Barriers to the Prevention of Suicide in Nursing Homes

Couillet, Audrey; Terra, Jean‐Louis; Brochard, Nassima; Chauliac, Nicolas

doi:10.1027/0227-5910/a000466

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…This study suggested that residential transitions may be an important point of engagement before the suicide crisis and that more can be done to support the mental health of older adults living in these settings [22]. Couillet et al demonstrated that barriers to preventing suicide in nursing homes lie in caregivers' suicide representation, seen as an expression of residents' autonomy, a response to the suffering associated with aging and the living conditions imposed on older adults in our society [23].…”

Section: Discussionmentioning

confidence: 91%

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

Dieudonné-Rahm¹,

Pautex²

2023

Swiss Med Wkly

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BACKGROUND: Older adults are at risk of assisted and self-initiated suicide. The links between prior attempts and assisted suicide in the elderly have not been investigated. Hence, we aimed to investigate and describe the occurrence, timing and determinants of suicide attempts prior to assisted and self-initiated suicide. METHODS: We developed a retrospective study of all assisted and self-initiated suicides among people over 65 years in the canton of Geneva, Switzerland, for a 10-year period (2010–2019). Cases were identified by cross-referencing hospitals’ routinely collected electronic data and a forensic report database. Cases were characterised in terms of sociodemographic factors, mental health disorders, main comorbidities, temporal sequence, methods of injury, medical complications and disclosure rates of previous attempts. The study used descriptive statistics. RESULTS: A total of 26 of 497 (5.2%) and 20 of 149 (13.4%) older adults had made previous attempts before assisted and self-initiated suicide, respectively. More than half of them had made a single attempt, mostly by medication poisoning, sometimes more than 10 years before dying. Individuals who made two attempts were significantly more represented among the assisted suicide decedents. One self-initiated suicide decedent and half of the assisted suicide cases had disclosed that they had considered suicide. Individual characteristics were similar, except for assisted suicide decedents, who were eight years older than self-initiated suicide decedents. Almost all the individuals had mental disorders. Depression, anxiety and chronic pain were particularly prevalent among decedents of assisted suicide. The substantial representation of women in both groups may be an indication of their vulnerability, possibly related to chronic pain and life stressors. CONCLUSIONS: Our results show commonalities between older assisted and self-initiated suicide decedents who made an attempt (s) before suicide. Further research is needed to demonstrate the overlap between the determinants of assisted suicide and other forms of suicidality and to support a suicide prevention strategy applicable to both types of suicide.

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Section: Discussionmentioning

confidence: 91%

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

Dieudonné-Rahm¹,

Pautex²

2023

Swiss Med Wkly

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“…The view of nursing homes as a place where people with dementia are left to die is broadly shared, even by nursing home staff. 42 Another reason may be a lack of research culture and funding in nursing homes. Other reasons are linked to methodological difficulties, such as high attrition rates expected in older people, which add to the more general difficulties of evaluating suicide prevention interventions.…”

Section: Discussionmentioning

confidence: 99%

Suicide Prevention Interventions for Older People in Nursing Homes and Long-Term Care Facilities: A Systematic Review

Chauliac

Leaune

Gardette

et al. 2019

J Geriatr Psychiatry Neurol

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Background: The death rate due to suicide among older people is high, especially among men. Because many older people live in nursing homes or long-term care facilities in high-income countries, reviewing the impact of prevention strategies on the suicidal behavior of residents in these settings is of interest. Methods: Following PRISMA guidelines, we performed a systematic review of the existing literature found in Pubmed, Scopus, Web of Science, PsycINFO, and Sociological Abstracts, focusing on interventions to prevent suicidal behavior or ideation in nursing home residents. The studies’ quality was evaluated according to TIDieR and MMAT. Results: Only 6 studies met the inclusion criteria. Four of them described various “gatekeeper” trainings for nursing home staff and 2 described interventions focused on residents. Only 1 study was randomized. Gatekeeper training studies were mostly before/after comparisons. No intervention demonstrated a direct effect on suicidal ideation or behaviors. One study showed that “life review” had a long-lasting effect on depression scores and another that gatekeeper training led to changes in the care of suicidal residents. Conclusions: Interventions to prevent suicidal ideation or behaviors in nursing homes are not rigorously evaluated, and no conclusion can be drawn on their effectiveness in preventing suicidal behaviors. We propose to better evaluate gatekeeper training for staff as well as peer support. Individual interventions targeting residents could be modified for broader implementation.

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“…We identified a total of nine core articles published in the preceding decade and one Older Adult Suicide Prevention Plan. [2,4,[6][7][8][9][10][11][12][13] Statements were extracted and compared against the Task Force for the European Evidence-Based Suicide Prevention Program (EESPP) consensus declaration. [14] Statements were clustered into four operating levels: (1) guiding principles; (2) universal prevention, focused on the entire population as the target-prevention through reducing risk and enhancing health; (3) indicated prevention, symptomatic and 'marked' high-risk individualinterventions to prevent acute disorders or adverse outcomes; and (4) selective prevention for high-risk groups, often focusing on clinical interventions in clinical populations-prevention through reducing risks.…”

Section: Statement Selectionmentioning

confidence: 99%

Strategies to Prevent Elderly Suicide: A Delphi Consensus Study

Barak

Fortune

Hobbs

et al. 2021

Australas Psychiatry

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Objectives In the next decades, many countries will become ‘ageing societies’. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. Methods A New Zealand (NZ) ‘expert panel’ has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults’ suicide prevention. Results A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for ‘A suicide prevention strategy for the elderly…’ to enhance the national all-ages suicide prevention strategy. Conclusion The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.

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Barriers to the Prevention of Suicide in Nursing Homes

Abstract: This study confirms the need to continue training on suicide prevention in nursing homes.

Cited by 7 publications

References 21 publications

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

Suicide Prevention Interventions for Older People in Nursing Homes and Long-Term Care Facilities: A Systematic Review

Strategies to Prevent Elderly Suicide: A Delphi Consensus Study

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