Clinical Characteristics and Risk Factors for Discharge Against Medical Advice among Elderly Patients Presenting with Suicidal behavior to Emergency Department during the Social Distancing Period in South Korea: A Nationwide Analysis using National Emergency Department Information System (NEDIS)

Abstract

Objective: Discharge against medical advice (DAMA) in elderly patients with suicidal behavior presents significant clinical and ethical challenges, particularly during public health crisis such as the COVID-19 pandemic. This study investigated clinical characteristics and risk factors associated with DAMA among elderly individuals (≥ 65years) presenting to emergency departments (EDs) in South Korea during the social distancing period. Methods: A retrospective observational study was conducted using data from the National Emergency Department Information System (NEDIS) between January 1, 2019 and December 31, 2020. Results: A total of 4,351 and 3,931 cases were reported in 2019 and 2020, respectively. DAMA rate increased slightly from 14.6% to 14.9% (p < .001) while ED discharge rates decreased from 15.0% to 14.3%. Intensive care units (ICU) admissions increased from 69.0% to 70.3% (p < .001) and post-hospitalization DAMA increased from 10.9% to 12.7% (p = .007). Mortality after admission increased from 10.2% to 11.3% (p = .007). DAMA was significantly associated with older age (OR: 1.39, p < .001) and the use of highly lethal methods such as hanging (OR: 5.54, p < .001) and poisoning (OR: 5.39, p < .001). Conclusions: These findings underscore the need for ethical frameworks and multidisciplinary interventions to support decision-making and prevent recurrent suicidal behavior among elderly patients.