‘He just gave up’: an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

Abstract

This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson's concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context.

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

“…Feelings of being a burden to others and subsequent perceptions that death is a viable way to avoid this were also found to be present in other studies with older adults expressing passive suicide ideation and their carers (e.g. Hafford-Letchfield et al, 2018).…”

“…Greater attention to incorporating coproduction within these studies would benefit both the development and future use of such measures. Finally, previous qualitative studies have indicated perceived financial and caring burdensomeness is a likely factor in explaining older people's suicide ideation (Hafford-Letchfield et al, 2018). Given reported links between this and severe depression in some (Stoll et al, 2021), further research on how it manifests in older people, and how it can be addressed, is warranted.…”

“…However, screening for depression in older people is not routine across settings (Gleeson et al, 2018) and numerous studies have highlighted a reluctance to speak openly about mental health among this generation (e.g. Hafford-Letchfield et al, 2018). In contrast, other research has suggested there is a preference for talking therapies among older people, but in the UK at least, access to these interventions remains low in this group (Frost et al, 2018).…”

“It’s a Living Experience”: Bereavement by Suicide in Later Life

“…Grief therapies that use a family-focused approach include family-strengthening skills, particularly for families who show a high level of distress and find social and physical adjustment challenging [ 30 , 31 ]. A conceptual review of ageing and suicide [ 10 ] has demonstrated how older people experience the loss of something they had enjoyed doing or feeling, a loss of value, a feeling of tiredness and, in some cases, a feeling that they were in a process of losing themselves. All of these factors that can manifest alongside the physical aspects of caring can pose serious risk factors for self-harm and suicide in later life.…”

“…The lack of theoretical and methodological consistency in suicide and ageing research has also been noted [ 8 , 9 ]. Research findings also call for the greater engagement of care professionals [ 10 , 11 , 12 ] and consideration of the interpersonal and structural impacts of ageism [ 13 ] in order to find answers to the multi-faceted impact of bereavement by suicide. This study sought to explore the experience of being bereaved by suicide on the individual in later life, the implications for help-seeking, support needs and how bereavement by suicide interacts with ageing experiences.…”