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Bareeqa SB, Samar SS, Masood Y, Husain MM. Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231176309. [PMID: 37247610 DOI: 10.1177/00302228231176309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Long-term care facilities (LTC) plays a pivotal role in caring for geriatric population. However, the risk of suicide in long-term care institutions among older individuals is little understood (e.g., nursing homes, assisted living facilities). OBJECTIVE The purpose of this systematic review is to pool and meta-analyze the data on prevalence of suicidal behaviors in geriatric population residing in long-term care facilities. METHODS We have conducted the systematic review in accordance with the PRISMA guidelines. The utilized databases are Pubmed, Medline, Google scholar and Scopus. The Meta-analysis was done using OpenMeta [analyst] software. Subgroup analysis was also performed. RESULTS After running an analysis on pooled data from twenty cross-sectional studies with 3,023,224 participants, the prevalence of suicidal behavior is 6.4% (95% CI = 5.7-7) in LTC. CONCLUSION This meta-analysis shows pooled prevalence of suicidal behavior among geriatric residents of LTC was found to be moderately high all over the world.
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Affiliation(s)
| | | | - Yasir Masood
- Department of Social Sciences, Washington University in St. Louis, St Louis, MO, USA
| | - Mustafa M Husain
- Department of Psychiatry, Neurology and Medicine, UT Southwestern Medical Centre, Dallas, TX, USA
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Beach VL, Brown SL, Cukrowicz KC. Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter? Aging Ment Health 2021; 25:1759-1767. [PMID: 33317336 DOI: 10.1080/13607863.2020.1855102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.
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Affiliation(s)
- Victoria L Beach
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Still ready to give up on life? A longitudinal phenomenological study into wishes to die among older adults. Soc Sci Med 2021; 284:114180. [PMID: 34266673 DOI: 10.1016/j.socscimed.2021.114180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE There is a paucity of empirical studies exploring wishes to die (WTD) in older adults without a life-threatening disease or psychiatric disorder, especially on how these WTD evolve over time. OBJECTIVE This study aims to deepen our understanding of living with a WTD by elucidating multifaceted trajectories of death wishes in older adults without a life-threatening disease or psychiatric disorder. METHODS Interviews were conducted between 2013 and 2019 with Dutch men and women aged 70 and older who expressed a WTD (preferably at a self-chosen moment). Using a phenomenological, longitudinal analysis approach, 35 serial interviews were analyzed. RESULTS This resulted in four thematic meanings following four trajectories, namely: 1) a realized WTD, facing the ultimate decision with both freedom and a sense of fate; 2) an intensifying WTD, reaching a deadlock; 3) a diminishing WTD, experiencing tentative space for new possibilities; and 4) a vanishing WTD, being surprised by an unexpected turn. In the cases examined, the individuals' WTD was characterized by ambivalence and subject to change over time. Fluctuating, often asynchronous patterns of physical, social, psychological, and existential distress were lived intertwined. The WTD should thus be understood as dynamic and unpredictable, often impacted by external circumstances. CONCLUSIONS An important clinically relevant finding is that even persons with a pronounced WTD can experience openness to new possibilities, leading to a diminished or vanished WTD and/or desire to act on their WTD. Often such changes were related to (re-)establishment of connections with other people and/or society or with themselves. Since most research in this area is cross-sectional, the current longitudinal findings of this study are unique in providing insight into changes over time, thus contributing to the fields of death and suicide studies.
