Late-life Suicide Risk-assessment Training
Late-life Suicide Risk-assessment Training
Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty-two participants from two Veterans Affairs Medical Centers participated in a 6.5-hour-long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre- and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late-life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.
Older adults (aged ≥ 65) are particularly vulnerable to suicide and are disproportionately more likely to complete suicide than younger cohorts. Little is known about the degree to which physical and mental healthcare providers are aware of this disproportionate risk in this specific population. Awareness of this information alone may significantly improve suicide prevention strategies directed toward older adults. Thus, awareness of and attitudes about this issue should be a target for educational activities. Once an appropriate level of appreciation for the problem is established, focus should turn to ensuring that providers have the tools to determine suicide risk and intervene when necessary.
Assessment and conceptualization of suicide risk have improved by increasing the utility of such assessments to clinical intervention and management, although the integration of these approaches into clinical work has been slow at best, even among mental health professionals. The problem is exacerbated for older adults because they typically present to primary care providers who receive far-less-relevant training than mental health specialists and may be less inclined to discuss depression or suicide, yet older adults are more likely to seek mental health care in primary care settings, with up to 73% of older adults who committed suicide having visited their primary care provider within 1 month of their death. Better identification of suicide risk in older adults will require training of providers across the healthcare spectrum.
Particularly in older adults, identification of suicide risk in a manner that informs intervention poses unique challenges. Primary among these is that individual risk factors may function differently for older adults than they do in younger people. One well-documented difference is that older adults may be less likely to express emotional distress[8, 9, 10] or to admit to having suicidal ideation or intent than younger individuals. This alone may test the utility of a standard clinical assessment of suicidal intent, plans, and means because the intent may be denied or not reported. Older adults are also more likely to use highly lethal methods to complete suicide. To assess and manage suicide risk in older adults effectively, a provider needs to be aware of, and able to account for, the greater severity of the risk factor "access to lethal means." Other specific factors, including chronic disease and pain and social isolation and loneliness, may be more common and increase suicide risk in older adults, suggesting the need for specialized training.
Given the above considerations, any educational program seeking to equip providers across the spectrum of care to intervene aggressively in the presence of late-life suicide risk should focus on increasing provider awareness of and changing attitudes toward suicide risk in older adults; improving provider knowledge and skills for assessing and conceptualizing general suicide risk (including the distinction between dynamic, changeable risk factors and static, unchanging risk factors); and improving knowledge and skills in applying these methods specifically to older adults. These goals were the primary objectives for the training program described here.
Abstract and Introduction
Abstract
Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty-two participants from two Veterans Affairs Medical Centers participated in a 6.5-hour-long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre- and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late-life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.
Introduction
Older adults (aged ≥ 65) are particularly vulnerable to suicide and are disproportionately more likely to complete suicide than younger cohorts. Little is known about the degree to which physical and mental healthcare providers are aware of this disproportionate risk in this specific population. Awareness of this information alone may significantly improve suicide prevention strategies directed toward older adults. Thus, awareness of and attitudes about this issue should be a target for educational activities. Once an appropriate level of appreciation for the problem is established, focus should turn to ensuring that providers have the tools to determine suicide risk and intervene when necessary.
Assessment and conceptualization of suicide risk have improved by increasing the utility of such assessments to clinical intervention and management, although the integration of these approaches into clinical work has been slow at best, even among mental health professionals. The problem is exacerbated for older adults because they typically present to primary care providers who receive far-less-relevant training than mental health specialists and may be less inclined to discuss depression or suicide, yet older adults are more likely to seek mental health care in primary care settings, with up to 73% of older adults who committed suicide having visited their primary care provider within 1 month of their death. Better identification of suicide risk in older adults will require training of providers across the healthcare spectrum.
Particularly in older adults, identification of suicide risk in a manner that informs intervention poses unique challenges. Primary among these is that individual risk factors may function differently for older adults than they do in younger people. One well-documented difference is that older adults may be less likely to express emotional distress[8, 9, 10] or to admit to having suicidal ideation or intent than younger individuals. This alone may test the utility of a standard clinical assessment of suicidal intent, plans, and means because the intent may be denied or not reported. Older adults are also more likely to use highly lethal methods to complete suicide. To assess and manage suicide risk in older adults effectively, a provider needs to be aware of, and able to account for, the greater severity of the risk factor "access to lethal means." Other specific factors, including chronic disease and pain and social isolation and loneliness, may be more common and increase suicide risk in older adults, suggesting the need for specialized training.
Given the above considerations, any educational program seeking to equip providers across the spectrum of care to intervene aggressively in the presence of late-life suicide risk should focus on increasing provider awareness of and changing attitudes toward suicide risk in older adults; improving provider knowledge and skills for assessing and conceptualizing general suicide risk (including the distinction between dynamic, changeable risk factors and static, unchanging risk factors); and improving knowledge and skills in applying these methods specifically to older adults. These goals were the primary objectives for the training program described here.
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