroni and A. Padovani (2012). Suicide risk in frontotemporal lobe degeneration: to be considered, to be prevented. Alzheimer Disease & Associated Disorders, 26, 194196.

C. Ballard , C. Bannister , M. Solis , F. Oyebode and G. Wilcock (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135144.

C. Bamford , S. Lamont , M. Eccles , L. Robinson , C. May and J. Bond (2004). Disclosing a diagnosis of dementia: a systematic review. International Journal of Geriatric Psychiatry, 19, 151169.

Y. Barak and D. Aizenberg (2002). Suicide amongst Alzheimer's disease patients: a 10-year survey. Dementia and Geriatric Cognitive Disorders, 14, 101103.

A. L. Beautrais (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 19.

M. Benatar et al. (2016). Presymptomatic ALS genetic counseling and testing: experience and recommendations. Neurology, 86, 22952302.

B. D. Carpenter et al. (2008). Reaction to a dementia diagnosis in individuals with Alzheimer's disease and mild cognitive impairment. Journal of the American Geriatrics Society, 56, 405412.

R.J. Caselli , E.A. Coon and L. Johansson (2015). Midlife personality and risk of Alzheimer disease and distress: a 38-year follow-up. Neurology, 85, 298299

H. Catell and D. J. Jolley (1995). One hundred cases of suicide in elderly people. The British Journal of Psychiatry, 166, 451457.

J. Chan , B. Draper and S. Banerjee (2007). Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. International Journal of Geriatric Psychiatry, 22, 720732.

B. Cipriani , M. Vedovello , C. Lucetti , A. D. Fiorino and A. Nuti (2013). Dementia and suicidal behavior. Aggression and Violent Behavior, 18, 256659.

B. Draper (1996). Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577587.

B. Draper , H. Brodaty , L. F. Low , V. Richards , H. Paton and D. Lie (2002). Self-destructive behaviors in nursing home residents. Journal of the American Geriatrics Society, 50, 354358.

B. Draper , C. Maccuspie-Moore and H. Brodaty (1998). Suicidal ideation and the 'wish to die' in dementia patients: the role of depression. Age and Ageing, 27, 503507.

B. Draper , C. Peisah , J. Snowdon and H. Brodaty (2010). Early dementia diagnosis and the risk of suicide and euthanasia. Alzheimer's & Dementia, 6, 7582.

A. Erlangen , S. H. Zarit and Y. Conwell (2008). Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. The American Journal of Geriatric Psychiatry, 16, 220–8.

L. A. Farrer (1986). Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. American Journal of Medical Genetics, 24, 305311.

J. A. Gallego , V. Rachmallu , E. Y. Yuen , S. Fink , L. M. Duque and J. M. Kane (2015). Predictors of suicide attempts in 3.322 patients with affective disorders and schizophrenia spectrum disorders. Psychiatry Research, 228, 791796.

J. Gather and J. Vollmann (2013). Physician-assisted suicide of patients with dementia. A medical ethical analysis with a special focus on patient autonomy. International Journal of Law and Psychiatry, 36, 444453.

J. S. Goldman (2015). Genetic testing and counseling in the diagnosis and management of young-onset dementias. Psychiatric Clinics of North America, 38, 295308.

J. Hamann et al. (2011). Patient participation in medical and social decisions in Alzheimer's disease. Journal of the American Geriatrics Society, 59, 20452052.

K. Harkins et al. (2015). Development of a process to disclose amyloid imaging results to cognitively normal older adult research participants. Alzheimers Research & Therapy, 7, 26.

C. Haw (2009). Dementia: suicide by drowning. The British Journal of Psychiatry, 194, 563564; author reply 564.

C. Haw , D. Harwood and K. Hawton (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21, 440453.

A. Heide et al. (2007). End-of-life practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine, 356, 19571965.

J. P. Kim and M. Y. Hyun (2013). Depression and suicidal ideation in elders with dementia. Journal of Korean Academy of Nursing, 43, 296303.

S. Kim , J. H. Ha , J. Yu , D. H. Park and S. H. Ryu (2014). Path analysis of suicide ideation in older people. International Psychogeriatrics, 26, 509515.

A. B. Knapskog , M. L. Barca and K. Engedal (2014). Prevalence of depression among memory clinic patients as measured by the Cornell scale of depression in dementia. Aging and Mental Health, 18, 579587.

W. S. Lim , E. H. Rubin , M. Coats and J. C. Morris (2005). Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Disease & Associated Disorders, 19, 214219.

R. Macleod et al. (2013). Recommendations for the predictive genetic test in Huntington's disease. Clinical Genetics, 83, 221231.

P. Menzel and M. Chandler-Cramer (2014). Advance directives, dementia, and withholding food and water by mouth. Hastings Center Report, 44, 2337.

R. Moretti , P. Torre , R. M. Antonello and G. Cazzato (2006). Behavioral alterations and vascular dementia. The Neurologist, 12, 4347.

S. Nunnemann , D. Last , T. Schuster , H. Foerstl , A. Kurz and J. Diehl-Schmid (2011). Survival in a German population with frontotemporal lobar degeneration. Neuroepidemiology, 37, 160165.

