Life experiences of elderly people with suicide ideation at the long-term care hospitals in South Korea

Suicide ideation in older people: a qualitative review and Meta-aggregation of Asian studies

Aims

To appraise and synthesize qualitative studies examining older Asian people's experiences of suicidal ideation.

Design

Qualitative review and meta-aggregation.

Data sources

Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity.

Review methods

This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute's System for the Unified Management of the Assessment and Review of Information.

Results

Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review-The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age.

Conclusion

Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.

Exploring life and help-seeking experiences regarding suicidal ideations among nursing home residents

Globally, older adults, especially nursing home residents, are at a higher risk of suicide. This study examined the life of nursing home residents with suicidal ideations and their help-seeking experiences. A qualitative analysis of 19 semi-structured interviews was conducted. Results indicate that suicidal ideations among nursing home residents correlates with their negative life experiences, both personally and institutionally. In terms of their life experiences, themes included the desire for death, emotional loneliness, a state of discomfort arising from incapacity, feeling like a burden on children, and dealing with the low-quality service. Older adults' negative attitudes toward seeking assistance as well as limited resort resources and ineffective help-seeking hinder them from finding more support or treatment. This study adds to a growing body of research on late-life suicide in institutional settings, and relevant findings can serve as references in improving nursing home residents' life quality and developing suicide-prevention strategies.

Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study

OBJECTIVES

This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC).

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included.

METHODS

Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models.

RESULTS

Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant.

CONCLUSIONS AND IMPLICATIONS

There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.

Testing the Effectiveness of a Salutogenic Model for Reducing Suicidal Tendencies in a Population of Elderly and Young Adults

Suicide is a leading cause of mortality worldwide, with the elderly having the highest suicide rates. This study tests the effectiveness of a salutogenic model in normative elderly people compared with young adults in protecting against risk behaviors and suicidal tendencies, based on two variables: locus of control and meaning in life (mediating variable between locus of control and suicidal tendency). Participants were 191 people aged 65 to 100 years and 200 young adults aged 18 to 28 years old. Participants completed questionnaires on locus of control and purpose in life and were assessed for suicidal tendencies. Findings reveal a negative effect of age on locus of control, purpose in life, and a negative correlation between purpose in life and internal locus of control and suicidal tendency. Purpose in life mediates between internal locus of control and suicidal tendency in both populations. The salutogenic model has significant implications and can be used to reduce suicidal tendencies.

A Qualitative Exploration of South Korean Emerging Adults' Perspectives on Death and Suicide Through Short Stories

Despite the alarming suicide rate among South Korean emerging adults, relatively little is known about their unfettered perspectives on death and suicide. Therefore, an innovative data collection technique was developed to apprehend the meanings that emerging adults attribute to death and suicide in their explorations of the phenomena through a selection of short stories. A convenience sample (N = 114) responded to a survey in which participants transferred their feelings toward death and suicide to characters or events in the short stories. A qualitative content analysis revealed relatively permissive perspectives toward death and suicide. Negative perspectives on death are associated with societal victimization and positive perspectives with naturalistic fatalism. Positive perspectives on suicide are overwhelmingly rooted in existential, individual choices while negative perspectives focus on societal pressures. These perspectives contribute to illuminating tensions between traditionalist collectivism and contemporary individualism in Korean society that could inform suicide prevention initiatives for emerging adults.