Suicide research and suicide prevention have given comparatively little attention to the older adult residents of nursing homes. This population is characterized by advanced age, significant infirmity, limited autonomy and social connections, and other factors associated with high suicide risk such as self-neglect. However, little is known of the actual incidence and prevalence of suicide in older adults in such residential care settings, partly because of how such deaths are reported. Suicide risk screenings are nominal, facility staff lack training to identify signs of suicidality, and suicide prevention programs are not common in the nursing home industry. These deficits can be remedied by increasing awareness among family members, facility caregivers, contracted providers, community aging services, accrediting and regulatory agencies, and residents.
Babatunde, T., Polidano, K., Bartlam, B., McCloskey, E., Dikomitis, L. et al. (2019). Self-harm in older adults: A systemic review, British Journal of Psychology, 24, 1–15, doi:10.1192/bjp.2019.11.
BartelsS. J.CoakleyE.OxmanT. E.ConstantinoG.OslinD.ChenH.ZubritskyC.ChealK.DuraiU. N. B.GalloJ. J.LlorenteM.SanchezH. (2002). Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 10(4), 417–427. https://doi.org/10.1097/00019442-200207000-00008
4.
CavanaghJ.OwensD.JohnstoneE. (1999). Life events in suicide and undetermined death in southeast Scotland: A case-control study using the method of psychological autopsy. Social Psychiatry and Psychiatric Epidemiology, 34(12), 645–650. https://doi.org/10.1007/s001270050187
5.
Center for Mental Health Services. (2009). Report on the 2008 summit on opportunities for mental health promotion and suicide prevention in senior living communities.
ChanS.ChiuF.LamC.LeungP.ConwellY. (2006). Elderly suicide and the 2003 SARS epidemic in Hong Kong. International Journal of Geriatric Psychiatry, 21(2), 113–118. https://doi.org/10.1002/gps.1432
10.
ChauliacN.LeauneE.GardetteV.PouletE.DuclosD. (2020). Suicide prevention interventions for older people in nursing homes and long-term care facilities: A systematic review. Journal of Geriatric Psychiatry and Neurology, 33(6), 307–315. https://doi.org/10.1177/0891988719892343
11.
Cheung, Y., Chau, P. & Yip, S. (2008) A revisit on older adults suicides and severe acute respiratory syndrome (SARS) epidemic in Hong Kong. International Journal of Geriatric Psychiatry, 23(12), 1231–1238. doi: 10.1002/gps.2056.
12.
ContiE. C.JahnD. R.SimonsK. V.EdinboroL. P. C.JacobsM. L.VinsonL.StahlS. T.Van OrdenK. A. (2020). Safety planning to manage suicide risk with older adults: Case examples and recommendations. Clinical Gerontologist, 43(1), 104–109. https://doi.org/10.1080/07317115.2019.1611685
13.
ConwellY. (1995). Elder abuse—A risk factor for suicide?Crisis, 16(3), 104–105.
14.
DavisP.KenarneyK.MurdellD.ZabakK. (2001). The potential for elderly suicide: Is health care missing it?Director (Cincinnati, Ohio), 9(4), 122–125. https://pubmed.ncbi.nlm.nih.gov/15307367/
DobbsD.EckertJ. K.RubinsteinB.KeimigL.ClarkL.FrankowskiA. C.ZimmermanS. (2008). An ethnographic study of stigma and ageism in residential care or assisted living. The Gerontologist, 48(4), 517–526. https://doi.org/10.1093/geront/48.4.517
Dong, X., & Wang, B. (2017). Incidence of elder abuse in a U.S. Chinese population: Findings from the longitudinal cohort PINE Study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 72, S95–S101. https://doi.org/10.1093/gerona/glx005
20.
DraperB.BrodatyH.LowL.RichardsV. (2003). Prediction of mortality in nursing home residents: Impact of passive self-harm behavior. International Psychogeriatrics, 15(2), 187–196. https://doi.org/10.1017/s1041610203008871
21.
DubersteinP.ConwellY.ConnerK.EberlyS.CaineE. (2004). Suicide at 50 years of age and older: Perceived physical illness, family discord and financial strain. Psychological Medicine, 34(1), 137–146. https://doi.org/10.1017/s0033291703008584
22.
