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Self-Poisoning in Older Adults
- Stuart K K Lee, Nicola Cassidy, Ciaran F. Donegan, Alan R. Moore, Joseph A. Tracey (19 August 2009)
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Stuart K K Lee, Registrar Beaumont Hospital, Dublin 9., Nicola Cassidy, Ciaran F. Donegan, Alan R. Moore, Joseph A. Tracey
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SIR – We read with interest the article by Doak et al. entitled ‘Self -poisoning in older adults: patterns of drug ingestion and clinical outcomes’ [1]. The authors characterised the type of agents ingested by older adults admitted to hospital following deliberate drug overdose and compared clinical outcomes to a group of younger patients. Self-poisoning is a frequent method of attempted suicide in the elderly population [2]. Similar to Doak et al., we recently investigated the epidemiology of poisoning among older adults (>65 years of age), using retrospective data from the National Poisons Information Centre (NPIC) of Ireland [3]. From 2001-2003, there were 575 cases of poisoning in older Irish adults, of which 214 (37.2%) were cases of deliberate self- poisoning. Deliberate overdose occurred predominately in the 65-69 year age group and may be a consequence of retirement and subsequent depression. Females outnumbered males and this trend reflects suicide data [2]. The incidence of self-poisoning in Irish older adults was higher than reported elsewhere [4]. Our enquiries originated from hospital emergency departments, general practitioners, nursing homes, community pharmacists, and members of the public, whereas Doak et al. used data from hospital presentations only. Our research revealed that 196 (91.6%) patients deliberately overdosed with pharmaceutical agents as opposed to chemical agents (n=18). Doak et al. have not commented on whether self-poisoning with non- pharmaceutical agents occurred in their patients. Our data showed that 107 out of 214 patients (50%) deliberately ingested multiple medications and 16 of these patients took more than 5 different medications in overdose. Hypnotic sedatives, cardiovascular drugs, and antidepressants were the most common medications implicated in our study. This contrasts with the findings of Doak et al. where paracetamol, other analgesics, and antidepressants were the commonest means of self-poisoning across all age groups [1]. The NPIC is not consulted regarding every case of paracetamol poisoning and our data may not reflect the true incidence of analgesic poisoning in older adults. Doak et al. investigated the duration of hospital stay, whether critical care was required, clinical outcomes, and discharge data for their patients. They reported two fatalities in patients aged over 70 years. In contrast, we graded symptom severity according to the criteria of the European Association of Poison Centres and Clinical Toxicologists [5]. 8 of our patients developed severe toxicity, 6 patients required intensive care admission, and there were 2 fatalities. Comparative studies are to be welcomed to further characterise the epidemiology of poisoning. We support the conclusions of Doak et al. and recommend that physicians should consider the potential for self-harm in older adults when prescribing medications. Future research should focus on the underlying reasons for self-poisoning in older adults and identify more precisely patient groups most at risk. SKK Lee1*, N Cassidy2, CF Donegan1, AR Moore1, JA Tracey2. 1 Department of Medicine for the Elderly, Beaumont Hospital, Dublin 9, Ireland. 2 The National Poisons Information Centre, Beaumont Hospital, Dublin 9, Ireland. Email: stuartlee08@gmail.com *To whom the correspondence should be addressed. References 1. Doak MW, Nixon AC, Lupton DJ, Waring WS. Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age and Aging 2009;38:407-411 2. Shah A. Attempted suicide in the elderly in England: age- associated rates, time trends and methods. International Psychogeriatrics. Published online by Cambridge University Press 04 Jun 2009 doi:10.1017/S1041610209009442 3. Cassidy N, Lee SKK, Donegan CF, Tracey JA. Poisoning in older adults: the experience of the national poisons information centre. Irish Medical Journal 2008;101(9):268-270 4. Crouch BI, Caravati EM, Mitchell A, Martin AC. Poisoning in older adults: A 5-year experience of US poison control centers. The Annals of Pharmacotherapy 2004;38(12):2005-2011 5. Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998;36:205-213 Conflict of Interest:None declared |
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