Sylvie Lapierre

A Systematic Review of Elderly Suicide Prevention Programs

BACKGROUND Suicide rates are highest among the elderly, yet research on suicide prevention in old age remains a much-neglected area. AIMS We carried out a systematic review to examine the results of interventions aimed at suicidal elderly persons and to identify successful strategies and areas needing further exploration. METHODS Searches through various electronic databases yielded 19 studies with an empirical evaluation of a suicide prevention or intervention program designed especially for adults aged 60 years and older. RESULTS Most studies were centered on the reduction of risk factors (depression screening and treatment, and decreasing isolation), but when gender was considered, programs were mostly efficient for women. The empirical evaluations of programs attending to the needs of high-risk older adults seemed positive; most studies showed a reduction in the level of suicidal ideation of patients or in the suicide rate of the participating communities. However, not all studies used measures of suicidality to evaluate the outcome of the intervention, and rarely did they aim at improving protective factors. CONCLUSIONS Innovative strategies should improve resilience and positive aging, engage family and community gatekeepers, use telecommunications to reach vulnerable older adult, and evaluate the effects of means restriction and physicians education on elderly suicide.

A systematic review of social factors and suicidal behavior in older adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

A systematic review of physical illness, functional disability, and suicidal behaviour among older adults

Objectives: To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. Method: Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. Results: Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. Conclusion: Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.

Key considerations for preventing suicide in older adults: consensus opinions of an expert panel.

BACKGROUND The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide. AIMS To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations. CONCLUSIONS The suggestions span a wide range and are offered for consideration by local groups preparing new interventions, as well as large scale public health care planning.

Personal Goals and Subjective Well-Being in Later Life:

With a sentence completion technique, 708 elderly participants (65 to 90 years of age) expressed 15,027 personal aspirations. These goals were classified according to their motivational content in ten major categories and their relationships with various aspects of subjective well-being were studied. Two goal profiles emerged from this analysis. Aspirations centered on self-preservation were associated with poor self-rated physical health, being burden by difficulties, lack of meaning to life, dissatisfaction with life, and negative expectations for the future. Aspirations of self-development and interest in the well-being of others were associated with feelings of well-being in later life. Development of meaningful personal goals was discussed as a new intervention approach with the elders.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.

Addressing suicidal ideations through the realization of meaningful personal goals.

A personal goal intervention program was offered to early retirees aged 50 to 65 years with the objective of increasing their subjective well-being. The program was aimed at helping the participants set, plan, pursue, and realize their personal goals. A subsample of 21 participants with suicidal ideas was identified from a larger sample (N = 354) of retirees living in the community who took part in the study to evaluate the program. The experimental (n = 10) and control (n = 11) groups were compared on their answers to 16 goal and psychological well-being questionnaires. By the end of the program, the experimental group had improved significantly more than the control group on hope, goal realization process, serenity, flexibility, and positive attitude toward retirement. The levels of depression and psychological distress significantly decreased. These gains were maintained 6 months later. The positive results obtained from this study could lead to an innovative way to help people with suicidal ideations.

Motivational goal objects in later life.

With a sentence completion technique, 708 elderly participants (64 to 90 years of age) expressed 15,020 personal aspirations. These goals were classified according to their motivational content in ten major categories and their relationships with different sociodemographic variables were studied. Two goal profiles emerge from this analysis. Aspirations centered on self-preservation are associated with very old age, functional impairment, lower S.E.S. and education, being alone or institutionalized. Aspirations of self-development and interpersonal relationships are associated with younger age, physical autonomy, higher S.E.S. and education, being married or living at home. Development of meaningful personal goals are discussed as a mean of intervention with elderly individuals.

Suicidal Ideation and Self-Determination in Institutionalized Elderly

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

Ténacité et flexibilité dans la poursuite de projets personnels : impact sur le bien-être à la retraite

This research pertained to personal goals during retirement and especially to the influence of tenacity and flexibility on measures of psychological well-being. The participants ( N = 147) had been retired for less than three years and were aged between 49 and 75 years ( M = 58 years). The participants had to identify four personal goals and rate each of them along 15 dimensions. Psychological well-being was evaluated with scales of depression, self-esteem and life satisfaction. Regression analyses showed that flexibility in the presence of obstacles to the realization of goals accounts for 44 per cent of the variance in depression, 29 per cent of life satisfaction and 25 per cent of self-esteem. Tenacity had a more modest impact. Flexibility seems to be the strategy which is most useful in facing difficulties in the pursuit of goals during retirement.