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- Research Proposal and Null Hypothesis with Example (Tutorial 2019)
- Suicide risk in long-term care facilities: A systematic review
Suicide risk is highest in later life, however, little is known about the risk of suicide among older adults in long-term care facilities e. The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Of the 4, unique research articles identified, 36 were selected for inclusion in this review.
Of the included reports, 20were cross-sectional, 10 were longitudinal, three qualitative, and five were intervention studies. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline.
Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics e.
Existing research on suicide risk in long-term care facilities is limited, but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents.
It is increasingly recognized that suicide in later life is an important public health problem.
Suicide is among the top 10 leading causes of death in the US U. In recent years suicide risk has been rising for middle-aged aged 35 — 64 adults CDC, ; Caine et al.
Prevention strategies that promote well-being across settings and over the lifespan are needed. The Surgeon General National Strategy for Suicide Prevention specifically identifies healthcare organizations, aging services networks, and other programs that offer support to older adults as settings for suicide prevention efforts U.
DHHS, However, the suicide risk in long-term care LTC facilities i. In the US, currently 1.
Research Proposal and Null Hypothesis with Example (Tutorial 2019)
It is possible that concerns about the transition to a LTC facility may itself be a risk factor for self-harm Loebel et al. However, LTC facilities also offers facilitated contact with peers, greater monitoring of daily activities, more contact with health and mental health professionals, and presumably less access to lethal means of suicide.
In sum, neither the quantity of suicidal behavior, nor the factors that influence suicide risk in these settings, is well understood. For instance, suicide prevention strategies that are effective in community or primary care settings may not be applicable to long-term care and senior living facilities. There is also the need to develop interventions that reflect the needs of future residents of LTC facilities e.
In this paper we review the empirical research on suicide risk in long-term care facilities over the past 25 years, synthesize the descriptive and analytic epidemiology of suicide in these settings, and provide suggestions for future prevention and intervention efforts. Four databases were searched between 5 June and 30 June The reference lists of previous systematic reviews, meta-analyses, and selected studies were screened.
Only peer-reviewed original empirical articles were considered for inclusion. For multiple publications from the same study, only those presenting novel results or analyses were included. Abstracted data included: year, first author, location, study design, sample characteristics, measures, outcome, and summary of the main findings. Of articles selected for full-text abstraction, those investigating suicide risk factors e. Reports on assisted suicide, euthanasia, or end-of-life decision-making were excluded.
A total of 4, unique research articles were retrieved from search see Flowchart. After screening titles based on our inclusion criteria, articles were selected for full-text abstraction.
From the articles abstracted, 36 articles were retained for analysis. The 36 articles selected for analysis encompassed 20 cross-sectional reports, 10 cohort studies, three qualitative studies, and five intervention studies.
First, we note that these 36 reports used a wide range of terminology to describe suicidal behavior. However, in other cases terms were more global e. Finally, we have organized these studies according to the primary outcome examined: completed suicide Table 1 , suicidal thoughts or attempts Table 2 , and interventions aimed at addressing suicide risk in LTC Table 3.
Many reports examined multiple aspects of suicide risk in a single study, and in these cases we categorized them according to the most serious outcome assessed i.
Table 1 summarizes the findings from studies evaluating the epidemiology and risk factors for completed suicide in LTC settings. Seven studies estimated of the prevalence of completed suicide in LTC settings. In a study of LTC facilities housing 30, residents, Osgood et al. Six studies estimated the incidence for completed suicide in LTC settings, with substantial variability across the reports.
For example, Abrams et al. In an analysis of 12 LTC facilities from — Menghini and Evans estimated the incidence of completed suicide to be 35 per , person-years Menghini and Evans, Using data from Italy, Scocco et al.
While they did not estimate cumulative incidence, Mezuk et al. The most common methods of suicide in LTC settings included hanging 5 studies , jumping 3 studies , drug overdose 2 studies , firearm 2 studies , wrist slashing, asphyxiation, refusing to eat or drink, medication refusal, drowning, and self-poisoning Abrams et al.
When compared to methods of suicide in the community, cases in LTC facilities were less likely to involve firearms and 2. The prevalence of suicidal thoughts and attempts in LTC settings is generally high, particularly compared to the general population.
In Table 2 we distinguish between lifetime prevalence report of suicidal thoughts or a suicide attempt at any point in time and point prevalence report of suicidal thoughts or a suicide attempt contemporaneous with the time of interview, generally within the past 14 — 30 days.
In their study of LTC residents, Scocco et al. In a study of LTC residents, Draper et al. In an analysis of new LTC residents, Ron reported that the prevalence of suicidal thoughts was highest in the first seven months since entering as measured by the Scale for Suicidal Ideation Ron, Malfent et al.
Finally, in a small study comparing suicide risk between LTC residents and psychiatric inpatients, the point prevalence of suicidal thoughts as assessed by the Beck Scale for Suicidal Ideation was comparable between the groups approximately 2.