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Chai Y, Luo H, Yip PSF, Perlman CM, Hirdes JP. Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study. J Am Med Dir Assoc 2021; 22:2160-2168.e18. [PMID: 33454310 DOI: 10.1016/j.jamda.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Temkin-Greener H, Orth J, Conwell Y, Li Y. Suicidal Ideation in US Nursing Homes: Association With Individual and Facility Factors. Am J Geriatr Psychiatry 2020; 28:288-298. [PMID: 32001114 PMCID: PMC7050379 DOI: 10.1016/j.jagp.2019.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess prevalence of suicidal ideation (SI) among new postacute and long-stay nursing home (NH) admissions and examine the associations with individual and NH-level factors. SETTING/PARTICIPANTS A total of 1,864,102 postacute and 304,106 long-stay admissions to just over 15,000 NHs between 7/1/2014 and 6/30/2015. MEASUREMENT Using 100% of the national Minimum Data Set 3.0, we identified SI and key covariates. SI was based on responses to one item on the PHQ-9 scale. For postacute residents, SI was measured at admission and discharge. For long-stay residents, SI was assessed at admission and assessments closest to 90, 180, and 365 days thereafter. Patient sociodemographics, functional and cognitive status, comorbid conditions, and other covariates were included as independent variables, as were several NH-level factors. Logistic regression models were fit to estimate SI risk at admission and at subsequent time intervals. RESULTS Observed 2-week prevalence rates of SI were highest at admission (1.24% for postacute and 1.84% for long stays) and declined thereafter at each subsequent time interval. The odds of SI were significantly increased for residents with severe depression at admission and all subsequent intervals. Residents in for-profits had significantly lower rates of SI, compared with those in not-for-profits. CONCLUSIONS Our findings demonstrate that SI risk in NHs is highest at admission and subsequently declines. We found several potentially modifiable individual-level risk factors for SI. The identification of SI may be seriously underreported in for-profit-facilities. Future research may be needed to explore how the PHQ-9 item on SI is understood by residents and recorded by staff.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (HT-G, JO, YL), Rochester, NY.
| | - Jessica Orth
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (HT-G, JO, YL), Rochester, NY
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry (YC), Rochester, NY
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (HT-G, JO, YL), Rochester, NY
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Nie Y, Hu Z, Zhu T, Xu H. A Cross-Sectional Study of the Prevalence of and Risk Factors for Suicidal Ideation Among the Elderly in Nursing Homes in Hunan Province, China. Front Psychiatry 2020; 11:339. [PMID: 32477170 PMCID: PMC7241427 DOI: 10.3389/fpsyt.2020.00339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/03/2020] [Indexed: 11/30/2022] Open
Abstract
Our study aims to explore the risk factors for suicidal ideation and their interaction among the elderly in nursing homes in Hunan province, China. A cross-sectional study was conducted among the elderly in nursing homes in Hunan Province. Twenty-four nursing homes were selected by multistage cluster random sampling, and 817 elderly residents were investigated using a set of structured questionnaires. The main outcome measures included general information, suicidal ideation, depression symptoms, social support, activities of daily living (ADL), stressful life events, and sleep quality. Multivariate binary logistic regression was performed to explore the risk factors for suicidal ideation among the elderly in nursing homes, and additive interaction was used to analyze the interaction between risk factors. The prevalence of suicidal ideation among the elderly in nursing homes in Hunan province was 17.9% (95% confidence interval(CI): 15.2%, 20.6%). Living in a rural area (odds ratio(OR)=1.88, 95% CI: 1.03, 3.44), infrequent visits from relatives (OR=2.61, 95% CI: 1.42, 4.78), history of chronic disease (OR=2.34, 95% CI: 1.09, 5.01), depression symptoms (OR=8.11, 95% CI: 4.52, 14.54), lower social support (OR=3.85, 95% CI: 1.94, 7.61), and ADL disability status (OR=4.38, 95% CI: 2.10, 9.14) increased the risk of suicidal ideation. Additive interactions were detected between depression symptoms and ADL status, with a relative excess risk due to interaction (RERI) of 8.73 (95% CI: 2.04, 15.43), and between depression symptoms and social support, with an RERI of 5.98 (95% CI: 0.86, 11.10). The prevalence of suicidal ideation among the elderly in nursing homes is relatively high. Both physical conditions and psychosocial factors were associated with suicidal ideation among the elderly. These findings have significant implications for the prediction and prevention of suicidal behaviors.
