Towards Zero Suicide: need and opportunities to improve implementation of clinical elements for older adults

Abstract

Objective: The Zero Suicide (ZS) framework is increasingly used in Australia, but without published adaptations for older people, and limited access by older people when implemented. The aim of this paper is to inform Towards Zero Suicide (TZS) implementations to benefit older adults by considering the key differences in older adults at risk of suicide according to each clinical component of the ZS framework. Conclusion: TZS aspires to reduce deaths by suicide for people within healthcare by refocusing interventions on suicidality rather than diagnosis alone, emphasising evidence-based practices and cultural change. For TZS to be effective for older people, it is essential to ensure practices are based upon evidence relevant to older people and to ensure ageism is effectively counteracted. Older adults have distinct patterns of help seeking and service use, accompanied by differences in risk factors, presentations, and outcomes of suicidal behaviours. Ageism affects assessment, decision-making and actions to address self-harm and suicide for older people. Immediate and longer-term actions are essential to effectively implement TZS in this population.

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

“…For example, the participants spoke about such thoughts using terms such as being “fed up” or “tired” with life or making statements such as “what's the point anymore?” In line with earlier work (Frey et al, 2018 ; Calear, 2019 ), the stigma surrounding mental health and suicide-related topics in later life appeared to mean that these individuals felt more comfortable discussing these topics in colloquial ways through informal (e.g., friends), rather than formal, networks (e.g., GPs or other healthcare providers). Older people progressing from more passive (e.g., suicidal thoughts or wishes to die) to active suicidal expressions (e.g., neglect or self-harm with intent) are also more likely to engage in implicit, rather than explicit, expressions/behaviors (Wand and McKay, 2022 ). For example, these individuals may begin deliberately not looking after themselves, stopping eating or drinking, refusing to take important medication, or otherwise engaging in unsafe or destructive behaviors, for example, excessive drinking and eating high-sugar foods if the person was diabetic, or not seeking help for serious medical conditions.…”

A systematic review of evidence-based aftercare for older adults following self-harm

“…There is good evidence that the presentation, engagement and needs of older adults are different to younger adults, mandating adaptation of existing suicide prevention models based on evidence derived from older-adult populations. Such evidence (Wand et al, 2018a(Wand et al, , 2018b(Wand et al, , 2018c(Wand et al, , 2019a(Wand et al, , 2019b has elucidated the specific importance of addressing ageism and treatment nihilism among health care professionals, and inclusion of primary care and transition services in the prevention of suicide in older adults (McKay et al, 2021;Wand et al, 2021a).…”