Suicide prevention, mental health promotion, and falls prevention among older adults

Transcription

1 Suicide prevention, mental health promotion, and falls prevention among older adults Anara Guard Suicide Prevention Resource Center Safe States Alliance annual meeting April 15, 2010

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3 Rates increase with age U.S. Suicide Mortality Rate per 100,000 (2006) Male Female Rate per 100,000 Age Group

4 WHY? RISK FACTORS FOR SUICIDE AMONG OLDER ADULTS Depression major depression, other Prior suicide attempts Co-morbid general medical conditions Social dependency or isolation Family discord, losses Personality inflexibility, rigid coping Access to firearms Alcohol use disorders

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6 Summit Assumptions Broad-based approach to emotional health Promoting emotional health is not solely the job of mental health professionals Senior living communities are diverse settings No one-size-fits-all approach

7 Wellness Dimensions Physical Emotional Social Spiritual Intellectual Vocational

8 Framework for prevention Whole population Promoting health and mental health At risk Recognizing and responding to signs Crisis response To both the individual and others affected

9 Sample Activities/Ideas Whole-Population Approaches Train residents re: signs and symptoms of depression Establish peer support groups for residents Promote wellness activities At-Risk Approaches Train residence health providers Strengthen pre-admission screening Address stigma and promote help-seeking Response to Crises and Suicidal Behavior Approaches Develop protocols for crisis response Provide postvention support Incorporate media guidelines

10 Risk factors for suicide or falls? Depression Social isolation Health problems Vision deficits Gait and balance Muscle weakness Pain Postural hypotension Medication side effects Alcohol Fear of falling Fear of being institutionalized Fatalistic beliefs Keeping secrets

11 The hidden problem of alcohol

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13 Falls assessment in action

14 Shared remedies? Exercise Vision checks Cardiovascular assessment Social support Recognizing and responding to signs of depression Recognizing and responding to signs of falls risk Simultaneous screening Encouraging conversations with providers

15 OLDER ADULT SUICIDE METHODS

16 A question Can older adult falls prevention programs engage in mental health promotion at the same time?

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18 The Growing Elderly U.S. Population % million % million % million % million Census 2000

19 THE INCIDENCE & RATES BY AGE GROUP (2005) ,344 1,940 Males 22.73/100, Females 3.99/100, ,200 1,889 Males 35.77/100, Females 4.00/100, Males 45.23/100, Females 3.99/100,000

20 Optimal Approach Whole Population + High Risk + Response

21 PROTECTIVE FACTORS Effective clinical care for mental, physical, and substance use disorders Easy access to a variety of clinical interventions and support for helpseeking Restricted access to highly lethal means of suicide Strong connections to family and community support Support through ongoing medical and mental health care relationships Skills in problem solving, conflict resolution, and nonviolent handling of disputes Cultural and religious beliefs that discourage suicide and support selfpreservation

22 ATTEMPTS & COMPLETIONS For all ages combined, ratio of attempts to completion = 25 to 1 For young (15-24), ratio of attempts to completions = to 1. For elderly (65+), ratio of attempts to completions = 4 to 1. Source: American Association of Suicidology

23 LETHALITY OF LATE LIFE SUICIDE Older people are: more frail (more likely to die) more isolated (less likely to be rescued) more planful and determined Implying: interventions must be aggressive primary and secondary prevention are key

24 Considerations for Preventing Suicides in Older Adults Over 80% of violent deaths among the elderly are suicides Nearly 85% of suicides are males Nearly 70% involve a firearm and nearly 85% occur at home Over 45% exhibit signs of depression Over 30% have a diagnosed mental health problem Over 25% disclosed their intent to complete suicide 25% were in current treatment for a mental health problem 25% had been treated for a mental health problem prior to their death 8% had a history of prior attempts 33% left a suicide note Over 60% had a physical health problem that family members say likely contributed to their suicide Over 20% had a crisis occur in the two weeks preceding their death Source: CDC preliminary data from period

25 SUICIDE PREVENTION FOR OLDER ADULTS Treatment of Depression in Primary Care PROSPECT (treatment guidelines & care management) found reductions in suicidal ideation and depressive symptoms. IMPACT (depression care management) found reductions in depressive symptoms. Physician Education Götland, Sweden Restricting Access to firearms Intervention has not been evaluated. Good underlying evidence. Screening Good instruments. Limited evidence. Community Outreach Gatekeeper training (Spokane, WA) TeleHelp-TeleCheck (Northern Italy)

26 Summit: It Takes a Community : Opportunities for Mental Health Promotion & Suicide Prevention Efforts in Senior Living Communities Location: Asbury Methodist Village, Continuing Care Retirement Community, Gaithersburg, Maryland, USA Dates: October 16-17, 2008 Participants: Approximately 70 (residents, facility managers, wellness staff, clinicians, policymakers, advocates and representatives from non-profit organizations)

27 Are Senior Living Community residents at higher risk for suicide? Older adult suicide is a serious problem: Disproportionately high Higher suicide completion rates -- AAS Fact Sheet: Elderly Suicide Unclear whether SLC risk is higher, BUT Same risk factors as other seniors, plus others Little attention to mental health needs in assisted living (Cummings, 2003) Individual facilities experiencing deaths Congregate living = (missed?) opportunities to intervene

28 Using public health approach as the basis Developed a framework for a comprehensive approach to create shared language and concepts Built the presentations, break-out discussions, and other agenda elements around that structure Participants became strategic planners right in the meeting

29 Introductory Presentation Public Health Approach Suicide Prevention Four-step Public Health Model Comprehensive = Prevention/Intervention/Response Risk and protective factors Logic of creating interventions A Comprehensive Framework Key Prevention Concepts Including safe messaging Overview of Summit Agenda and Breakout groups

30 A Framework for Mental Health Promotion and Suicide Prevention in Senior Living Facilities

31 RISK FOR OLDER MEN White men over 85 are at the greatest risk of all age-gender-race groups. In 2004, men accounted for 84.6% of suicides among persons aged 65 years and older Elderly male suicide rate 7.7 times the elderly female suicide rate. Source: National Center for Health Statistics, National Vital Statistics System

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