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Affiliation(s)
- Yu Nie
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tingting Zhu
- Department of Scientific Research Management, Shanghai Health Development Research Center, Shanghai, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Minayo MCDS, Figueiredo AEB, Mangas RMDN. Study of scientific publications (2002-2017) on suicidal ideation, suicide attempts and self-neglect of elderly people hospitalized in Long-Term Care Establishments. CIENCIA & SAUDE COLETIVA 2019; 24:1393-1404. [PMID: 31066841 DOI: 10.1590/1413-81232018244.01422019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/29/2018] [Indexed: 11/22/2022] Open
Abstract
This is a study on scientific work on the ideation, suicide attempt and self-neglect of elderly residents in LTCEs from 2002 to 2017. Documents were retrieved from the following sources: BVS/SP, SciELO, Scopus, PubMed and Web of Science, with the following descriptors: suicide attempt, suicidal ideation, self-neglect, elderly, long-term care establishment, and their correspondents in Portuguese, Spanish and French. Twenty-six papers on the subject were found. There is a consensus among the authors, whose texts are analyzed here, concerning the factors that lead the elderly to suicidal behavior: depression, illness and pain, complicated and traumatic mourning, anxiety and despair after recovery from depressive episode, poor living conditions, death of close relatives, friends, family conflicts, family history of self-inflicted events. The protection factors found are religiosity, optimistic lifestyle, satisfaction with life and investment in the autonomy and power of relationships and communication and monitored drug therapy for mental disorders such as depression.
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Affiliation(s)
- Maria Cecília de Souza Minayo
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
| | - Ana Elisa Bastos Figueiredo
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
| | - Raimunda Matilde do Nascimento Mangas
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
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Fachola MCH, Lucero R, Porto V, Díaz E, París MDLA. Suicide attempts and suicide ideation among the elderly in Uruguay. CIENCIA & SAUDE COLETIVA 2015; 20:1693-702. [PMID: 26060947 DOI: 10.1590/1413-81232015206.02252015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022] Open
Abstract
An investigation is presented into Suicide Attempts (SA) among the Elderly in Uruguay conducted in 2014 in a Public Health institution in Montevideo linked to a Claves/Fiocruz project. Starting with an initial project, semi-structured interviews were conducted with institutionalized individuals with a history of suicide attempts, as well as a review of the literature and research into preventive norms and actions by public health authorities in the country. The results reveal difficulties of individuals in talking about SA as well as shame associated with aging. There was also a major difficulty talking about family ties, confirming gender differences in the method of SA and greater suicide ideation among women, although the possibility of SA repetition does not appear to be a concern. The study elicits reflection on the importance of attention, care, quality of life and the effects of institutionalized life upon the elderly.
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Affiliation(s)
| | - Rossana Lucero
- Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Magallanes, Montevideo, Uruguay,
| | - Viviana Porto
- Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Magallanes, Montevideo, Uruguay,
| | - Elizabeth Díaz
- Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Magallanes, Montevideo, Uruguay,
| | - María de Los Angeles París
- Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Magallanes, Montevideo, Uruguay,
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Abstract
Suicide is the deliberate act of causing death by self-directed injurious behavior with intent to die. Assisted dying, also known as assisted suicide, involves others to help hasten death. Physician-assisted dying specifically refers to the participation of a physician in facilitating one's death by providing a lethal means. Any decision to actively end a life has profound emotional and psychological effects on survivors. The article discusses the effects that older adults' deaths through suicide, assisted dying, and physician-assisted dying have on survivors and the implications for clinical practice.
