Health‐care use before suicide among older adults with newly diagnosed dementia in a national Medicare cohort

Introduction Older adults recently diagnosed with dementia face elevated short‐term suicide risk, yet little is known about their ensuing contact with the health‐care system prior to suicide. METHODS Medicare claims from 2012 to 2015 linked to the National Death Index were used to examine the timing and type of service use among 824 beneficiaries who died by suicide within 1 year of index dementia diagnosis. RESULTS One fourth (23.4%) of suicide deaths occurred within 30 days of dementia diagnosis and 69.1% died within 180 days. Most decedents (80.3%) had ≥ 1 health‐care encounter within 30 days before death, with other outpatient and emergency departments being the most frequent setting in the final 1 to 15 days. Only 16.6% saw a mental health specialist within 180 days of dying. DISCUSSION Findings highlight substantial clinical contact shortly before suicide, indicating critical missed opportunities to intervene through universal depression and suicide risk screening, timely mental health referral, and integrated care after dementia diagnosis.