Robin Bonifas, PhD, MSW
Assistant Professor
College of Public Programs
SCHOOL OF SOCIAL WORK
Kristen Rathjen
Rebecca Ong
Debra Hobaica
Natalie Goff
Holly Gilbert
Carmen Calderon
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The national rate of suicide for older adults age 60 and older
was 14.7 per 100,000 in 2005 (McDermott, 2009).
In 2006, 5,299 older adults killed themselves. This is
equivalent to 14 deaths per day.
In 2006, the state of Arizona ranked at #4 in the United
States for the most older adult suicides with a rate of 25.5
cases per 100,000 people.
Compare: 10 cases per 100,000 in the population vs. 15 older
adult cases per 100,000
In 2006, older adults made up 12.5% of the U.S. population
and accounted for 15.9% of all suicides.
For older adults age 85 and older the rate was 28.02 deaths
per 100,000.
According to the Centers for Disease Control and
Prevention, 103 individuals in long term care completed
suicide in 2003 (Reiss & Tishler, 2008).
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National statistics are
not clear on the
prevalence of suicides
in nursing homes
Very little information
has been published but
there are studies that
give insight to this
issue
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A study examined the number of suicides from 1990-2005 of
NYC residents aged 60 and older that were residing in longterm care (LTC) facilities compared with those that were
residing in the outside community:
» There were 47 suicides by residents in LTC facilities.
» There were 1,724 suicides by people residing in the
community.
» The LTC group was relatively older (a mean age of a 76.2)
compared to than the community-dwelling group (a
mean age of 72.9).
» In both groups, most decedents were male (61.7% of LTC
and 69.7% of community-dwelling groups) and nonHispanic white (68.1% of LTC and 72.0% of communitydwelling groups).
Mezuk, B., Prescott, M., Tardiff, K., Vlahov, D., & Galea, S. (2008). Suicide in older adults in
long-term care: 1990 to 2005. Journal of the American Geriatrics Society, 56(11), 2107-2111.
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Suicides in LTC were less likely to be due to firearms and
more likely to be due to a long fall compared to the
community-dwelling group.
Over the 15-year period, there was a decrease in the number
of suicides per year in the community-dwelling group.
There was no change in the number of suicides in the LTC
group.
LTC residents should be routinely screened and periodically
reassessed for psychiatric disorders associated with suicide
risk, including depression and dementia, and appropriately
treated.
Mezuk, B., Prescott, M., Tardiff, K., Vlahov, D., & Galea, S. (2008). Suicide in older adults in long-term
care: 1990 to 2005. Journal of the American Geriatrics Society, 56(11), 2107-2111.
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As a part of the National Suicide Prevention Project, a study
in Finland looked at suicides among older adults in nursing
homes during a 12-month period:
» 1,397 suicides occurred between April 1, 1987 and March
31, 1988.
» 12 residents aged 60 or older took their own lives, which
represented 0.9% of all suicides in the study.
» The mean age was 76.1 plus or minus 5.7 years.
» 75 % were male.
» The most common suicide method was hanging (67%).
Suominen, K., Henriksson, M., Isometsa, E., Conwell, Y., Heila, H., & Lonnqvist, J. (2003).
Nursing home suicides – a psychological autopsy study. International Journal of Geriatric
Psychiatry, 18, 1095-1101.
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Five residents (42%) had been placed in a nursing home
during the last year before their deaths.
Four (33%) residents had reported pain and four (33%) had
previously attempted suicide.
Nine (75%) residents were diagnosed with a depressive
syndrome.
Three (25%) residents were diagnosed with alcohol
dependence or abuse.
None of the three cases with diagnosable major depression
was receiving antidepressant.
The nursing home residents who died by suicide had highly
co-morbid somatopsychiatric disorders, compared to older
adults in general.
Suominen, K., Henriksson, M., Isometsa, E., Conwell, Y., Heila, H., & Lonnqvist, J. (2003). Nursing
home suicides – a psychological autopsy study. International Journal of Geriatric Psychiatry, 18,
1095-1101.
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A computerized database search was conducted to identify cases
of completed suicide between 1981 and 1997 in Olmsted County,
Minnesota and surrounding communities where there are 846
nursing home beds:
» Five cases of completed suicide and three suicide attempts
were identified, including six men and two women.
» Deaths were the result of drowning, hanging or medication
overdose.
» The age ranged from 69 to 87 years old.
» Most had been nursing home (NH) residents for less than 6
months.
» Suicide risk among NH residents seems to be highest among
men and those recently admitted to facilities.
Menghini, V. & Evans, J. (2000). Suicide among nursing home residents: A population-based study.
Journal of the American Medical Directors Association, 1(2), 47-50.
»
»
»
»
»
Giving away belongings
Withdrawal from family,
friends and caregivers
Loss of interest in
enjoyable activities
Abuse of alcohol and/or
drugs
Irresponsible behavior
»
»
»
»
»
»
Impulsivity
Self-mutilation
Lack of interest in
appearance
Disturbed sleep
Change or loss of appetite
and in weight
Physical health complaints
(Living Works Education USA, 2008)
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Types of Feelings
» Desperate
» Angry
» Guilty
» Worthless
» Lonely
» Sad
» Hopeless
» Helpless
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»
»
»
»
»
»
What might be said:
“I won’t be needing this anymore”
“I can’t take it anymore”
“Everything will be over soon”
“You are all better off without me”
“I wish I were dead”
“All of my problems will be over
soon”
(Living Works Education USA, 2008)
Reviewer Anonymous:
It would be helpful to include some information about
what a safe plan might entail.
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Ask clearly and directly about thoughts of suicide:
» Are you having thoughts of suicide?
» Do you have a plan?
» Are you in so much pain that it feels unbearable?
Listen for their reasons for wanting to die.