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Raijmakers NJH, van der Heide A, Kouwenhoven PSC, van Thiel GJMW, van Delden JJM, Rietjens JAC. Assistance in dying for older people without a serious medical condition who have a wish to die: a national cross-sectional survey. JOURNAL OF MEDICAL ETHICS 2015; 41:145-150. [PMID: 24335917 DOI: 10.1136/medethics-2012-101304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The Dutch euthanasia law regulates physician assistance in dying for patients who are suffering unbearably from a medical condition. We studied the attitudes of the Dutch population to assistance in dying for older persons who have a wish to die without the presence of a serious medical condition. METHODS A cross-sectional survey was conducted among a random sample of the Dutch public (response rate 78%, n=1960), using statements and vignettes about attitudes to assistance in dying for older persons who are tired of living. RESULTS A minority of 26% agreed with a vignette in which a physician warrants the request for physician-assisted suicide of an older person who is tired of living without having a serious medical condition. Furthermore, 21% agreed with the statement 'In my opinion euthanasia should be allowed for persons who are tired of living without having a serious disease'. People supporting euthanasia for older persons who are tired of living were more likely than opponents to be highly educated (OR 1.6; 95% CI 1.1 to 2.3), to be non-religious (OR 1.7; 95% CI 1.3 to 2.3), to have little trust in physicians (OR 1.6; 95% CI 1.2 to 2.2), and to prefer to make their own healthcare decisions (OR 1.7; 95% CI 1.3 to 2.3). CONCLUSIONS Although it is lower than the level of support for assistance in dying for patients whose suffering is rooted in a serious medical condition, our finding that a substantial minority of the general public supports physician assistance in dying for older people who are tired of living implies that this topic may need to be taken seriously in the debate about end-of-life decision-making.
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Affiliation(s)
- Natasja J H Raijmakers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pauline S C Kouwenhoven
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Johannes J M van Delden
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Mezuk B, Rock A, Lohman MC, Choi M. Suicide risk in long-term care facilities: a systematic review. Int J Geriatr Psychiatry 2014; 29:1198-211. [PMID: 24854089 PMCID: PMC4232590 DOI: 10.1002/gps.4142] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/23/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. METHODS Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. RESULTS Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. CONCLUSIONS Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents.
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Affiliation(s)
- Briana Mezuk
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University
- Institute for Social Research, University of Michigan
| | - Andrew Rock
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University
| | - Matthew C. Lohman
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University
| | - Moon Choi
- College of Social Work, University of Kentucky, Lexington, Kentucky
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
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Torresani S, Toffol E, Scocco P, Fanolla A. Suicide in elderly South Tyroleans in various residential settings at the time of death: a psychological autopsy study. Psychogeriatrics 2014; 14:101-9. [PMID: 24954833 DOI: 10.1111/psyg.12046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/12/2013] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Completed suicide is more frequent among older adults than any other age group. Data on suicide in nursing homes and other residential facilities are inconsistent. This work aims to describe the characteristics of elderly suicide victims in different residential settings compared to young suicide victims. METHODS Data on people who died by suicide in the South Tyrol (Alto Adige) region of Italy between 2000 and 2009 were gathered from the local Provincial Mortality Register. Further detailed information was collected via questionnaires to mental health departments and psychological services, family physicians and relatives of the deceased. RESULTS A total of 525 cases of suicide were recorded, with a linearly decreasing trend during the study period. About one-third of the suicides occurred in those aged 60 years and over. Suicide in the elderly was associated with low education level (odds ratio (OR) = 7.1, P < 0.001), living in a one-person household (OR = 2.4, P < 0.01), not having economic troubles (OR = 6.1, P < 0.01), having seen a doctor in the past month (OR = 2.4, P < 0.01) and living in a residential facility (OR = 2.6, P < 0.05). Twenty-four (17.9%) suicide victims aged 60 years and over were in a residential facility/hospital at the time of the death. They were more likely to be women, not married, and to die by jumping from a height. CONCLUSIONS The suicide risk should be carefully assessed in the elderly who live alone or are institutionalized or hospitalized. Efforts are warranted to reduce seniors' access to high places in hospitals and facilities.
