In a study from South Korea published by The Journal of Bone & Joint Surgery, older adults who had undergone surgical repair of a hip fracture were at a 3 times higher risk of suicide in the first 6 months after surgery than individuals who had not sustained a hip fracture.
“So far, we have focused on the treatment of comorbidity and hip fracture itself in the management of elderly patients with hip fracture, but evaluation and management of their mental stress and emotional status are also important,” said senior author Yong-Han Cha, MD, from Eulji University Hospital, Daejeon, South Korea.
Using a national health-insurance database in South Korea, the researchers identified 11,477 patients who underwent surgical repair of a hip fracture. Each patient was matched with 2 controls with similar demographic and health characteristics who had not sustained a hip fracture. The average age was 75 years, and nearly three-fourths of patients were women.
The researchers compared the suicide rates of the injured and uninjured cohorts over an average follow-up of about 4.5 years (total 158,139 person-years), identifying a total of 170 patients who died by suicide.
Through the first 6 months, there were 14 suicides among nearly 11,500 patients with a hip fracture compared with 10 suicides among nearly 23,000 matched controls. The cumulative rate of suicide was 0.13% among those with a hip fracture (incidence rate: 266.1 per 100,000 person-years) and 0.04% among the matched controls (incidence rate: 89.2 per 100,000 person-years). Thus, older adults with hip fracture were about 3 times more likely to die by suicide within the first 6 months following surgical treatment.
The difference in suicide rates persisted through the first year but was not significant at longer follow-up intervals. This may reflect the high risk of death and poor health among patients with a hip fracture, the researchers speculate: Patients who survive beyond the first year may represent a cohort with higher levels of health and functioning.
The suicide rate during the first 6 months following surgical treatment was “remarkably high,” the researchers said, even compared with studies of older adults with cancer and other serious diseases. The findings are also consistent with data showing the “steadily increasing number of elderly suicides in South Korea,” they said.
The authors note some limitations of their study, including a lack of data on fracture severity and on the causative factors leading to suicide. However, because it was based on a large national database, the findings “could be generalized to other populations,” they said.
Meanwhile, the high suicide rate underscores the need to target mental health issues in older adults after surgical repair of a hip fracture. The study authors concluded, “These results imply the need for a new approach to psychiatric evaluation and management among elderly patients with hip fracture.”
Jang S-Y, Yang D-S, Cha Y-H, Yoo H-J, Kim K-J, Choy W-S. Suicide in elderly patients with hip fracture: a South Korean nationwide cohort study. J Bone Joint Surg. 17 June 2020;102(12):1059-65. doi: 10.2106/JBJS.19.01436.