Suicide in Nursing Homes

Lisa ArmstrongSociology of Suicide

SOC 797.03

Elderly Statistics(Source: American Psychological Association)

•People aged 65+ are the fastest growing segment of the U.S. population

•Elderly mental and behavioral problems are projected to quadruple from 4 million in 1970 to 15 million by 2030

•50-70% of primary care visits are related to psychological factors such as depression

•The World Health Organization projects that by 2020, depression will be the leading cause of disability, second only to cardiovascular disease

Elderly Suicide Statistics(Source: American Association of Suicidology)

•Currently, elderly account for 12.3% of the population, but account for 17.5% of suicides

•By 2030, people aged 65+ will comprise 21.8% of population and account for 35% of suicides

•There is 1 elderly suicide every 95 minutes

•At age 85+, the suicide rate is 4x higher than the average annual rate, at 51 compared to 11

•At ages 65+, 1 suicide for every 4 attempts

•At ages 15-24, 1 suicide for 100-200 attempt

•85% of elderly suicides are male

Methods of Suicide(Source: American Association of Suicidology)

•Firearms were responsible for 72% of elderly suicide deaths

•Men use firearms twice as often as women

•One of the leading causes of elderly suicide is undiagnosed/untreated depression

Profile of Suicide Risk(Source: Elderly Suicide, Secondary Prevention)

•Gender: Male

•Religion: Protestant; seldom attends church (Catholic/Jewish faiths protective factor)

•Race: White

•Marital Status: Widowed/Divorced

•Environment: Urban, living alone, isolated, recent move

•Employment Status: Retired or unemployed

•Physical Health: Poor heath, terminal illness, multiple illnesses, presence of pain

Profile of Suicide Risk (cont’d)

(Source: Elderly Suicide, Secondary Prevention)

•Mental Health: Depressed, lonely, hopeless, fatalistic, low self-esteem, dissatisfied with life, alcohol abuse or dependence

•Background: Family history of suicide or depression, personal history of depression, history of broken home, childhood trauma

•Motivation: Wish to end an intolerable situation, recent death of spouse, social role changes, fear of prolonged illness, poor health

•Method: Firearms, Hanging, Jumping

•Suicide Attempts: Usually successful on first attempt, failed attempts = high risk

Reaching Out(Source: Elderly Suicide, Secondary Prevention)

•Older adults are not inclined to use suicide hotlines or crisis intervention centers

•They generally do not speak directly of suicide ideation, but rather present physical/somatic complaints to physician

•Among suicide victims aged 55+, 20% saw a general physician on the same day and 40% within one week of their suicide

Suicide in Nursing Homes (Source: Suicidality in Nursing Home Residents)

•Currently, 5% or 1.4m persons aged 65+ live in nursing homes in the United States

•By 2030, projected to double to 3m persons

•20-50% of people aged 85+ will require nursing home care before they die

•Relocation to a nursing home places older adults at risk for developing depression and suicide ideation and completion

•Depression/mental health issues are under-recognized and poorly treated in nursing homes

•Most psychologists lack formal training in geropsychology

Suicide in Nursing Homes (Source: Suicidality in Nursing Home Residents, Suicide Phenomena in Nursing Homes)

•The nursing home environment itself can trigger suicidal behavior

•Anticipation of nursing home placement may be a precipitant of suicide among the elderly

•Large nursing homes with high staff turnover, and those that fail to address the loss of resident autonomy and decision-making ability have higher rates of suicidal behavior

•Protective factors are not always effectively operating in nursing homes

NH Protective Factors (Source: Suicidality in Nursing Home Residents, Suicide Phenomena in Nursing Homes)

•In 1988 NY nursing home residents aged 70+ suicide rate was significantly lower than that of their general population peers – 19.74 compared to 98.56 per 100,000

•Nursing home residents used different suicide methods from their matched controls – firearms were less frequently used

•Jumping, hanging, drug overdose, drowning, and cutting are the most common suicide strategies used by nursing home residents

•Objects that can be used for self-harm can be removed and implementation of a ‘suicide watch’ is often effective

NH Risk Factors (Source: Suicidality in Nursing Home Residents, Suicide Phenomena in Nursing Homes)

•Indirect Self-Destructive Behavior

•Methods of passive suicide such as refusing to eat, drinking excessively, delaying or refusing treatment of medical conditions, or taking unnecessary risks

•80 per 100,000 nursing home residents die from indirect self-destructive behavior

•There is a positive association between the level of indirect self-destructive behavior and suicidal ideation

•Most indirect self-destructive behaviors are not “counted” as suicides by official registries

Conclusion •Most studies suggest that nursing home residents may present a lower suicidal risk than their matched controls from the general elderly population

•This is predominantly due to the access of ‘direct’ means/methods to suicide and the close contact/supervision from nursing home staff

•However, data may be underestimated, due to methodological problems of data collection by registries, particularly with regard to suicide as a result of self-destructive behavior

Durkheimian Perspective•Egoistic Suicide – excessive individualism

•“Suicide varies inversely with the degree of social integration of the social groups of which the individual forms a part.”

•“The more weakened the groups to which he belongs, the less he depends on them, the more he consequently depends only on himself.”

•“Admitted masters of their destinies, it is their privilege to end their lives…they have no reason to endure life’s sufferings patiently, for they cling to life more resolutely when belonging to a group they love.”

•“The bond attaching man to life relaxes because that attaching him to society is itself slack”

•Consider retirement and the sense of loss of purpose, and isolation from religious, domestic, and political community

Durkheimian Perspective•Altruistic Suicide – excessive integration

•“Suicides of men on the threshold of old age or stricken with sickness.”

•“The weight of society is thus brought to bear on him to lead him to destroy himself”.

•“For the individual to occupy so little place in collective life he must be almost completely absorbed in the group and highly integrated.”

•“To all intents and purposes, indistinct from his companions, he is only an inseparable part of the whole without personal value.”

•Consider the burden of healthcare costs, usefulness to state/society, loss of public respect, stigma of illness (AIDS), loss of autonomy/individuality in nursing home

Durkheimian Perspective•Anomic Suicide – lack of regulation

•“A declassification occurs which suddenly casts individuals into a lower state than their previous one. Then they must reduce their requirements, restrain their needs, learn greater self-control. All the advantages of social influence are lost so far as they are concerned…they are not adjusted to the condition forced on them, and its very prospect is intolerable; hence the suffering which detaches them from a reduced existence even before they have made trial of it.”

•Consider the giving up of one’s personal abode, belongings, social status, etc. in moving to a nursing home.

Durkheimian Perspective•Fatalistic Suicide – excessive regulation

•“Inflexible nature of a rule against which there is no appeal”

•“Persons with futures pitilessly blocked and passions violently choked by oppressive discipline.”

•Consider that many people do not have a ‘choice’ with regards to being placed in nursing home care, often through mental or physical disability or incapacity

•Their daily lives are extremely routine-bound from waking time, mealtime and bedtime, to medication regimens

•Privacy, autonomy and personal decision-making are often cited as major causes of depression and suicide ideation

Suicide in Nursing Homes

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