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Biomedical subjects

E Salib

Publications and source records attributed to E Salib.

At least 19 recordsLinked to original sources
PubMed2002

Analgesics in the elderly.

The aim of the study is to investigate whether elderly patients on long-term weak opioid analgesics could suffer the problems of tolerance and dependence. The prevalence of potential dependence amongst long-term users was assessed by a semi-structured questionnaire applying the Diagnostic Criteria for Research (DCR-10) criteria for Dependence Syndrome. The sample consisted of 25 randomly selected elderly patients drawn from four practices in North Cheshire, who had been on continuous repeat prescription of low potency opioid and compound analgesics containing them for a minimum of one year without apparent problem to themselves or their GPs. Approximately 2.8% of the elderly GP practice population were shown to be on opioid analgesics continuously for at a least one year. The study found that an estimated 40% of patients on low potency opioids fulfilled the DCR-10 criteria for Dependence Syndrome. It could be argued however that the finding may be, at least partly, the result of an undetermined specificity of DCR-10 as a screening tool. The finding, in such a small sample, is interesting but requires critical examination, as we believe it to be the first study of the possible effect of long-term use of opioid analgesics in primary care. The unexpectedly high prevalence highlights the need for further research in this area.

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PubMed2002

The significance of suicide notes in the elderly.

Suicide notes are traditionally considered as markers of the severity of the suicide attempt and are said to provide valuable insight into the thinking of suicide victims before the fatal act. Few studies have described the characteristics of elderly suicide note-writers and their final thoughts. This study is a retrospective view of suicide notes obtained from coroners' records of all elderly suicides in Cheshire over a period of 10 years, 1989-1998. Out of 125 suicides, 54 (43%) had suicide notes, which were reported in the coroner's records. Of these there were 31 (57%) male and 23 (43%) female subjects. Elderly suicide note-leavers were more likely to be unknown to psychiatric services (p < 0.01) and to have used a non-violent method of suicide (p < 0.01). Sex, marital status, social isolation, mental or physical morbidity did not appear to be linked with leaving a suicide note. More cases that took an overdose, used plastic bags, electrocuted themselves, or used car exhaust also left suicide notes. Those who died by more violent means such as hanging, drowning, jumping from height, immolation or wounding appeared less likely to have left a suicide note. No statistically significant difference in the content of the suicide notes was observed in relation to sex or age. Many elderly are isolated and may have no one to write a note to, while others have lost the ability to express themselves. Therefore, it is not possible to say that the different incidence of note leaving observed for suicide was due to differing levels of suicidal intent. Although only a proportion of elderly suicide victims leave suicide notes, the absence of a suicide note must not be considered an indicator of a less serious attempt.

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PubMed2002

Their last words: a review of suicide notes in the elderly.

Suicide notes are considered as markers of the severity of a suicide attempt and are said to provide valuable insight into the thinking of suicide victims before the fatal act. However, very few studies have described elderly suicide note-writers and their final thoughts. In this retrospective review of suicide notes obtained from coroners' records in North Cheshire over a period of 13 years from 1989-2001 we examined the content of suicide notes and their clinical significance. Suicide note-writers may not be typical of the average suicide and information elicited from the study of suicide notes may only apply to note-writers and not to suicide in general. However, the absence of a suicide note must not be considered an indicator of a less serious attempt. Future studies of suicide notes need to provide insight into the unique nature of these documents and to allow better understanding of the suicidal mind.

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PubMed2001

Spiritual healing in elderly psychiatric patients: a case-control study in an Egyptian psychiatric hospital.

In some cultures, mental illness and its treatment may be closely linked to beliefs relating to sin, suffering, and separation from the divine, or even possession by evil. The aim of this study was to explore whether there was an association between receiving spiritual healing and the occurrence of schizophrenic relapses in a sample of elderly Egyptian patients. The method used was a case-control study, comparing patients with an ICD 10 diagnosis of schizophrenia who received spiritual healing and those without spiritual healing, in terms of the occurrence of relapses during a specified period. Patients who received spiritual healing relapsed more frequently than those who did not (adjusted OR 3.5 p < 0.05). Relapse was also associated with age and certain methods of healing. The risk of relapse was independent of gender, duration of illness and type of religion. The study found spiritual healing to be positively associated with relapse of schizophrenia in a sample of elderly Egyptian patients. It is however difficult to ascertain that the relapse actually started after the process of spiritual healing and not before it. The study findings may suggest that religious history, at least in some cases, should be taken into consideration when planning future management.

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PubMed2001

History of deliberate self harm may predict methods of fatal self harm in the elderly.