Listen for their reasons for wanting to live.
Implement a safe plan.
Follow-up with client.
(Living Works Education USA, 2008)
(Living Works Education USA, p.14, 2008)
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Direct or overt actions that
will most-likely cause
injury or death:
» Includes wrist slashing,
jumping, hanging,
smothering, gunshot
and overdose
(Reiss & Tishler, 2008)
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Indirect self-destructive
behavior:
» Refusing to eat or drink
» Refusing medications
» Refusing to follow
medication directions
(Reiss & Tishler, 2008).
Presence of mental illness
 Mood disorders such as depression:
» In many cases, depression in older adults is not
recognized by staff.
» Those who are treated for depression are frequently
undertreated.
» When comorbid with anxiety, suicide risk goes up.
» Hopelessness also increases risk of suicide.
 Physical illness & functional impairment:
» Physical illness accompanied by pain
» Medical conditions such as stroke, cancer, dementia
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(Reiss & Tishler, 2008)
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Stressful life events:
» Loss of Health
» Loss of autonomy
» Loss of family and friends
»
Loss of support system
»
Change in important roles
(Reiss & Tishler, 2008)
Environmental Stressors:
»
NH environment can generate
suicidal behavior when there is
a high prevalence of staff
turnover and attention is not
given to the impact of a loss or
decrease in decision making and
independence of residents.
(Reiss & Tishler, 2008)
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Risk factors for suicide in
older adults include
refusal to eat, refusal to
take medications and
medical non-compliance.
However, these signs are
many times ignored,
misinterpreted or
unidentified.
Walker and Osgood (2000)
found that LTC staff are in
need of better training to
identify risk factors and
intervention strategies.
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Training should focus on:
» Learning to identify the methods of suicide by older adults
» Understanding why dementia increases the risk of suicide
» Identifying hopelessness and major life changes as
potential triggers of suicidal ideation
» Identifying primary and secondary treatment options
The results of the study done by Walker and Osgood (2000)
indicate that after a training curriculum, the majority of staff
were able to identify a gun shot as the most common
method of suicide among older adults. The staff also
increased their knowledge of depression, hopelessness and
suicide.
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Screening should include:
» Brief Interviews
» A standardized rating
scale
» A geriatric depression
scale for NH residents
who do not have
cognitive issues
» Use of the Cornell Scale
for Depression in
Dementia for NH
residents with cognitive
difficulties
(Reiss & Tishler, 2008)
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After screening for depression, clinicians should screen for
suicidal ideation.
Examples of questions to ask:
» “Have you been feeling so sad lately that you were thinking
about death or dying”?
» “Have you had thoughts that life is not worth living”?
» “Have you been thinking about harming yourself”?
(Reiss & Tishler, 2008, p. 267)
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Medications
Psychotherapy:
» Supervised peer volunteer
programs
» Group cognitive therapy
» Bright light therapy
» Reminiscence/life review
Adjusting environments to include:
» Photographs of residents and
family members
» Interesting reading materials
» Pets
» Music
» Enjoyable activities
(Reiss & Tishler, 2008)
References
American Association of Suicidology. (2009a). Suicide and the elderly [Fact sheet]. Retrieved from
http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-158.pdf
American Association of Suicidology. (2009b). USA suicide: 2006 official final data [Fact sheet].
Retrieved from http://www.suicidology.org/c/document_library/get_file?
folderId=228&name=DLFE-142.pdf
American Association of Suicidology. (n.d.). USA state suicide rates and rankings among the elderly and
young, 2006 [Fact sheet]. Retrieved from http://www.suicidology.org/c/document_library/
get_file?folderId=228&name=DLFE-144.pdf
Living Works Education USA, I. (2008). Applied suicide intervention skills training. Fayetteville,
NC.
McDermott, B. (Researcher). (2009, March 1). Older adult suicide in Maricopa County: trends and
needs. Phoenix, AZ: Area Agency on Aging, Region One ElderVention.
Menghini, V. & Evans, J. (2000). Suicide among nursing home residents: A population-based study.
Journal of the American Medical Directors Association, 1(2), 47-50.
Mezuk, B., Prescott, M. R., Tardiff, K., Vlahov, D., & Galea, S. (2008). Suicide in older adults in
long-term care: 1990 to 2005. Journal of the American Geriatrics Society, 56(11),
2107-2111.
References continued
National Institute of Mental Health, NIHM. (2007, April). Older adults: depression and suicide facts.
Retrieved from http://www.nimh.nih.gov/health/publications/older-adults-depression-andsuicide-facts-fact-sheet/index.shtml#conwell-later-life
Reiss, N. S., & Tishler, C. L. (2008). Suicidality in nursing home residents: Part I. prevalence, risk factors,
methods, assessments and management. Professional Psychology: Research and Practice,
39(3), 264-270.
Reiss, N. S., & Tishler, C. L. (2008). Suicidality in nursing home residents: Part II. special issues.
Professional Psychology: Research and Practice, 39(3), 271-275.
Scocco, P., Fantoni, G., Rapattoni, M., Girolamo de, G., Pavan, L. (2009). Death ideas, suicidal thoughts,
and plans among nursing home residents. Journal of Geriatric Psychiatry and Neurology,
22(2), 141-148.
Suominen, K., Henriksson, M., Isometsa, E., Conwell, Y., Heila, H., and Lonnqvist, J. (2003). Nursing
home suicides: A psychological autopsy study [Electronic version]. International Journal of
Geriatric Psychiatry, 18, 1095-1101.
Walker, B.L., and Osgood, N. J. (2000). Preventing suicide and depression: A training program for longterm care staff. OMEGA, 42(1) 55-69.
Zarit, S. H., & Zarit, J. M. (2007). Mental disorders in older adults. New York: Guilford Press.