Nancy J. Osgood

Suicide in later life

This paper addresses a number of issues related to suicide among person over the age of 60 in the United States. We begin with a presentation of the epidemiology of late life suicide in the United States, followed by discussion of related demographic information, including known risk factors for both suicide attempts and completed suicides. We then proceed to discuss issues related to the assessment of suicidality among older men and women. The next issue is the topic of “rational” suicide, which is a highly controversial, yet increasingly common phenomenon, to which psychotherapists and health care providers will be exposed in working with older adults. Finally, the paper concludes with suggestions for intervention in order to reduce suicide ideation and improve the individuals quality of life.

STAFF AND ELDERLY KNOWLEDGE AND ATTITUDES TOWARD ELDERLY SEXUALITY

This study compared staff and elderly knowledge, attitudes, and practices related to sexual expression by elderly persons in a long‐term care setting. Volunteers (N = 194) responded agree or disagree to 159 items. Significant differences were observed between the staff and elderly responses on 36 items. Areas of greatest differences involved knowledge and attitudes about consensual sex and sexual abuse, issues related to family attitudes toward remarriage and sexual expression, and age‐related changes and health problems related to sexuality. Items related to masturbation received the greatest percentage of no response. The staff had significantly higher total scores as compared to the elderly reflecting more knowledge, positive attitudes, and support for more proactive responses toward elderly sexuality. Findings have major implications for staff training in long‐term care settings.

A statewide model detection and prevention program for geriatric alcoholism and alcohol abuse: increased knowledge among service providers.

To facilitate the professional development of service providers, the Virginia project on geriatric alcohol abuse and alcoholism developed and used an informational booklet, brochure, and video in a “:train the trainer” model. A core group received extensive training, and then trained colleagues in their local communities. Knowledge gains were documented among both trainers and trainees. Follow-up interviews with agency personnel revealed substantial impact on a broad spectrum of service systems and improvements in interagency coordination. Results are discussed in terms of the educational needs of professional service providers regarding the unique aspects of alcoholism and alcohol abuse in the older population.

The Impact of Creative Dance and Movement Training on the Life Satisfaction of Older Adults: An Exploratory Study

This study examined the impact of dance and movement training on the life satisfaction of older adults. Members of the experimental group participated in weekly dance and movement classes for 8 months. A matched comparison group was selected Members of both groups were pretested using a global measure of life satisfaction and the Philadelphia Geriatric Center Morale Scale. Analysis of covariance revealed significant positive changes in life satisfaction in the experimental group when compared to the matched group (p = .05). Observations and verbal comments support these findings.

Preventing Suicide and Depression: A Training Program for Long-Term Care Staff:

Approximately 5 percent of those sixty-five and older live in long-term care facilities (1.5 million). Neither suicide and depression among the elderly who reside in long-term care facilities nor prevention techniques are well-understood by staff. This article discusses the development of a curriculum designed to train long-term care staff in preventing suicide among the elderly and the results of a pilot test of a training program based on that curriculum. The participants (N=43) significantly improved their scores from pre- to post-test on the knowledge, attitudes, and practices subtests. The knowledge areas in which staff performed the most poorly at pre-test were related to identifying appropriate primary and secondary interventions, the relationship between dementia and suicide, methods of self-destruction used by the elderly, and understanding of depression in the elderly. There was a significant relationship between pre-test and post-test scores on all subtests. Staff with higher levels of education had significantly higher pre- and post-test scores on the knowledge and attitudes subtests. More experienced staff had significantly higher post-test scores on the practices subtest. A large majority of the participants had highly positive attitudes toward the program and thought the program had been very useful or useful to them as caregivers. The study demonstrated the need for staff training related to suicide prevention in long-term care as well as the usefulness of even a brief training.

