Suicide among older adults: Interactions among key risk factors

2020 ◽  
pp. 009121742098238
Author(s):  
Silvia C Hernandez ◽  
James C Overholser ◽  
Kristie L Philips ◽  
James Lavacot ◽  
Craig A Stockmeier
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Rating Scale ◽  
Physical Illness ◽  
Health Attitudes ◽  
Psychological Autopsy ◽  
Next Of Kin ◽  
Medical Problems ◽  
Hopelessness Depression

Objective The present study aimed to understand how key risk factors of older adult suicide interact to ultimately lead to death by suicide using data collected post-mortem. Method A psychological autopsy was used to gather detailed information about psychiatric diagnosis, medical problems, social isolation, and negative attitudes expressed by the individual during the six months prior to their death. Interviews with next-of-kin, medical and psychiatric records, and the Cumulative Illness Rating Scale for Geriatrics were used. Subjects included 32 older adults who died by suicide and 45 older adults who died by natural causes. Results Hopelessness, depression, and negative health attitudes were strongly correlated with suicide. Older age was associated with social isolation, suggesting an indirect relationship with suicide via hopelessness, depression, and negative health attitudes. Physical illness did not increase risk. Multivariate analyses suggested that hopelessness fully mediated the effects of social isolation, negative health attitudes, and depression on suicide. Conclusions Psychological factors played the largest role in suicide deaths compared to social isolation and physical illness. Suicide interventions aimed at older adults should ensure hopelessness, depression, and negative health attitudes are primary targets.

scholarly journals BACK TO BASICS: HOPELESSNESS AS THE MEDIATING FACTOR FOR COMPLETED SUICIDE AMONG OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S269-S270
Author(s):  
Silvia C Hernandez ◽  
James C Overholser ◽  
James Lavacot ◽  
Kristie L Philips ◽  
Craig A Stockmeier
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Structural Equation ◽  
Physical Illness ◽  
Advanced Age ◽  
Equation Modeling ◽  
Psychological Autopsy ◽  
Increased Risk ◽  
Increase Risk

Abstract Individuals 65 years and older are at high risk for completing suicide. Though risk factors have been established in the literature, the dominant atheoretical approach has left the field at an impasse. The present study aimed to integrate core risk factors of hopelessness, depression, physical illness, and social isolation by proposing a biopsychosocial framework of older adult suicide. A psychological autopsy was used to compare individuals 65 years and older who died either by suicide (n = 32) or natural causes (n = 45). Structural equation modeling results suggested that hopelessness was the only factor directly associated with suicide (B = .01, β = 0.84, SE = 13.31, p ≤ .001), fully mediating the relationships between suicide and social isolation, negative attitudes about physical health, and depression. The proposed model adequately fit the data, explaining 71% of the variance in cause of death. Advanced age (75+ years) moderately increased social isolation, which weakly increased hopelessness, contributing to suicide in a smaller magnitude than expected. Though individuals in the advanced age group had a wider range of physical illnesses, this did not increase risk. Rather, negative perceptions of health increased risk for all individuals 65 years and older via depression and hopelessness, irrespective of the presence of impairing physical illness. Findings support the claim that hopelessness plays a pivotal role in the progression from suicidal ideation to completion among older adults. Directly targeting hopelessness could help prevent at-risk older adults from acting on their thoughts of suicide.

scholarly journals Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study

2006 ◽  
Vol 36 (9) ◽  
pp. 1265-1274 ◽  
Author(s):  
DANIEL MICHAEL JAMES HARWOOD ◽  
KEITH HAWTON ◽  
TONY HOPE ◽  
LOUISE HARRISS ◽  
ROBIN JACOBY
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Functional Limitation ◽  
Interpersonal Problems ◽  
Case Control ◽  
Physical Illness ◽  
Control Analysis ◽  
Psychological Autopsy ◽  
Life Problems ◽  
Risk Factors For Suicide

Background. The role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention.Method. The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes.Results. The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82% and felt to be contributory to death in 62%. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55% of the sample and contributory in 31%. The corresponding figures for bereavement-related problems were 47% and 25%. In the case-control analysis, the problems found to be risk factors for suicide were problems related to a bereavement over 1 year before death (OR 3·5, 95% CI 1·2–10·6), and problems with accommodation (OR 5·0, 95% CI 1·1–22·8), finances (p=0·01), and retirement (p=0·02).Conclusion. Physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long- term bereavement-related problems may be more specific risk factors.