EllisJ. (2010). Psychological transition into a residential care facility: Older people’s experiences. Journal of Advanced Nursing, 66(5), 1159–1168. https://doi.org/10.1111/j.1365-2648.2010.05280.x
23.
GamlielE.Levi-BelzY. (2016). To end life or to safe life: Ageism moderate the effect of message framing towards older adults’ suicide. International Psychogeriatrics, 28(8), 1383–1390. https://doi.org/10.1017/S1041610216000636
GloverJ.SrinivasanS. (2013). Assessment of the person with late-life depression. The Psychiatric Clinics of North America, 36(4), 545–560. https://doi.org/10.1016/j.psc.2013.08.004
26.
GoldbergT.BoteroA. (2008). Causes of death in elderly nursing home residents. Journal of the American Medical Directors Association, 9(8), 565–567. https://doi.org/10.1016/j.jamda.2008.04.011
27.
GruszeckiA. C.EdwardsJ.PowersR. E.DavisG. G. (2004). Investigation of elderly deaths in nursing homes by the medical examiner over a year. The American Journal of Forensic Medicine and Pathology, 25(3), 209–212. https://doi.org/10.1097/01.paf.0000127395.82329.c7
28.
GünakM.BarnesD.YaffeK.LiY.ByersA. (2021). Risk of suicide attempt in patients with recent diagnosis of mild cognitive impairment or dementia. JAMA Psychiatry, 78(6), 659–666. https://doi.org/10.1001/jamapsychiatry.2021.0150
29.
GunnellD.FrankelS. (1994). Prevention of suicide: Aspirations and evidence. BMJ (Clinical Research ed.), 308(6938), 1227–1233. https://doi.org/10.1136/bmj.308.6938.1227
HawC.HarwoodD.HawtonK. (2009). Dementia and suicidal behavior: A review of the literature. International Psychogeriatrics, 21(3), 440–453. https://doi.org/10.1017/S1041610209009065
KhazemL.JahnD.CukrowiczK.AnestisM. (2015). Physical disability and the interpersonal theory of suicide. Death Studies, 39(10), 641–646. https://doi.org/10.1080/07481187.2015.1047061
37.
KiossesD.SzantoK.AlexopoulosG. (2014). Suicide in older adults: The role of emotions and cognition. Current Psychiatry Reports, 16(11), 495. https://doi.org/10.1007/s11920-014-0495
LapierreS.ErlangsenA.WaernM.De LeoD.OyamaH.ScoccoP.GalloJ.SzantoK.ConwellY.DraperB.QuinnettP. (2011). A systematic review of elderly suicide prevention programs. Crisis, 32(2), 88–98. http://doi.org/10.1027/0227-5910/a000076
40.
LauR.MorseC.MacfarlaneS. (2010). Psychological factors among elderly women with suicidal intentions or attempts to suicide: A controlled comparison. Journal of Women & Aging, 22(1), 3–14. http://doi.org/10.1080/08952840903488831
LiS.MiddletonA.OttenbacherK.GoodwinJ. (2018). Trajectories over the first year of long-term care nursing home residence. Journal of the American Medical Directors Association, 19(4), 333–341. https://doi.org/10.1016/j.jamda.2017.09.021
43.
MagagnaG.de la FuenteE. I.VargasC.LozanoL. M.CabezasJ. L. (2013). Bayesian estimation of the prevalence of suicide risk in institutionalized older people. OMEGA—Journal of Death and Dying, 66(2), 121–133. https://doi.org/10.2190/OM.66.2.b
44.
MenghiniV.EvansJ. (2000). Suicide among nursing home residents: A population-based study. Journal of the American Medical Directors Association, 1(2), 47–50. https://pubmed.ncbi.nlm.nih.gov/12818030/
45.
MezukB.LohmanM.LeslieM.PowellV. (2015). Suicide risk in nursing homes and assisted living facilities: 2003-2011. American Journal of Public Health, 105(7), 1495–1502. https://doi.org/10.2105/AJPH.2015.302573
46.
MezukB.PrescottM. R.TardiffK.VlahovD.GaleaS. (2008). Suicide in older adults in long-term care: 1990-2005. Journal of the American Geriatrics Society, 56(11), 2107–2111. https://doi.org/10.1111/j.1532-5415.2008.01990.x
47.