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Fässberg MM, Ostling S, Börjesson-Hanson A, Skoog I, Wærn M. Suicidal feelings in the twilight of life: a cross-sectional population-based study of 97-year-olds. BMJ Open 2013; 3:bmjopen-2012-002260. [PMID: 23377994 PMCID: PMC3586106 DOI: 10.1136/bmjopen-2012-002260] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the occurrence of past month suicidal feelings in extreme old age. Further, to identify factors associated with such feelings. DESIGN Cross-sectional population-based study. SETTING Gothenburg, Sweden. PARTICIPANTS 269 adults (197 women, 72 men) without dementia born in 1901-1909 who participated in a psychiatric examination. MAIN OUTCOME MEASURES Death thoughts and suicidal feelings. The latter were rated in accordance with the Paykel questions (life not worth living, death wishes, thoughts of taking own life, seriously considered taking own life, attempted suicide) during the past month. RESULTS One quarter of the sample (26.7%) reported that they thought about their own death at least once a month. Past month thoughts that life was not worth living were acknowledged by 7.9% of the total sample, death wishes by 10.5% and thoughts of taking life by 3.8%. Few had serious thoughts of taking own life (0.8%) and none had attempted suicide. In all, 11.5% acknowledged some level of suicidal feelings. Most (77.4%) of those who reported such feelings fulfilled criteria for neither major nor minor depression. Neither poor perceived health nor disability (hearing, vision and motor function) was associated with suicidal feelings. Problematic sleep and deficient social contacts were also related to suicidal feelings after adjustment for depression. CONCLUSIONS Suicidal feelings may occur outside the context of depression and disability in this age group. Results can inform clinicians who care for persons who reach extreme old age.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Section for Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
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Jahn DR, Poindexter EK, Graham RD, Cukrowicz KC. The moderating effect of the negative impact of recent life events on the relation between intrinsic religiosity and death ideation in older adults. Suicide Life Threat Behav 2012; 42:589-601. [PMID: 22934958 DOI: 10.1111/j.1943-278x.2012.00114.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Researchers tested the hypothesis that the negative impact of recent life events would moderate the relationship between intrinsic religiosity and death ideation in older adults. Participants (n = 272) completed assessments of death ideation, intrinsic religiosity, and negative impact of recent life events. We confirmed the presence of concurrent moderation and found that older adults with greater negative impact of recent life events and high intrinsic religiosity reported greater death ideation. These relatively surprising findings may be due to reduced fear of death in intrinsically religious older adults, an explanation consistent with previous research.
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Affiliation(s)
- Danielle R Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX 79409-2051, USA
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Albers G, Harding R, Pasman HRW, Onwuteaka-Philipsen BD, Hall S, Toscani F, Ribbe MW, Deliens L. What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review. Palliat Med 2012; 26:722-33. [PMID: 21697265 DOI: 10.1177/0269216311412232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The European population is rapidly ageing, resulting in increasing numbers of older people dying in long-term care facilities. There is an urgent need for palliative care in long-term care facilities. AIM The aim of this study was to systematically review the literature on palliative care research in long-term care facilities in Europe with respect to how the palliative care populations were described, and to determine the study designs and patient outcome measures utilized. METHODS We used a systematic literature review. The search strategy included searches of PubMed, Embase and PsychINFO databases from 2000 up to May 2010, using search terms related to 'palliative care' and 'end-of-life care' combined with search terms related to 'long-term care'. We selected articles that reported studies on patient outcome data of palliative care populations residing in a long-term care facility in Europe. RESULTS This review demonstrated that there are few, and mainly descriptive, European studies on palliative care research in long-term care facilities. Fourteen studies were retained in the review, of which eight were conducted in the Netherlands. None of these studies described their study population specifically as a palliative care or end-of-life care population. Retrospective and prospective designs were applied using many different measurement instruments. Most instruments were proxy ratings. Symptom (management) was the most frequently measured outcome. CONCLUSION To improve future research on palliative care in long-term care facilities, agreement on what can be considered as palliative care in long-term care facilities and, the availability of well-developed and tested measurement instruments is needed to provide more evidence, and to make future research more comparable.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
