The lead author of a new study on suicides related to long-term care says the research is a call for operators to examine how they are supporting mental health among residents, especially those just moving in.
“The whole point of this work is that people say, ‘Is there something we could be doing differently?’ ” Briana Mezuk, Ph.D., told McKnight’s Senior Living.
Mezuk and colleagues at the University of Michigan believe their study, published Friday by JAMA Network Open, may be the most extensive analysis of suicide related to long-term care in the United States to date.
They used a computer algorithm (and then manually reviewed the data) to search the text of medical examiner and law enforcement reports for 47,759 suicide deaths of adults aged 55 or more years from 2003 to 2015. The researchers identified 1,037 deaths by suicide (2.2%) associated with long-term care, including 428 adults who were living in independent living communities, assisted living communities or nursing homes and 449 adults who were described in death reports as being in the process of transitioning into or out of such long-term care settings. They found that another 160 suicides occurred among older adults who were caring for a family member who was living in a long-term care setting, had experienced a recent hospitalization that was thought to possibly indicate a need for long-term care, or had expressed concerns about the financial burden of long-term care.
Transitions, when residents are moving into a community, “may be an important point of engagement for preventing suicide among older adults,” Mezuk and colleagues wrote.
“Many of the transition cases that we identified referenced fear, loss of autonomy, isolation, being a burden, financial costs, etc.,” she said.
Suicide prevention efforts should try to address these factors — going beyond restricting means or considering medication to help with potential underlying conditions such as depression, Mezuk said. Providers, she added, should ask themselves:
- What should the transition be like?
- What kind of resources do family members need to either talk to their parents or their spouse about this? What kind of supports do they need?
- How long should the transition be?
- How are we partnering with healthcare providers, church groups and other organizations?
- What is the culture of our community? What is it like to live here?
- What’s going on in the resident’s life outside of this building?
“Suicide is an extreme outcome. It’s the tip of the iceberg, and we shouldn’t necessarily have reducing suicide as our only goal, but rather we should be pursuing things upstream of that,” Mezuk said. “We should help people understand that they have a reason to be alive. And the things that do that are promoting social connections, promoting meaningful experiences, promoting meaningful goals.”
Volunteer opportunities for residents can be one way to foster mental health, she said. “Residents have, literally, a lifetime of skills and experiences. Find ways for them to use them,” Mezuk said. Instead of bringing children in to sing to residents, for instance, have residents read to children.
Other suggestions? “Allow residents to participate in the policy-making / rule-making of the institutions. Allow pets. Recognize the importance of conversations about death / aging — don’t ignore it,” she said. “And don’t view the outcome as ‘suicide prevention.’ View it as ‘mental health promotion.’ This is good for both residents and staff.”
At the corporate and industry level, Mezuk said, senior living executives should consider building properties in locations that don’t isolate residents from the greater community.
“At least here in Michigan, you drive down the highway and that’s where the assisted living facility is,” she said. “It’s off to the side of the highway on a huge campus that’s connected to absolutely nothing. And if you don’t have a car or you can’t drive, that’s it. You might as well be on an island in the middle of the ocean.”
At a policy level, Mezuk said, suicide should be a reportable event to state licensing agencies so that independent living and assisted living operators, and others, can better understand what is happening across the industry.
The researcher also recommends that operators implement the free resource “Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Living Communities” (also known as the SPARK Kit) from the federal Substance Abuse and Mental Health Services Administration, and then monitor its effect on the community. The toolkit is available in English and Spanish.
A LeadingAge spokeswoman also pointed out that the organization has free-to-members videos on mental health in its Learning Hub. They are available for purchase for nonmembers.
The results of the JAMA Network Open study, LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living, “corroborate what LeadingAge members know already: supporting older adults physically and emotionally is a critical factor in providing person-centered, high-quality care.”
Beth Martino, senior vice president of public affairs for the American Health Care Association, also agreed with researchers’ point of trying to meet residents’ mental health needs, saying the industry “must remain vigilant.”
“Suicides among long-term care residents is a serious issue, and providers are committed to preventing these tragic events,” she said. “While this study indicates suicides associated with long-term care are extremely rare among older adults — especially those occurring within actual facilities — one suicide is one too many.”