Suicide Among Older Adults Living in or Transitioning to Residential Long-Term Care

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

This is the title of a very interesting study out of the University of Michigan that was published June 14, 2019 in JAMA Network Open. Researchers looked at 47,759 deaths in the National Violent Death Reporting System (NVDRS) from 2003-2015 and identified 1037 suicides among adults 55 years and older associated with LTC during this time period.  The researchers asked this question: how common is suicide in residential long-term care (LTC) settings, and is transitioning into or out of LTC associated with suicide among older adults?  Their conclusions: “Over a 13-year period, approximately 2.2% of suicides among adults 55 years and older were associated with LTC in some manner. Clinicians, administrators, and policy makers should consider ways to promote the mental health and well-being of older adults experiencing functioning limitations and their families.”  In the upper left corner of the hyperlinked website (1st sentence in this blog) you’ll find a link to the 12-page PDF that is well worth the read.

“Forty million US adults are 65 years and older, and 5.5 million are 85 years and older; by 2050, 1 in 5 will be 65 or older.  Suicide is the 10th leading cause of death in the United States, and the rate of suicide has risen substantially in the past decade, particularly for older adults.” (Italics, bolding and underlining are my addition to this quote from their abstract.)  “The Centers for Disease Control and Prevention estimates that there are approximately 16 000 nursing homes and 31 000 assisted living facilities in the United States and almost 25% of Medicare beneficiaries in 2010 were living in these settings. As such, residential LTC may be a potential location for identifying individuals at high risk of self-harm and for implementing interventions to reduce suicide risk. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognized the potential for residential LTC to serve as a point of engagement in their 2011 Promoting Emotional Health and Preventing Suicide toolkit (English) for practitioners on how to promote emotional health and prevent suicide in these settings.  There is also a Spanish toolkit available.  In addition to the 12-page toolkit, you’ll find a wealth of additional materials at those same websites – all are in PDF format beneath the link to the toolkit.  There’s a Getting Started Guide and Trainer’s Manual as well as a Fact Sheet for Residents, 2 Staff Workshops and a Family and Resident Workshop.  All are great resources.

A key take-away from this study is found in the conclusions:

“Leaders in the field have continued to call for a shift away from a medicalized paradigm of residential LTC toward institutional practices that instead focus on fostering meaningful interactions between residents, promote engagement in care, and enhance quality of life.  In addition, existing, scalable programs that support older adults living in the community (e.g., home health care, meal assistance, transportation, and community health workers) offer the potential to promote quality of life for older adults who may be considering transitioning into or out of residential LTC.

Suicide is indeed a serious concern – one that certainly deserves our attention and action.  I encourage you and your staff to review the study and utilize the SAMHSA resources that are available.  We’re all talking about quality of life.  Let’s do something now to make that a reality and truly bring quality to the lives of those we care for and care about!