Interventions to Reduce Suicidal Ideation in Elderly

The Practice Issue in Need of Change

Elderly individuals comprise one of the most vulnerable populations due to the frailty resulting from their old age (Chatterji, Byles, Cutler, Seeman, & Verdes, 2015; Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). Also, elderly people, often being incapable of caring about themselves and protecting themselves, often may become the victims of neglect and abuse. Thus, it is unsurprising that they often may commit suicide.

For instance, Worthington (n.d.) states that in 2005, 5,404 suicides were committed by individuals aged 65 and older; while older adults of that age accounted for only 12.4% of the total population, they represented nearly 16.6% of all the suicides committed in the U.S. in 2005 (para. 4). Therefore, it is paramount to implement suicide prevention programs and interventions to help geriatric patients reduce their suicidal ideation, consequently lowering their rates of suicide.

Thus, the current project is aimed at providing elderly individuals with interventions for reducing suicidal ideation. It is hoped that utilizing such interventions may help geriatric patients with suicidal ideation to decrease the latter, restoring their desire to live and lowering the rates of suicide among these patients.

PICOT question is as follows: Does implement an intervention aimed at lowering suicidal ideation (I) among geriatric patients (P) for two months (T) allows for decreasing the levels of suicidal ideation among these patients (O) when compared to their levels of suicidal ideation before the intervention (C)?

The significance of this issue is conditioned by the fact that in the case when the suicidal ideation of geriatric patients is not addressed, it may lead to the suicide of these patients, or at least significantly worsen their quality of life.

Description of the Search of the Literature for Evidence

To find the literature with evidence, two databases were searched: Google Scholar (limited to articles from 2013) and PubMed (no time limits). Two articles were retained: Golding, Nadorff, Winer, and Ward (2015), and Morin et al. (2013). These are analyzed in Table 1 below. The search tracker and the PICOT question organizer can be found in Tables 2 and 3 below.

First Author (Year) Conceptual Framework Design / Method Sample / Setting Major Variables Studied (and their Definitions) Measurement Data Analysis Findings Appraisal: Worth to Practice
Golding (2015) Interpersonal-psychological theory of suicide (partially explains the association between insomnia and suicide risk) Observational; correlational study using surveying and inferential statistics Sample collected from surveys on amazon.com Insomnia (the lack of sleep)
Nightmares (scary dreams)
Suicide risk (risk of ending one’s life deliberately)
Multiple Likert-scale questionnaires to evaluate different variables Pearson’s r, descriptives, ANOVA, multiple linear regression Duration of nightmares predicts the risk of suicide signific antly useful; allows for identifying patients with insomnia as vulnerable to suicide
Morin (2013) Not identified; it is supposed that alcoholism and suicide are associates in elderly people Case-comparison. Inferential statistics Five hospitals in the west of Sweden. 103 participants aged>70 treated in hospital due to a suicide attempt Depression (operational definition: Montgomery-Asberg Depression Rating Scale), physical health (operational definition: Cumulative Illness Rating Scale for Geriatrics), suicidal intent (operational definition: Suicidal Intent Scale); alcohol use disorder (addiction to alcohol) Various scales measuring depression, suicidal intent, etc. Comparison of semi-structured interviews; analysis of quantitative data using Cox’s conditional logistic regression; binary logistic regressions Strong associations between alcohol use disorders and suicide attempts treated in hospitals Useful; shows that alcohol-dependent elderly people are at an increased risk of suicide.

Table 1. Evaluation table. Adapted from Fineout-Overholt, Melnyk, Stillwell, and Williamson (2010).

Search # Initial search terms Database And/Or? Added search terms Title (Ti)
Anywhere, etc.
# of articles found
1 suicide elderly people Google Scholar No patents, no citations; from 2013 15,700
2 suicide elderly people PubMed 22,318

Table 2. Search Tracker.

PICOT
P Population Geriatric patients
I Intervention or
Issue of interest
Intervention for lowering suicidal ideation
C Comparison Baseline
O Outcome Lowering suicidal ideation
T Time frame Two months

Table 3. PICOT question organizer.

Assignment 3

The PICOT question was as follows: Does implement an intervention aimed at lowering suicidal ideation (I) among geriatric patients (P) for two months (T) allows for decreasing the levels of suicidal ideation among these patients (O) when compared to their levels of suicidal ideation before the intervention (C)?

Using the terms from this PICOT question, such as “suicide,” “suicidal ideation,” “elderly,” “geriatric,” and “patients,” allowed for finding several articles on the required topic.

The MESH terms from the branches “psychiatry and psychology” and “health care” were used. Both more general terms (patients) and more specific ones (suicidal ideation, geriatric,) were used. These terms were useful in finding the article by Cha & Lee (2017). Also, see the search tracker table (Table 4) and the evaluation table (Table 5) below.

On the whole, it should be stressed that using these search terms allowed for finding an adequate number of articles on the desired topic. However, it is noteworthy that Google Scholar initially tended to find a great number of outdated sources. Turning on the year of publication filter (since 2013) permitted for discovering more recent sources.

Search # Initial search terms Database And/Or? Added search terms Title (Ti)
Anywhere, etc.
# of articles found
1 suicidal ideation elderly Google Scholar No patents, no citations; from 2013 16,500
2 suicidal ideation elderly PubMed 3,567

Table 4. Search Tracker.

First Author (Year) Conceptual Framework Design / Method Sample / Setting Major Variables Studied (and their Definitions) Measurement Data Analysis Findings Appraisal: Worth to Practice
Cha (2017) Not identified, it is stressed that it is believed that ego-resilience and social support can help address depression and suicidal ideation in elderly Chinese people. Cross-sectional descriptive study Elderly people (65 and older) living in a rural area in Korea. Ego-resilience (the ability to deal with a situation even in tough conditions), social support (support from friends, family, colleagues), depression (a clinical condition characterized by low mood, inability to experience happiness, etc., suicidal ideation (the desire to commit suicide) Questionnaires ANOVA, multiple regression, SEM analysis It was unveiled that ego-resilience considerably predicts suicidal ideation. Useful; can be utilized in interventions aimed to reduce suicidal ideation.

Table 5. Evaluation table. Adapted from Fineout-Overholt et al. (2010).

References

Cha, K. S., & Lee, H. S. (2017). The effects of ego-resilience, social support, and depression on suicidal ideation among the elderly in South Korea. Journal of Women & Aging, 28, 1-16. Web.

Chatterji, S., Byles, J., Cutler, D., Seeman, T., & Verdes, E. (2015). Health, functioning, and disability in older adults–present status and future implications. The Lancet, 385(9967), 563-575.

Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752-762.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Critical appraisal of the evidence: Part III. American Journal of Nursing, 110(11), 43-51. Web.

Golding, S., Nadorff, M. R., Winer, E. S., & Ward, K. C. (2015). Unpacking sleep and suicide in older adults in a combined online sample. Journal of Clinical Sleep Medicine, 11(12), 1385-1392. Web.

Morin, J., Wiktorsson, S., Marlow, T., Olesen, P. J., Skoog, I., & Waern, M. (2013). Alcohol use disorder in elderly suicide attempters: A comparison study. The American Journal of Geriatric Psychiatry, 21(2), 196-203. Web.

Worthington, B. (n.d.). Elder suicide: A needless tragedy. Web.

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