scholarly journals Social Isolation and Hospitalization Risk Factors Among Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 95-95
Author(s):  
J Mary Louise Pomeroy ◽  
Gilbert Gimm
Keyword(s):  
United States ◽  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
The United States ◽  
Community Dwelling ◽  
Psychosocial Risk ◽  
Depression And Anxiety ◽  
Socially Isolated ◽  
Community Dwelling Older Adults

Abstract PURPOSE: This study examines psychosocial risk factors associated with hospitalization among community-dwelling older adults in the United States. METHODS: Using two waves of the National Health and Aging Trends Study from 2011 and 2015, we conducted descriptive and multivariate analyses of individual-level data from a nationally representative sample of 8,003 Medicare beneficiaries ages 65 and older. Associations between hospitalization and risk factors including social isolation, depression, and anxiety were assessed. Covariates included gender, race/ethnicity, age, region, insurance type, falls, and comorbidities. RESULTS: Overall, about 20.9% of older adults reported a hospitalization within the past year and 22.2% were socially isolated. The odds of hospitalization were higher for socially isolated adults (OR 1.17; p = .02), for depressed adults (OR 1.25; p = .01), and for individuals with anxiety (OR 1.25; p = .02). Individuals living in the Western region had lower odds of hospitalization (OR 0.71; p = .001), whereas men (OR 1.13; p = .03), those requiring assistance with activities of daily living (OR 1.48; p < .001), and those having one (OR 1.41; p = .03) or more (OR 3.05; p < .001) chronic health conditions had higher odds of hospitalization. CONCLUSION: Social isolation, depression, and anxiety represent significant psychosocial risk factors for hospitalization among community-dwelling older adults in the United States. Efforts to reduce health care costs and improve health outcomes for older adults should explore ways to strengthen social integration and improve mental health.

scholarly journals Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department

2021 ◽  
Vol 11 ◽  
Author(s):  
Dong Wook Kim ◽  
Seo Eun Cho ◽  
Jae Myeong Kang ◽  
Soo Kyun Woo ◽  
Seung-Gul Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Emergency Department ◽  
Suicide Attempt ◽  
Old Age ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Interpersonal Stress ◽  
Suicide Attempters ◽  
Male Sex

Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department.Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups.Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = −0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = −0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale.Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.

scholarly journals COVID-19-Related Changes in Potential Risk Factors for Elder Mistreatment Reported by Caregivers of Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 940-940
Author(s):  
Lena Makaroun ◽  
Scott Beach ◽  
Tony Rosen ◽  
Ann-Marie Rosland
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Service Providers ◽  
Community Sample ◽  
Poor Mental Health ◽  
Elder Mistreatment ◽  
Care Recipients ◽  
Increased Risk

Abstract In previous studies, caregiver (CG) stress, substance use, poor physical health, poor mental health, financial problems, and social isolation have been associated with increased risk of elder mistreatment (EM) for older care recipients (CR). This study aimed to assess how the COVID-19 pandemic has impacted these CG-related risk factors for EM in a community sample of CGs. A non-probability sample of 433 CGs caring for adult CRs age ≥60 years with physical (76%), cognitive (34%) and mental health (14%) conditions completed a survey on COVID-19 impacts in April-May 2020. CGs had mean age 61 (range 21 – 91), were 75% female and 92% non-Hispanic White. Over 40% of CGs reported doing worse financially since COVID-19. Compared to before COVID-19, 15% reported drinking more alcohol and 64% reported somewhat or greatly increased feelings of social isolation and loneliness. CGs reported that COVID-19 had made caregiving more physically (18.7%), emotionally (48.5%) and financially (14.5%) difficult, interfered with their own healthcare (19%), and led to family conflict over caring for CR (13.2%). Younger CGs (age <65) and those with annual income <$50,000 were more likely to report negative COVID-19 impacts. This study suggests CGs of older adults may be experiencing increased stress, alcohol use, social isolation and negative impacts on their own health and financial situation. Healthcare and social service providers should assess for these EM risk-factors in caregivers and connect them and their care recipients with resources and services to address these stressors to reduce risk of EM during the COVID-19 pandemic.

scholarly journals A Virtual Companionship Intervention Reduces Loneliness During the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 966-966
Author(s):  
Ellen Rudy ◽  
Kelsey McNamara ◽  
Rajiv Patel ◽  
Corey Sturm
Keyword(s):  
Risk Factors ◽  
Social Support ◽  
Older Adults ◽  
Social Isolation ◽  
Free Access ◽  
National Service ◽  
Medicare Advantage ◽  
Virtual Visits ◽  
Clinical Conditions ◽  
The Impact

