Suicide prevention in older adults
Dr. Eleanor Barbera
In preparing for a webinar on suicide prevention, I came across startling statistics about suicide rates among older adults. Despite the concern we often hear about teen suicide, the rate for elders is even higher.
While older adults make up 12% of the U.S. population, they account for 18% of all suicide deaths. In 2014, the highest suicide rate in the U.S. population (19.3 per 100,000 people) was among people 85 years or older.
In addition, elder suicide may be under reported by 40% or more. Not counted are "silent suicides," like deaths from overdoses, self-starvation or dehydration, and "accidents.”
Training staff to assess suicide
Given its prevalence, it's important for long-term care staff members to know how to recognize and address suicidal thinking and behaviors.
As a psychologist who's been assessing suicidality since my teen years as a peer counselor in college, I feel comfortable with the process. Most facility staff members, however, haven't had extensive training and are understandably anxious about an issue that's likely to be out of their area of expertise. This can lead to over-caution, such as unnecessary one-to-one observation, or to missing signs of distress.
Staff training programs should educate team members about factors increasing the likelihood of depression and thoughts of suicide. Many of these influences are prevalent in our elderly population, such as physical illness, pain, functional impairment, losses and social disconnectedness.
Make use of consulting psychologists by referring residents for evaluation after losses and a decline in condition such as a downgrade in diet from chopped to pureed food, a limb loss, a move from a wheelchair to a reclining chair or a death in the family.
Team communication and support
Virtually all workers know it's necessary to inform the charge nurse and other personnel about direct statements such as “I want to kill myself,” but staff members should be trained to look for other warning signs of potential suicide, which include changes in grooming, loss of interest in previously appealing activities, giving away possessions and making statements like, “I won't be needing any more appointments.”
Staff members need to know the appropriate procedures when encountering a suicidal resident: Immediate risk would lead to one-to-one supervision and hospitalization. Low risk requires one-to-one supervision and removing dangerous objects until the team can meet and plan care. Residents with minimal risk can be referred to mental health professionals or other staff specifically trained to work with those expressing suicidal thinking.
Assessing the level of risk requires a trained staff member who evaluates the lethality of the suicide plan, whether there is a past history of attempts (bearing in mind that 75% of elders who die by suicide have had no prior attempts) and other factors.
Free training resources
Facilities looking for staff training resources will find excellent material available for free on the Substance Abuse and Mental Health Services Administration website.
Its toolkit, Promoting Emotional Health and Preventing Suicide, is designed for senior living communities and can be adapted as needed for the specific population within each facility. It includes training programs for staff and for residents and families, as well as a manual for trainers.
Assisting residents with thoughts of suicide can be an alarming proposition for many staff members, but with proper training and guidance these mental health emergencies can be managed with confidence and sensitivity.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.