MezukB.RockA.LohmanM.ChoiM. (2014). Suicide risk in long‐term care facilities: A systematic review. International Journal of Geriatric Psychiatry, 29(12), 1198–1211. https://doi.org/10.1002/gps.4142
48.
MezukB.TomohiroM.KoT.ViktoryiaA.JurgensD. (2019). Suicide among older adults living in or transitioning to long-term care, 2003-2015. JAMA Network Open, 2(6), e195627. https://doi.org/10.1001/jamanetworkopen.2019.5627
49.
MillsP.GallimoreB.WattsB.HemphillR. (2016). Suicide attempts and completions in veterans affairs nursing home care units and long-term care facilities: A review of root-cause analysis reports. International Journal of Geriatric Psychiatry, 31(5), 518–525. https://doi.org/10.1002/gps.4357
MurphyB.BugejaL.PilgrimJ.IbrahimJ. (2015). Completed suicide among nursing home residents: A systematic review. International Journal of Geriatric Psychiatry, 30(8), 802–814. https://doi.org/10.1002/gps.4299
NelsonF.FarberowN. (1980). Indirect self-destructive behavior in the elderly nursing home patient. Journal of Gerontology, 35(6), 949–957. https://doi.org/10.1093/geronj/35.6.949
Osgood, N. J., Manetta., A. A. (2001). Abuse and Suicidal Issues in Older Women. OMEGA – Journal of Death and Dying, 42(1), 71–81. https://doi.org/10.2190/ERX5-X0B8-6WDX-Y9VX
58.
PodgorskiC.LangfordL.PearsonJ.ConwellY. (2010). Suicide prevention for older adults in residential communities: Implications for policy and practice. PLoS Medicine, 7(5), e1000254. https://doi.org/10.1371/journal.pmed.1000254
59.
ReissN.TishlerC. (2008). Suicidality in nursing home residents: Part II. Special issues. Professional Psychology: Research and Practice, 39(3), 271–275. https://doi.org/10.1037/0735-7028.39.3.271
60.
SabodashV.MendezM.FongS.HsiaoJ. (2013). Suicidal behavior in dementia: A special risk in semantic dementia. American Journal of Alzheimer's Disease & Other Dementiasr, 28(6), 592–599. https://doi.org/10.1177/1533317513494447
61.
Manuel Sousa de Sao, J, & AmadoC. (2017). On studying ageism in long-term care: A systematic review of the literature. International Psychogeriatrics, 29(3), 373–387. https://doi.org/10.1017/S1041610216001915
62.
ScoccoP.de GirolamoG.PavanL. (2006). Suicide phenomena in nursing homes: A neglected issue in geriatric research and clinical management?Journal of the American Geriatrics Society, 54(8), 1299–1300. https://doi.org/10.1111/j.1532-5415.2006.00846.x
StanleyI.HomM.JoinerT. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clinical Psychology Review, 44, 25–44. https://doi.org/10.1016/j.cpr.2015.12.002
Temkin-GreenerH.OrthJ.ConwellY.LiY. (2020). Suicidal ideation in US nursing homes: Association with individual and facility factors. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 28(3), 288–298. https://doi.org/10.1016/j.jagp.2019.12.011
Van OrdenK. A.BamontiP.KingD.DubersteinP. (2012). Does perceived burdensomeness erode meaning in life among older adults?Aging & Mental Health, 16(7), 855–860. https://doi.org/10.1080/13607863.2012.657156
Van OrdenK. A.O'RileyA. A.SimningA.PodgorskiC.RichardsonT. M.ConwellY. (2015). Passive suicide ideation: An indicator of risk among older adults seeking aging services?The Gerontologist, 55(6), 972–980. https://doi.org/10.1093/geront/gnu026
73.
WandA.PeisahC.DraperB.BrodatyH. (2018). Why do the very old self-harm? A qualitative study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 26(8), 862–871. https://doi.org/10.1016/j.jagp.2018.03.005
WuL.ShenM.ChenH.ZhangT.CaoZ.XiangH.WangY. (2013). The relationship between elder mistreatment and suicidal ideation in rural older adults in China. The American Journal of Geriatric Psychiatry, 21(10), 1020–1028. https://doi.org/10.1016/j.jagp.2013.01.036