Abstract Loneliness and social isolation are established risk factors for many clinical conditions yet few scalable interventions exist. Papa Inc. is a national service that pairs older adults with “Papa Pals” (empathetic, laypeople) who provide companionship and assistance with everyday tasks. Participants have free access if their Medicare Advantage plan offers it. During the COVID-19 pandemic, Papa provided virtual companionship visits via telephone or video. This study evaluated the impact of virtual companionship visits on loneliness status (UCLA 3-item Loneliness Scale) during the COVID-19 pandemic. The sample (N=894) included adults ages 65+ who identified as lonely at baseline and who completed at least one virtual visit between March 18, 2020 and December 31, 2020. Virtual visits were classified into four categories based on participants’ total number of visit minutes: Low (124 ave min), Medium Low (ML) (305 ave min), Medium High (MH) (567 ave min), and High (1360 ave min). Lonely and severely lonely participants engaged a mean of 573 and 673 minutes in the program, respectively. Improvement in loneliness status was associated with greater use of minutes for the ML and MH participants compared to Low participants (ML OR: 1.46 95CI: 1.00 - 2.11, MH OR 1.65 95CI: 1.13 - 2.40). These findings indicate that a virtual companionship intervention can be an impactful and scalable tool for older adults who want to age at home and have limited social support, especially during the uncertain COVID landscape. Further research is warranted to understand persistent loneliness.

Risk factors for social isolation in post-hospitalized older adults

2020 ◽  
Vol 88 ◽  
pp. 104036
Author(s):  
Dharani Nagarajan ◽  
Den-Ching A. Lee ◽  
Lauren M. Robins ◽  
Terry P. Haines
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Hospitalized Older Adults

scholarly journals Changes in Elder Mistreatment Risk Factors Reported by Caregivers of Older Adults During the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 73-74
Author(s):  
Lena Makaroun ◽  
Scott Beach ◽  
Tony Rosen ◽  
Ann-Marie Rosland
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Social Service ◽  
Service Providers ◽  
Community Sample ◽  
Elder Mistreatment ◽  
Financial Situation ◽  
Care Recipients ◽  
Related Risk

Abstract This study aimed to assess how the COVID-19 pandemic has impacted caregiver (CG)-related risk factors for elder mistreatment (EM) in a community sample of CGs. A non-probability sample of 433 CGs caring for care recipients (CRs) age ≥60 years completed a survey on COVID-19 impacts in April-May 2020. Compared to before COVID-19, over 40% of caregivers reported doing worse financially, 16% were experiencing new financial hardship, 19.4% were a lot more worried about their financial situation, 15% reported drinking more alcohol, and 64% had somewhat or greatly increased feelings of social isolation and loneliness. CGs reported that COVID-19 had made caregiving more physically (18.7%), emotionally (48.5%) and financially (14.5%) difficult and interfered with their own healthcare (19%). Differences found between younger and older caregivers will be presented and implications of these increased CG-related EM risk factors for healthcare and social service providers discussed.

scholarly journals Risk Factors for Social Isolation Among Older Adults in Long Term Care: A Scoping Review

2020 ◽  
Author(s):  
Sheila A. Boamah ◽  
Rachel Weldrick ◽  
Tin-Suet Joan Lee ◽  
Nicole Taylor
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Scoping Review ◽  
Long Term Care ◽  
Community Dwelling ◽  
Structural Factors ◽  
Term Care ◽  
Online Databases

Objectives: A wealth of literature has established risk factors for social isolation among older people, however much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

scholarly journals Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

2019 ◽  
Vol 60 (1) ◽  
pp. 101-111 ◽  
Author(s):  
Xiaoling Xiang ◽  
Jieling Chen ◽  
MinHee Kim
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Social Isolation ◽  
Daily Living ◽  
Multinomial Logistic Regression ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Nationally Representative ◽  
Design And Methods

Abstract Background and Objectives The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories. Research Design and Methods The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1–Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories. Results Three trajectory groups were identified: the “never” group (65.5%) remained nonhomebound; the “chronic” group were largely persistently homebound (8.3%); and the “onset” group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the “onset” and “chronic” versus the “never” trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the “chronic” trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk. Discussion and Implications The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

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