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Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, Gallo J, Szanto K, Conwell Y, Draper B, Quinnett P. A systematic review of elderly suicide prevention programs. CRISIS 2011; 32:88-98. [PMID: 21602163 DOI: 10.1027/0227-5910/a000076] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Suicide rates are highest among the elderly, yet research on suicide prevention in old age remains a much-neglected area. AIMS We carried out a systematic review to examine the results of interventions aimed at suicidal elderly persons and to identify successful strategies and areas needing further exploration. METHODS Searches through various electronic databases yielded 19 studies with an empirical evaluation of a suicide prevention or intervention program designed especially for adults aged 60 years and older. RESULTS Most studies were centered on the reduction of risk factors (depression screening and treatment, and decreasing isolation), but when gender was considered, programs were mostly efficient for women. The empirical evaluations of programs attending to the needs of high-risk older adults seemed positive; most studies showed a reduction in the level of suicidal ideation of patients or in the suicide rate of the participating communities. However, not all studies used measures of suicidality to evaluate the outcome of the intervention, and rarely did they aim at improving protective factors. CONCLUSIONS Innovative strategies should improve resilience and positive aging, engage family and community gatekeepers, use telecommunications to reach vulnerable older adult, and evaluate the effects of means restriction and physicians education on elderly suicide.
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Affiliation(s)
- Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada.
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Yan SM, Yi SG. Death and suicidal ideation among nursing home residents in a Chinese city – a pilot study. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/17525098.2011.590463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Psychosocial Concerns in the Context of Geriatric Palliative Care in Nursing Homes. TOPICS IN GERIATRIC REHABILITATION 2011. [DOI: 10.1097/tgr0b013e3181ff698f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry 2010; 25:843-9. [PMID: 19946865 DOI: 10.1002/gps.2426] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The highest suicide rates are found among the elderly, therefore suicidal ideation is prevalent in long-term care facilities. Despite these facts and multiplying losses, most residents show no signs of suicidal ideation. There is a lack of information on which factors protect against suicidal thoughts among the elderly. The aim of this pilot study was to assess the prevalence and correlates of suicidal ideation with risk and protective factors among older residential care home residents in Vienna. METHODS This cross-sectional study was conducted in 15 Viennese residential care homes. Participants completed a self-report questionnaire containing sociodemographic factors, physical health, mental health, and protective factors like optimistic attributional style, self-efficacy, and internal locus of control as well as satisfaction with life and were finally asked about active and passive suicidal thoughts and behaviors. RESULTS With the voluntary participation of 129 residents aged 60 years or more, active suicidal ideation during the last month was identified in 7% of the elderly, 11% reported active suicidal ideation during the past year. Primarily, we found that protective factors like internal locus of control, self-efficacy, and satisfaction with life were important single predictors of active suicidal ideation during the past month. Depressive symptoms and current psychotherapeutic treatment were additionally important predictors. CONCLUSIONS Suicidal ideation is prevalent in Viennese residential care homes; consequently it is necessary to recognize and treat suicidal ideation in an adequate way. Our findings suggest that research and prevention strategies could not merely target risk, but also include protective factors.
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Affiliation(s)
- Daniela Malfent
- Centre for Public Health, Institute for Medical Psychology, Medical University of Vienna, Vienna, Austria
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Abstract
SummarySuicide is accepted as a major health problem worldwide, especially in the young and middle aged. It is, however, a significant health problem in older people as well, and those aged 65 years and over generally have the highest suicide rates compared with all other age groups. In research literature from the last decade, there has been an increased interest in disentangling the phenomenon of suicide in later life. This paper aims to critically review the literature on suicide and suicidality in later life published from 2000 to 2009. Prevalence rates as well as risk and protective factors are mapped and correlates reviewed. The association between suicidality and help-seeking behaviour is considered. Finally, potential prevention strategies are reviewed.
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