The impact of alcoholism education on service providers, elders, and their family members

Virginia is the first state in the country to conduct a statewide detection and prevention program for geriatric alcoholism. The project employed a train-the-trainer model in which a core group of trainers received extensive (8-hour) training about alcoholism and aging and, in turn, trained small groups of persons in their local communities in abbreviated (2-hour) sessions. Comparisons of pre- and post-training knowledge test scores revealed statistically significant knowledge gains among both sets of participants. Follow-up surveys to participants provided evidence of the programs continued utility. Interviews with key service providers indicated a substantial impact on a broad spectrum of service systems and a strengthening of interagency coordination. Evidence supports the need for alcoholism education, the effectiveness of a train-the-trainer model in addressing educational needs, and the impact of such a program on the broader service community reaching older adults.

Alcoholism and aging : an annotated bibliography and review

Series Foreword by Erdman B. Palmore Introduction Alcoholism and Aging: An Overview Bibliographies Overview Articles Books and Book Chapters Empirical Studies Miscellaneous Works Author Index Subject Index

Addictions Services: Follow-Up to the Statewide Model Detection and Prevention Program for Geriatric Alcoholism and Alcohol Abuse

A follow-up study was conducted to investigate the long term consequences of a statewide geriatric alcoholism detection and prevention effort in Virginia. High levels of knowledge had been retained seven years after the initial training. Quantitative and qualitative data provided by 64 of the volunteers, who were trained to conduct workshops in their communities, verified the programs ability to: 1) encourage further training or study in the area, 2) enhance the detection of alcohol problems, and 3) increase the incidence of assistance to individuals with alcohol problems. Ancillary data revealed the programs effects on personal drinking habits.

The suicidal patient in long-term care institutions

In comparison with older adults living in the community, elders who are institutionalized are older, sicker, and more likely to have no living family members, factors that place them at risk for suicide. Somatization, or physical suffering, is a frequently overlooked symptom of elderly depression, perhaps because it is falsely assumed that such symptoms expressed by the older adult are normal concomitants of aging. Strengthening and extending existing family roles in supporting the elder who is suicidal and depressed is vital to reducing loneliness, emotional pain, loss of independence, and to increasing self-concept. An expanded knowledge of mental health needs of older adults and their families is critical in suicide prevention. A major step toward prevention is the recognition of depressive symptomatology and key elements and clues to suicide in the institutionalized elderly.

Book Review: The Last Choice: Preemptive Suicide in Advanced Age

In The Last Choice: Preemptive Suicide in Advanced Age , Prado argues that preemptive suicide is rational and should be accepted and legally sanc tioned and facilitated, where warranted, in our society. What Prado means by preemptive suicide is “self-destruction as an unforced anticipatory option as opposed to suicide forced by actual circumstances” (p. xi). Prado sees a major difference between preemptive suicide and surcease suicide or “sui cide forced by immediate torment and desperatio n . . .escaping actual intoler able circumstances” (p. 2). Traditionally, those who have argued in favor of suicide have favored surcease suicide to end intolerable pain and suffering. Prado views preemptive suicide as an elective choice, a way to avoid demeaning decline and needless suffering. Prado points out that arguments for euthanasia and legalized assisted suicide are driven primarily by current population pressures and economic concerns. He argues that in the 1990s we have witnessed a “reshaping of the ‘normal’ view of self-destruction” (p. xiii). As he states it, “We’re seeing an essential change that turns on its being accepted as normal that some lives shouldn’t be lived, aren’t worth living, at least to their ends” (p. xiv). Prado believes that in this social cultural climate, preemptive suicide will come to be more acceptable as we accept as a truth that life has a “volitional terminus” (p. xiv). After carefully defining preemptive suicide and distinguishing it from sur cease suicide, Prado devotes the remainder of the book to convincing the reader that preemptive suicide in advanced age is a rational choice. In stating his case, Prado focuses on the debilitating aspects of aging, including physi cal debilitation, but more important, mental and spiritual deterioration. The latter distorts or erases memories; erodes reasoning, aptitude for integrative thought, and accurate self-reflection; and diminishes the self so that the affected individuals “cease to exist as the person they are” (p. 17). According to Prado, an older adult who chooses preemptive suicide makes the decision that it is better to be dead now than diminished in the future.