Individual-level risk factors for completed suicide in LTC generally mirror those of suicide in the general population: male gender; Osgood and Brant, ; history of depression, substance abuse, loss of spouse within the past year, previous history of suicidal behavior, intact cognition, and impaired mobility Menghini and Evans, ; Suominen et al.
Findings are similar for suicidal thoughts and attempts, including lack of a confidant, depressed mood, feelings of helplessness, lower life satisfaction, lower well-being Haight, ; Uncapher et al.
Meeks and Tennyson also reported suicidal thoughts were positively correlated with the number of medications prescribed Meeks and Tennyson, For recently relocated LTC residents, suicidal thoughts were associated with history of family conflict and dysfunction Haight and Hendrix, Although it is hypothesized that organizational characteristics of LTC facilities e.
In her seminal study of suicidal behavior in LTC facilities, Osgood reported that staff turnover and facility size were positively correlated with the frequency of attempted suicide, completed suicide, and indirect life-threatening behavior; lower per diem costs and type of facility ownership public, private, religious, other were also positively correlated with completed suicide Osgood, More recently, Scocco et al.
Low et al. There is very little known about whether anticipating placement in a LTC facility may act as a risk factor for suicide.
Individuals who were married were more likely to report LTC placement as a reason for suicide as compared to unmarried persons Loebel et al. In a study of new LTC admissions, Morriss et al.
Assessment and evaluation of preventative interventions for suicide in LTC settings remains limited Table 3. Three studies focused on interventions for healthcare providers and geriatric caregivers, while only two were directed to LTC residents themselves. Ziervogel et al. In a study evaluating knowledge and ability to recognize risk factors for completed suicide and indirect suicidal behavior among clinical psychologists who work with older adults, providers were generally able to identify clinical risk factors e.
The primary finding from this review is that although completed suicide is rare, both passive and active suicidal thoughts are common among residents of LTC facilities.
Suicide risk in long-term care facilities: A systematic review
The main correlates of suicidal behavior in these settings are the same as those in the community: depression, social isolation, loneliness, health problems and functional decline. Finally, only a handful of intervention studies have examined promoting mental health for older adults in these settings, and the effectiveness of these programs is largely unknown.
This review highlights the limitations of extant research. Most of the studies here involved small samples that have unknown generalizability. Only a handful of studies included comparisons to older adults living in the general community, which means it is unresolved whether suicide risk is elevated in these settings among and beyond what is expected among older adults living in the general community. Almost all reports were cross-sectional in nature and enrolled a mix of both new and established residents.
Inconsistent terminology regarding aspects of suicidality i.
These issues also limit our ability to understand the source of the substantial variability across studies as to the prevalence of suicide risk, including the possibility that suicide risk in LTC may have changed over the past 25 years as LTC systems i.
We also note that there is very limited research on either the LTC transition process or periods of risk among LTC residents, or whether organizational characteristics of these settings e. One reason for the lack of information on suicide risk in LTC facilities is that prior to universal screening for suicidal ideation in these facilities had not been widely adopted nor recommended as an approach to prevent suicide U.
The full MDS 3. Data from the revised MDS assessments may therefore provide valuable information about suicidality among LTC residents and periods of greatest risk.
The release of the National Survey of Residential Care Facilities demonstrates both the rapid growth in non-nursing home LTC alternatives, as well as the wide range of variability in assisted living and other residential care facilities Caffrey et al.
Strong trends indicate that assisted living facilities are displacing the market for nursing homes in LTC, particularly for older adults with fewer functional limitations Grabowski et al. The characteristics of both the residents and the services offered by these facilities differs substantially from those in nursing homes Grabowski et al. To better understand the relationship between organizational-level characteristics and suicide risk in LTC facilities three areas need to be developed.
First, a clear theoretical framework for organizational-level interventions must be developed that identifies the essential components of effective interventions. Second, objective data of organizational-level characteristics associated with suicide risk in LTC facilities need to be collected; MDS 3.
Third, health services research needs to identify best practices of organizational-level interventions e. Long-term care facilities may serve as an opportunity for organizational-level interventions for suicide prevention. For example, in the Air Force implemented an institutionalizing community-wide prevention program endorsed by the senior ranks Knox et al. This program led to institutional policy changes regarding the availability of resources as well as radical changes in social norms to decrease stigma around help-seeking behaviors for all members of the community Knox et al.
Like the Air Force, LTC facilities may be appropriate settings for this type of organizational change.
Over the past 30 years, a small but growing body of research has shown that both passive and active suicidal thoughts, direct and indirect self-harm, as well as several risk factors for completed suicide, are prevalent among residents of LTC facilities. Additional inquiry regarding factors that contribute to, as well as those that may ameliorate, this burden is warranted. National Center for Biotechnology Information , U. Int J Geriatr Psychiatry. Author manuscript; available in PMC Dec 1.