S. T. O'Dwyer , W. Moyle , M. Zimmer-Gembeck and D. De Leo (2016). Suicidal ideation in family carers of people with dementia. Aging & Mental Health, 20, 222230.

S. O'Dwyer , W. Moyle and S. Van Wyk (2013). Suicidal ideation and resilience in family carers of people with dementia: a pilot qualitative study. Aging & Mental Health, 17, 753760.

P. Osvath , A. Kovacs , V. Voros and S. Fekete (2005). Risk factors of attempted suicide in the elderly: the role of cognitive impairment. International Journal of Psychiatry in Clinical Practice, 9, 221225.

C. Peisah , J. Snowdon , J. Kril and M. Rodriguez (2007). Clinicopathological findings of suicide in the elderly: three cases. Suicide and Life Threatening Behavior, 37, 648658.

M. Préville , R. Hébert , R. Boyer , G. Bravo and M. Seguin (2005). Physical health and mental disorder in elderly suicide: a case-control study. Aging & Mental Health, 9, 576584.

N. Purandare , R. C. Voshaar , C. Rodway , H. Bickley , A. Burns and N. Kapur (2009). Suicide in dementia: 9-year national clinical survey in England and Wales. The British Journal of Psychiatry, 194, 175180.

P. Qin (2011). The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. Journal of Psychiatric Research, 45, 14451452.

R. Rao , T. Dening , C. Brayne and F. A. Huppert (1997). Suicidal thinking in community residents over eighty. International Journal of Geriatric Psychiatry, 12, 337343.

S. Richard-Devantoy , M. T. Berlim and F. Jollant (2014a). A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychological Medicine, 44, 16631673.

K. Rohde , E. R. Peskind and M. A. Raskind (1995). Suicide in two patients with Alzheimer's disease. Journal of the American Geriatrics Society, 43, 187189.

A. Rubio , A. L. Vestner , J. M. Stewart , N. T. Forbes , Y. Conwell and C. Cox (2001). Suicide and Alzheimer's pathology in the elderly: a case-control study. Biological Psychiatry, 49, 137145.

V. Sabodash , M. F. Mendez , S. Fong and J. J. Hsiao (2013). Suicidal behavior in dementia: a special risk in semantic dementia. American Journal of Alzheimer's Disease and Other Dementias, 28, 592599.

L. S. Seyfried , H. C. Kales , R. V. Ignacio , Y. Conwell and M. Valenstein (2011). Predictors of suicide in patients with dementia. Alzheimer's & Dementia, 7, 567573.

M. M. Silverman , A. L. Berman , N. D. Sanddal , P. W. O'Carroll & T. E. Joiner (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide and Life Threatening Behavior, 37, 248263.

M. C. Snijdewind , D. L. Willems , L. Deliens , B. D. Onwuteaka-Philipsen and K. Chambaere (2015). A study of the first year of the end-of-life clinic for physician-assisted dying in the Netherlands. JAMA Internal Medicine, 175, 16331640.

E. J. Steinbart , C. O. Smith , P. Poorkaj and T. D. Bird (2001). Impact of DNA testing for early-onset familial Alzheimer disease and frontotemporal dementia. Archives of Neurology, 58, 18281831.

A. Surampalli et al. (2015). Psychological impact of predictive genetic testing in VCP inclusion body myopathy, paget disease of bone and frontotemporal dementia. Journal of Genetic Counseling, 24, 842850.

M. Synofzik , S. Biskup , T. Leyhe , M. Reimold , A. J. Fallgatter and F. Metzger (2012). Suicide attempt as the presenting symptom of C9orf72 dementia. The American Journal of Psychiatry, 169, 12111213.

E. Tomlinson and J. Stott (2015). Assisted dying in dementia: a systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these. International Journal of Geriatric Psychiatry, 30, 1020.

C. F. Tsai , S. J. Tsai , C. H. Yang and J. P. Hwang (2007). Chinese demented inpatients admitted following a suicide attempt: a case series. International Journal of Geriatric Psychiatry, 22, 11061109.

A. K. Upadhaya , Y. Conwell , P. R. Duberstein , D. Denning and C. Cox (1999). Attempted suicide in older depressed patients: effect of cognitive functioning. The American Journal of Geriatric Psychiatry, 7, 317320.

J. Van der Lee , T. J. Bakker , H. J. Duivenvoorden and R. M. Droes (2014). Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Research Reviews, 15, 7693.

K. Van Orden and Y. Conwell (2011). Suicides in late life. Current Psychiatry Reports, 13, 234241.

M. Waern , E. Rubenowitz , B. Runeson , I. Skoog , K. Wilhelmson and P. Allebeck (2002). Burden of illness and suicide in elderly people: case-control study. British Medical Journal, 324, 13551359.

M. Waern , E. Rubenowitz and K. Wilhelmson (2003). Predictors of suicide in the old elderly. Gerontology, 49, 328343.

S. Wiktorsson , B. Runeson , I. Skoog , S. Ostling and M. Waern (2010). Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. The American Journal of Geriatric Psychiatry, 18, 5767.

N. Williams , C. Dunford , A. Knowles and J. Warner (2007). Public attitudes to life-sustaining treatments and euthanasia in dementia. International Journal of Geriatric Psychiatry, 22, 12291234.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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