A recent study of older adults living in long-term care facilities revealed a significant prevalence of suicidal behaviors.
The study, presented at the 2022 American Association of Geriatric Psychiatry annual meeting, showed a 6.4% prevalence for suicidal behaviors among LTC residents over 60 years old, which equates to 64 per 100,000 persons.
The study’s co-researcher Syeda Beenish Bareeqa, MBBS, a clinical researcher at Jinnah Medical and Dental College in Pakistan and a University of Texas Southwestern Medical Center research observer, called the findings “alarming and unexpected.” However, it’s important to note these are not actual suicides or even necessarily suicide attempts. Suicidal behavior includes complete suicides, self-destructive behavior, non-suicidal self-injury and suicidal ideation, which includes thinking about or planning suicide.
Dr. Andrew Duxbury, MD, a gerontologist for UAB Medicine, said he’s not surprised at the study’s findings.
“For the most part, suicidal behaviors happen when people feel they don’t have any control,” he said. “For people in long-term care, a lot of autonomy has been taken away.”
Suicidal behaviors are increasingly common worldwide. The World Health Organization reports that more than 700,000 people die from suicide annually, and older adults contribute to that number. A 2019 WHO study reported U.S. suicide rates at 21.3 per 100,000 for people 55-64 years old, 17.3 for people 65-74 years old and 19.6 for people 75-84 years old. Note these are actual suicides, not suicidal behaviors, and they include all seniors, not just LTC residents.
LTC suicidal behavior study findings
With suicide becoming an increasing worldwide concern, Bareeqa joined with colleagues to study suicidal behaviors in more than 3 million LTC residents, mostly in the United States and Australia.
Beyond the 6.4% prevalence of suicidal behaviors in LTC residents, surprising findings included a higher prevalence among women (15.8%) versus men (7.9%). The finding is inconsistent with past studies, which establish male gender as a suicide risk factor. In fact, the WHO reports the male suicide rate is more than twice as high as the female suicide rate.
Among the suicidal behaviors studied, suicidal ideation was the most common—around 12% among a population of around 2 million people in eight studies.
LTC risk factors
According to the Administration for Community Living, a division of the U.S. Department of Health and Human Services, a person turning 65 has about a 70% chance of needing LTC.
There’s no indication that LTC residence leads to suicidal behaviors, and researchers are still studying the possible causes of suicidal behavior rates for seniors in LTC. However, LTC seems to pose some risk factors for suicidal behaviors. Residents typically have one or more physical or mental illnesses, and they also may be physically and socially isolated, which can lead to feelings of loneliness.
Add to these risk factors a feeling of being out of control and having no other options, and suicidal behavior in LTC facilities isn’t all that surprising, said Duxbury.
LTC systemic problems
It’s not only situational risk factors that make suicidal behaviors common in LTC facilities, said Duxbury. Systemic issues compound the problem, starting with a lack of staff members.
When LTC facilities are short-staffed, employees have less time to get to know residents, make personal connections and provide enrichment activities, Duxbury said. Instead, the staff focuses on basic needs: feeding, changing and medicating.
In addition, regulations on LTC facilities, which are heavily focused on the nursing aspect of nursing homes, make it difficult to implement life enrichments or change protocols, he said. Because the United States views nursing homes as a step down from hospitals, it’s no wonder little attention goes toward making them into true homes.
LTC facilities are also grossly underfunded, which perpetuates the lack of staff and resources to improve them, noted Duxbury.
He sees caregivers, other family members and volunteers as a short-term solution for helping LTC facilities improve their personal connections with residents. Seniors need people to visit with them—not to provide medications or check vitals, he said, but to ask them how they are and listen to them.
Supporting seniors in LTC
“The most important thing is to give these people some feeling of control,” Duxbury said. His advice for caregivers included:
- Be present. If family and friends visit often and are checking on residents, staff is more likely to provide better care.
- Focus on autonomy. “Remember, they see themselves as autonomous adults,” he said. “They are not infants.” To that end, caregivers must find ways to give them choices about their care and how they live their lives.
- Meet basic needs. “The one thing octogenarians have in common is a feeling of curiosity about what comes next. Figure out how to meet basic needs of curiosity, to create and to be needed. These are not that far down on Maslow’s Hierarchy of Needs.”
Duxbury maintains that most people want to live, and they see suicide as a last resort. In states where physician-assisted suicide is legal, the number of people who die from it is small, even though people might investigate it.
“They like to feel like they have the option. It makes them feel more in control.”
Despite physical and mental illnesses, age-related issues and more, said Duxbury, “People are incredibly resilient when given the tools.”
Recognizing suicidal behaviors and getting help
It’s important to look for suicide risk factors in seniors, including chronic and acute health conditions, deaths of loved ones, functional impairment, financial problems and social isolation, among others.
If you suspect suicidal ideation or other suicidal behaviors, take a look at some suicide warning signs and prevention measures. It’s also a good idea to confide your concerns in a trusted doctor or contact the National Suicide Prevention Hotline.