Older patients have a higher rate of psychiatric hospital admission after overdose

EE Morrison1,2, V Hepworth1, NI Lone1, JW Dear1,2, EA Sandilands2. 1University of Edinburgh, Edinburgh, UK, 2Royal Infirmary of Edinburgh, Edinburgh, UK

Introduction: Self-poisoning in older people (>65 years) is more likely to result in completed suicide than their younger counterparts. Clinical outcome in this population is poorly characterised. We studied all patients over the age of 65 years admitted between 2003 and 2013 to our regional toxicology unit with self-poisoning.

Methods: This retrospective observational study examined the hospital records of all patients over the age of 65 years who presented to the Royal Infirmary of Edinburgh (RIE) with self-poisoning (2003-2013). We compared this to a matched cohort of patients under 45 years old who presented with intentional self-poisoning on the same day of admission. Non-parametric two-tailed tests (Mann–Whitney U test) and Chi-squared tests were used where appropriate.

Results: 629 patients aged 65 years or greater presented to the RIE with self-poisoning between the 1st of January 2003 and the 1st of July 2013. 480 of these episodes were intentional acts (76.3%). 99 episodes were excluded as repeat presentations, leaving a study group of 381 episodes of first presentation of intentional self-poisoning in this age group (Table 1). Older patients demonstrate greater co-morbidity and a longer length of hospital admission following intentional self-poisoning (Table 1). This group also demonstrate a higher incidence of patient transfer to inpatient psychiatry services following discharge from acute medical services (Table 2).

Table 1: Demographic data of older and younger patient cohorts. * p = <0.05 vs younger population

Table 2: Destination at discharge from acute medical services following episode of self-poisoning. * p = <0.05 vs younger population

Conclusions: Self-poisoning in older people is associated with a significantly longer length of hospital stay. While this may be related to greater co-morbidity, we have also shown a significantly increased need for transfer to psychiatric services, suggesting an increased severity of psychological illness in older patients. There is an urgent need for more targeted medical, psychological, and social support in the management of this vulnerable patient population.