In this study we examined the association between methods of Deliberate Self Harm (DSH) by the elderly and their subsequent methods of Fatal Self Harm (FSH). Data was collected from the files of inquests into suicide by the elderly in Birmingham and Cheshire Coroner's Courts. All the subjects were above the age of 60, had history of deliberate self harm before the final act of fatal self harm and attracted either suicide or open verdict returned by the Coroners over a period of four years 1995-1998. We compared the methods of Deliberate Self Harm (DSH) to the methods of Fatal Self Harm (FSH) used by all the included elderly. 18 per cent of elderly victims of FSH had a previous history of DSH and in 35 per cent of the sample, the last known attempt of DSH occurred more than one year prior to the FSH. The majority of the methods that had been used in elderly DSH were used again in their final act of FSH. Nearly two thirds of all the elderly who died of an overdose had attempted suicide earlier by an overdose and one in five of those who died by hanging or drowning used the same method in an unsuccessful attempt of FSH within 12 months. A detailed history of DSH can improve the quality of risk assessment of self harm in the elderly. As more than one in three elderly victims of FSH attempted DSH more than a year prior to the final act, it is important when assessing an elderly DSH attempt that we obtain any previous case notes and question informants about the distant as well as the recent past.

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PubMed2001

Passive euthanasia in dementia: killing ... or letting die?

A sample of carers was asked to complete a self-administered questionnaire designed to collect information about carers' characteristics and obtain their views on passive euthanasia. Each carer was given an information sheet about the study, which included a detailed and clear account for the different types of euthanasia. The study showed a strong support for passive euthanasia from the non-professional carers of dementia patients. The strongest support was for the idea of a 'Living Will'. Having previous experience in looking after other people with dementia would appear to influence carers' perception of passive euthanasia. The subject of passive euthanasia and its ramifications for sufferers, carers and professionals warrants further exploration.

Adult↗
PubMed2001

Elderly suicide and attempted suicide: one syndrome.

In this study we explore whether elderly suicide victims who had a previous history of attempted suicide differ from those with no similar history. A group of the elderly, who ended their lives with fatal self-harm (FSH) and had a history of deliberate self-harm (DSH) was compared to a matching group of the elderly who also ended their lives with FSH, but who were not known to have had any history of DSH. The comparison was in respect of epidemiological, social, psychological characteristics, service input and methods of suicide. The elderly, with a history of DSH, were more likely to have been known to the mental health services than the elderly who did not have such a history (P<.05). The two groups used similar methods in their final FSH act. The elderly victims of FSH with or without a previous history of DSH share the same characteristics. The two groups appear to be part of one syndrome. Deliberate self-harm in the elderly should be taken seriously as an unsuccessful suicide rather than a manipulative act or a cry for help and attention.

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PubMed2000

Age and methods of fatal self harm (FSH). Is there a link?

OBJECTIVES: To examine the methods of fatal self harm (FSH) used by the elderly compared to young adults. METHODS: We compared the methods of FSH used by all the elderly over 60 years of age to those used by all younger adults, over 16 and under 60, in the city of Birmingham and Solihull over a period of 4 years, 1995-1998. We applied the term FSH to all deceased who were subjects of Coroner's inquests and attracted verdicts of suicide and open verdicts. FINDINGS: A significantly higher proportion of the elderly who fatally harmed themselves did so by drowning and asphyxia compared to the younger age group (p < 0.05 and p < 0.01, respectively). Significantly more women over the age of 60 committed acts of FSH by tying a plastic bag around the neck than those under 60 (p < 0.05). Method of death was not ascertained in a much higher proportion of elderly FSH (p < 0.01). The most common method of suicide among elderly men and women were hanging and self-poisoning by overdose, respectively. CONCLUSION: The study shows that the most common method of suicide in the elderly is poisoning by drug overdose. It raises the question about the quantity of drugs prescribed for the elderly, e.g. antidepressants, sedatives and pain killers. The study did not confirm previous reports that violent methods are used more frequently with increasing age.

Adolescent↗
PubMed2000

Autopsy in elderly psychiatric inpatients: a retrospective review of autopsy findings of deceased elderly psychiatric inpatients in north Cheshire 1980-1996.

In this 17-year review of death certificates of elderly inpatients of a large psychiatric hospital in North Cheshire, the frequency, trend and value of performing autopsies were examined. Details of death certificates were compared with certificates issued after post-mortem examination to see whether an autopsy yielded any additional or relevant information about conditions that are not directly related to death but might well be of importance to public health. The rate of post-mortem examination, at 9.5% of total hospital deaths, did not show any significant trend over most of the review period. The vast majority of autopsies examined had been requested by the coroner and not by the clinicians. The review showed that an autopsy may be of some value in providing more information regarding any underlying causes of death in elderly psychiatric patients, but has no value in ensuring higher rate of the recording of conditions such as dementia, in particular Alzheimer's disease. Selective hospital autopsy in elderly psychiatric patients to verify, neuropathologically, the clinical diagnosis of Alzheimer's disease, will improve our diagnostic accuracy and provide valid statistics to be used in estimating prevalence, trends, risk factors and for use in all aspects of future research into Alzheimer's disease.

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