Older adulthood is a time of emotional well-being for many, but advancing age is also associated with increased risks for suicide and dementia. Dementia is characterized by progressive cognitive impairment, functional disability, and neuropsychiatric symptoms—such as depression—which are common risk factors for late-life suicide. Previous research suggests that individuals with diagnosed dementia have a 3- to 10-fold higher risk of suicide compared to individuals without dementia, and that suicide risk is highest during early stages of the disease and within months of diagnosis. Proposed mechanisms of suicide risk in the context of dementia include executive dysfunction, feelings of burden, and depression, but the development and course of suicide risk in the context of dementia is largely unknown. There is a need for research to characterize the nature of risk with regards to disease stage, particularly during preclinical and prodromal stages to inform the development of early detection and intervention methods. Subjective cognitive decline (SCD) is associated with increased risk for dementia and may be a preclinical marker of dementia, particularly among older adults with persistent memory concerns. Elucidating the nature of suicide risk among older adults with SCD is an important step toward clarifying the etiology of suicide risk among adults with dementia, yet the prevalence and characteristics of suicidal ideation and behaviors in the context of SCD is unknown.
The aims of the current study are to examine the nature of suicidal ideation and proximal suicide risk factors among a well-characterized sample of older adults with SCD, and to examine the feasibility and acceptability of an ecological momentary assessment (EMA) battery to measure daily variations in suicidal thoughts and psychosocial risk factors among a subsample of older adults with SCD. We hypothesize that suicidal ideation will be associated with poorer executive function and greater feelings of burden over and above the effect of depression. With regard to EMA, we hypothesize that participants will demonstrate acceptable adherence to the EMA survey and find the procedures easy to use and minimally interfering.
Participants will be 110 adults aged 60 years and older with subjective memory concerns. Participants will be administered a comprehensive suicide risk assessment and a neuropsychological battery to measure suicidal ideation and behaviors, executive function, mood, and interpersonal risk factors for suicide (feelings of burdensomeness and belonging). Up to 30 participants will be selected from the larger sample (15 randomly, and up to 15 who endorse suicidal thoughts or behavior) to complete daily assessments of suicidal ideation and mood state via EMA on smartphones for 14 consecutive days.
Findings from this study will advance our understanding of the nature of suicide risk associated with SCD and will inform the development of an intervention that could be delivered to older adults with cognitive concerns and dementia in real-time when they are most at risk to manage issues as they arise and reduce risk for suicide.
