Suicide in Older Adults: Nursing Assessment of Suicide Risk

Abstract

A fundamental objective of the National Strategy for Suicide Prevention is the prevention of suicide in older adults, especially elderly males, because these individuals are at higher risk for suicide than any other age group. Furthermore, they are the fastest growing segment of the population. The suicide rates for older Caucasian men are particularly high. Because nurses play an important role in the identification of persons at risk for suicide, it is important that they be cognizant of the complex risk factors involved in late life suicide. Toward that end, we review the prevalence of suicidal behaviors in older adults and discuss risk factors that contribute to completed suicide in these individuals. Lastly, we discuss the role of nurses in the identification of older adults at risk for suicidal behavior so that life-saving treatment measures can be implemented.Older American's currently comprise about 13% of the population in the U.S., yet they account for 18% of all suicide deaths (Arias, Anderson, Kung, Murphy, & Kochanek, 2003). Suicide is the thirteenth leading cause of death in persons age 65 years or older (National Institute of Mental Health, 2004) and these individuals are at the highest risk for completed suicide. Furthermore, Caucasian men over the age of 85 have an especially high rate (59 per 100,000 persons) of completed suicide. Recognized as a major public health concern, the Office of the Surgeon General of the U.S. released the National Strategy for Suicide Prevention: Goals and Objectives for Action (Office of the Surgeon General, 1999). A central mandate of that strategy is the prevention of suicide in older adults because these individuals are at higher risk for suicide than any other age group and they are the fastest growing segment of the population (Arias et al., 2003 Older adults, however, present special challenges to suicide prevention efforts. For example, suicide and attempted suicide are often associated with depression, psychosis, and substance abuse among younger individuals, yet among older adults, depression and comorbid medical conditions play important contributory roles. (Alexopoulos, Bruce, Hull, Sirey, & Kakuma, 1999;Caine & Conwell, 2001;Conwell, Duberstein, & Caine, 2002;Miles, 1977;Pearson & Brown, 2000; Tuvey et al., 2002). Because nurses play a vital role in the identification of persons at risk for suicide, and the current "baby boom" cohort have substantially higher suicide rates than preceding generations (McIntosh, 1992), it is important to be cognizant of the complexity of risk factors associated with late life suicide. The purpose of this paper is to focus attention on the prevalence of suicidal behaviors in older adults and lay a foundation for understanding the role of risk factors in the prevention of suicide. We identify risk factors that contribute to completed suicide in these individuals and review the role of nurses in identifying older persons at risk for suicidal behavior so that life-saving treatment measures can be implemented.

Triaging suicidal patients: Sifting through the evidence

“…A possible reason for this is that older individuals are more likely to die in a suicide attempt (Conwell and Duberstein, 2005). A number of factors can account for this including more frail health which can render them less likely to survive an attempt, use of more forethought and more lethal means, and living alone meaning that they are less likely to be discovered in time (Conwell and Duberstein, 2005;Garand et al, 2006;Szanto et al, 2002). Elderly people may also demonstrate idiosyncratic reactions to antidepressants which may increase their suicide risk (Juurlink et al, 2006).…”

Inter‐rater reliability of the German version of the Nurses' Global Assessment of Suicide Risk scale

“…Garand et al () also report the use of the NGASR in populations of older adults. As a result, there is some limited evidence that indicates that while the NGASR was designed for nurses, it might have transferability to, and utility for, other professional groups.…”

Global Self-Rated Health Status Predicts Reasons for Living Among Older Adults

“…The purpose of the present study was to explore predictors of reasons for living among a sample of community-dwelling older adults. We included variables known to be related to suicide in general, including age, depression, adverse life events, the tendency to be optimistic or pessimistic, and physical health status (e.g., Conwell et al, 2002;Duberstein & Conwell, 2000;Garand, Mitchell, Dietrick, Hijjawi, & Pan, 2006;Préville, Hébert, Boyer, Bravo, & Seguin, 2005).…”