Assessing suicide ideation among older adults: a systematic review of screening and measurement tools

Abstract

Objectives: Rates of suicide in older adults may be higher than reported due to poor understandings of presentation of suicide ideation in this group. The objectives of this paper were to (i) review current measurement tools designed for older adults to detect suicide ideation and (ii) assess their psychometric properties. Design: We used a systematic review approach to identify measurement tools developed specifically for older adults without cognitive decline or impairment. Results: Ten articles that reported on a total of seven different measurement tools were identified. These included tools that focused on resiliency to suicide and those that measured risk of suicide behavior. There was wide variation across the articles: some were adaptations of existing scales to suit older populations, others were developed by authors; they varied in length from four to 69 items; a range of settings was used, and there was a mix of self-report and clinician-administered measures. Most displayed good psychometric properties, with both approaches showing similar quality. Limitations in terms of samples, settings, and measurement design are discussed. Conclusion: The case for specific measures for older adults is clear from this review. There appear to be unique factors that should be considered in understanding suicide ideation and behavior among older adults that may not be directly assessed in non-specific measurements. However, there is a need to expand the diversity of individuals included in measurement development to ensure they are appropriate across gender, culture and minority status, and for the views of professionals to be considered.

Talking really does matter: Lay perspectives from older people on talking about suicide in later life

“…Such statements highlight the further need for compassion and high-quality care that pays attention to the nuancing or tailoring of mainstream suicide prevention and mental health therapies for people in later life (Hafford-Letchfield et al, 2022a , b ). Validated screening tools used in suicidality with older people tend not to address these wider issues (Gleeson et al, 2022 ).…”

“…However, the aforementioned “gray area” behaviors presented by older people may lead to missed opportunities for healthcare providers to talk to these individuals about their suicide ideation and behavior (Shah and Erlangsen, 2014 ), particularly if the person has not received a diagnosis of depression. Gleeson et al's ( 2022 ) review of screening measures found that none of them actively included older people themselves in their development beyond item development (e.g., Edelstein et al, 2009 ; Carmel, 2017 ). Whilst the measures frequently included questions on social connectedness and support, none fully engaged with the theoretical issue of burdensomeness as a factor in determining suicide ideation.…”

“…Whilst the measures frequently included questions on social connectedness and support, none fully engaged with the theoretical issue of burdensomeness as a factor in determining suicide ideation. Furthermore, there is a question about how far the screening tools developed could be applied in the community and other groups of older people outside of clinical health settings, where the majority of people are living (Gleeson et al, 2022 ). In summary, the existing research highlights the need to raise more awareness of the breadth of suicide expression in later life and to foster greater sensitivity to how it might present.…”

“…Further engagement with community participatory research methods in which the voices of older people can be heard based on their own perspectives and experiences is important in addressing these gaps. Likewise, moving toward co-design of any tools or models of practice could support practice with their utility and application (Gleeson et al, 2022 ).…”

A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement

“…A recent systematic review of current measurement tools designed for older adults to assess suicide ideation (Gleeson et al, 2021) found wide variations. The authors highlighted the lack of consideration across gender, culture and minority status, and for the views of professionals and older people themselves to be considered.…”