Experts point to loneliness, disability and lack of proper care as reasons
By Melissa Bailey
 |
| Retired Seattle minister
Milt Andrews, 90, ended his life on Valentine’s Day 2013 at his assisted
living center, leaving behind a note written in black marker on the
cover of his laptop computer. |
(This article appeared previously in Kaiser Health News. This is an abridged version of the story. Click here to see the entire story.)
When Larry Anders moved into the Bay at Burlington nursing home in
late 2017, he wasn’t supposed to be there long. At 77, the stoic
Wisconsin machinist had just endured the death of his wife of 51 years
and a grim new diagnosis: throat cancer, stage 4.
His son and daughter expected him to stay two weeks, tops, before
going home to begin chemotherapy. From the start, they were alarmed by
the lack of care at the center, where, they said, staff seemed
indifferent, if not incompetent — failing to check on him promptly,
handing pills to a man who couldn’t swallow.
Anders never mentioned suicide to his children, who camped out day and night by his bedside to monitor his care.
But two days after Christmas, alone in his nursing home room, Anders killed himself. He didn’t leave a note.
The act stunned his family. His daughter, Lorie Juno, 50,
was so distressed that, a year later, she still refused to learn the details of her father’s death. The official cause was asphyxiation.
“It’s sad he was feeling in such a desperate place in the end,” Juno said.
Suicides in Long-Term Care: Often Overlooked
In a nation where
suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults — including the
2.2 million
who live in long-term care settings — are often overlooked. A six-month
investigation by Kaiser Health News and PBS NewsHour finds that older
Americans are quietly killing themselves in nursing homes, assisted
living centers and adult care homes.
Poor documentation makes it difficult to tell exactly how often such
deaths occur. But a KHN analysis of new data from the University of
Michigan suggests that hundreds of suicides by older adults each year —
nearly one per day — are related to long-term care. Thousands more
people may be at risk in those settings, where up to a third of
residents report suicidal thoughts,
research shows.
Each suicide results from a unique
blend of factors,
of course. But the fact that frail older Americans are managing to kill
themselves in what are supposed to be safe, supervised havens raises
questions about whether these facilities pay enough attention to risk
factors like mental health, physical decline and disconnectedness — and
events such as losing a spouse or leaving one’s home. More controversial
is whether older adults in those settings should be able to take their
lives through what some fiercely defend as “rational suicide.”
Tracking suicides in long-term care is difficult. No federal
regulations require reporting of such deaths and most states either
don’t count — or won’t divulge — how many people end their own lives in
those settings.
Is There Adequate Supervision?
Briana Mezuk, an associate professor of epidemiology at the University of Michigan,
found in 2015
that the rate of suicide in older adults in nursing homes in Virginia
was nearly the same as the rate in the general population, despite the
greater supervision the facilities provide.
In research they presented at the 2018 Gerontological Society of
America annual meeting, Mezuk’s team looked at nearly 50,000 suicides
among people 55 and older in the
National Violent Death Reporting System
(NVDRS) from 2003 to 2015 in 27 states. They found that 2.2% of those
suicides were related to long-term care. The people who died were either
people living in or transitioning to long-term care, or caregivers of
people in those circumstances.
KHN extrapolated the finding to the entire U.S., where 16,500
suicides were reported among people 55 and older in 2017, according to
federal figures. That suggests that at least 364 suicides a year occur
among people living in or moving to long-term care settings, or among
their caregivers. The numbers are likely higher, Mezuk said, since the
NVDRS data did not include such states as California and Florida, which
have large populations of elders living in long-term care sites.
Industry Says It’s Not the Facilities
But representatives of the long-term care industry point out that by any measure, such suicides are rare.
The deaths are “horrifically tragic” when they occur, said Dr. David
Gifford of the American Health Care Association. But, he added, the
facilities offer “a very supervised environment,” and settings that
receive Medicare or Medicaid funding are required to assess and monitor
patients for suicidal behavior.
“I think the industry is pretty attuned to it and paying attention to
it,” Gifford said, noting that mental health issues among older adults,
in general, must be addressed. “I don’t see this data as pointing to a
problem in the facilities.”
KHN examined over 500 attempted and completed suicides in long-term
care settings from 2012 to 2017 by analyzing thousands of death records,
medical examiner reports, state inspections, court cases and incident
reports.
Even in supervised settings, records show, older people find ways to
end their own lives. Many used guns, sometimes in places where firearms
weren’t allowed or should have been securely stored.
Others hanged
themselves, jumped from windows, overdosed on pills or suffocated
themselves with plastic bags. (The analysis did not examine medical
aid-in-dying, a rare and restricted method by which people who are
terminally ill and mentally competent can get a doctor’s prescription
for lethal drugs. That is legal only in
seven states and the District of Columbia.)
Despair, Loneliness, Longevity
Descriptions KHN unearthed in public records shed light on residents’
despair: Some told nursing home staff they were depressed or lonely;
some felt that their families had abandoned them or that they had
nothing to live for. Others said they had just lived long enough: “I am
too old to still be living,” one patient told staff. In some cases,
state inspectors found nursing homes to blame for failing to heed
suicidal warning signs or evicting patients who tried to kill
themselves.
A better understanding is crucial: Experts agree that late-life suicide is an under-recognized problem that is poised to grow.
By 2030, all baby boomers will be older than 65 and 1 in 5 U.S. residents will be of retirement age, according to
census data. Of those who reach 65,
two-thirds can expect to need some type of long-term care. And, for poorly understood reasons,
that generation
has had higher rates of suicide at every stage, said Dr. Yeates
Conwell, director of the Office for Aging Research and Health Services
at the University of Rochester.
“The rise in rates in people in middle age is going to be carried with them into older adulthood,” he said.
Long-term care settings could be a critical place to intervene to
avert suicide — and to help people find meaning, purpose and quality of
life, Mezuk said. “There’s so much more that can be done. It would be
hard for us to be doing less,” he said.
If You Need Help
If you or someone you know has talked about contemplating suicide,
call the National Suicide Prevention Lifeline at (800) 273-8255, or use
the online Lifeline Crisis Chat, both available 24 hours a day, seven
days a week.
People 60 and older can call the Institute on Aging’s 24-hour,
toll-free Friendship Line at (800) 971-0016. The Institute on Aging also
makes ongoing outreach calls to lonely older adults.
Full Article & Source:
The Hidden Suicide Epidemic Among Long-Term Care Residents
