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Suicide Risk May Be Higher in Senior Facilities

But recent life losses may underlie the worrisome numbers, researchers say

TUESDAY, May 18 (HealthDay News) -- Seniors living in assisted-living and long-term care facilities may have a higher rate of suicide than those who continue living in their own homes, suggests a new report.

People over 65 commit suicide at a rate of about 14 per 100,000 people, but in a study of Italian people living in long-term care facilities, researchers found that the rate of suicide was nearly 19 per 100,000 people.

One reason may be that stressful or troubling events -- such as death of a spouse, illness or a decline in physical function -- may underlie the move to a residential care facility, the researchers say.

"The risk of suicide may be heightened during the first year," said the report's lead author, Carol Podgorski, an assistant professor of psychiatry at the University of Rochester in New York. "There's relocation stress, and that's when they're dealing with whatever caused them to move."

The report was published online May 18 in the journal PLoS Medicine.

Teasing out the exact reasons that cause the increase as well as developing potential prevention strategies is important because nearly one-quarter of all seniors will live in a residential care facility at some point, according to background information in the report.

More than one million seniors in the United States live in assisted-living facilities, most of them female (about 80 percent), the report said. The average age of residents is about 85 years. Many others live in independent-living communities, long-term care facilities, also called nursing homes, and continuing care retirement communities, which include all three.

Overall risk factors for senior suicide include anxiety, substance abuse, psychotic disorders, social dependency or isolation, family troubles or losses, an inflexible personality and access to firearms. Specific risk factors for older people living in a residential home include being widowed or divorced, having a pessimistic outlook, sleeping more than nine hours a day and drinking more than three alcoholic beverages a day.

"Depression is the most important risk factor," said Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City. "But, the vast majority of people who are depressed don't try to take their lives, and we're not so good at predicting who really has a heightened risk of suicide."

The report found that depression rates in residential facilities for seniors were between 22 and 40 percent at admission.

So, what can you do to look out for your loved one?

"As you visit, see if they're engaged in activities and making friends. Are they going to church? Stopping going to church is a red flag. Make sure the person understands that they still have an important role in the family, that they're still needed," advised Podgorski.

As the transition from home to residential facility is occurring, Kennedy said to watch how your loved one is adjusting to the change. "If the stress of preparing for the move is starting to disorient the person, that's a clear indicator that they're going to need extra help."

He added that depression doesn't always present itself as a sad mood; sometimes people who are depressed appear angry and irritable.

Podgorski said that the facilities themselves have to be aware that people are at risk, especially their newest residents. "Facilities have to watch and be vigilant about seeing how people adjust. Retirement communities could probably do a better job of doing routine depression screening on admission," she said.

It's also important to make sure that residents are connected to their medical health providers and that any pain they have is controlled.

If your loved one shows signs of depression or suicidal thoughts, suggest he or she speak with the primary care physician to get a depression assessment. And, be sure you let someone at the facility know what's going on, recommended Podgorski.

"People think that they're alone, but they need to realize that other people have these feelings also," said Podgorski. "If you're depressed, you can't always remember how you used to problem-solve, so it's important to talk to others. Find out how they deal with feelings of hopelessness."

More information

Learn more about depression in nursing home residents from the American Geriatric Society's Foundation for Health in Aging.

SOURCES: Carol Podgorski, Ph.D., assistant professor of psychiatry, University of Rochester, Rochester, N.Y.; Gary Kennedy, M.D., director, division of geriatric psychiatry, Montefiore Medical Center, New York City; May 18, 2010, PLoS Medicine, online

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