Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes.

Key summary points: Aim: To describe a cohort of older trauma patients treated for injuries related to intentional injury over 20 years. Findings: Intentional injury among older patients is rare, but differences are evident when comparing older and younger survivors of suicide attempts. Differences with mortality method of self-inflicted injury, discharge to home and injury severity between genders were identified. Message: Although older patients are not the typical suicide attempt patient presenting at hospitals, their management and discharge planning are often complex and challenging due to undiagnosed mental health conditions, pre-existing comorbidities and difficulties with mental health resource options for this age group. Purpose: Older patients (Older) have complex health management needs often requiring additional resources. Mental health disorders are common among trauma patients, yet minimal information on older suicidal related injury and outcomes exists. A review of trauma patients with intentional self-inflicted injury at one trauma center was done to describe and identify unique elements of this cohort of patients. Methods: Trauma registry data from 2000 to 2019 were reviewed for intentional injury and data abstracted included demographics, injury severity, diagnoses, comorbidities and outcomes. Cohorts by age were compared: Older (65 +) vs Younger (< 65). Values considered significant at p ≤ 0.05. Results: 557 suicide attempts were identified with 9% among Older patients. Most patients were male with median age of 75 years for Older and 35 years for Younger cohort, with similar length of stay (LOS) and injury severity scores (ISS). Penetrating injury was more common among Older patients with firearm used most often, 34% vs 14% for Younger. Differences were evident between male and female Older patients with ISS 16.7 vs 5, p < 0.01 and mortality, p = 0.03. The outcome of discharge to home was significantly different between Older and Younger, 6% vs 20% (p < 0.05). A difference in mortality was evident, Older 38% vs Younger 18% (p < 0.05). Conclusion: With the growing aging population, it is important to acknowledge the resultant increase in concomitant mental health issues and suicidality among older patients, where depression may be undiagnosed and untreated. Providing care within this cohort may reduce future attempts and lessen the burden on the health care system. [ABSTRACT FROM AUTHOR]