Combating Suicide in the Population Most At Risk: Older, White Men

Aug 18, 2014, 9:43 AM

Human Capital Blog: Congratulations on your award! What led to your interest in suicide risk in long-term care facilities?

Briana Mezuk: Older adults, particularly non-Hispanic white men, have the highest risk of suicide. This risk increases exponentially after age 75, and recent data suggest that men in the Baby Boomer generation have a higher suicide risk than previous cohorts. There are many risk factors for this group, including social isolation, feelings of disconnection to society, and lack of social supports and close confidantes. Older men are often unwilling to talk about mental health problems with their physicians; they think they are supposed to ‘grin and bear it.’

HCB: What was the goal of your study?

Mezuk: We were trying to understand the epidemiology of suicide in long-term care facilities, and in nursing homes and assisted-living facilities in particular. Suicide risk in these settings may be higher, or lower, than in the general community. For example, suicide risk may be lower in supervised settings because residents would have less access to a means to self-harm. But suicide risk might be higher because residents often have health problems and, frequently, depressive symptoms that are risk factors for suicide. We used data from the Virginia Violent Death Reporting System to identify suicides that occurred among residents of, and among individuals anticipating moving into, these types of facilities.

HCB: What did you find?

Mezuk: We’re still in the process of finalizing the analysis. There were a total of about 3,400 suicides among adults aged 50 and older in Virginia between 2003 and 2011, 51 of which occurred in long-term care facilities. We estimate that the risk of suicide among older adults in nursing homes is about the same as it is for older adults living it the community—that is, risk isn’t higher or lower in long-term care settings. However, suicide decedents in long-term care were less likely to have had a precipitating crisis prior to their death relative to decedents in the community, suggesting that these were less impulsive acts.

We were also able to identify another 38 decedents who were anticipating or transitioning into a facility. Finally, we identified a group of 16 suicide decedents whose loved ones had recently transitioned into long-term care.

HCB: Did any of your findings surprise you?

Mezuk: We found that suicide risk was higher in better-performing facilities as indexed by Nursing Home Compare.  We hope to examine this relationship in other states to see if these preliminary findings are true in general or just in Virginia.  There are multiple processes that are likely relevant. It may be that there is differential selection into higher-performing nursing homes; for example, it may be that individuals with more severe mental health needs, a risk factor for suicide, may be matched to high-performing nursing homes that offer those services. We need additional studies to understand the reasons behind this relationship. The take-home message is that our data suggest there are organizational characteristics that may be related to suicide risk, and these things are modifiable.

HCB: What are the implications of your research?

Mezuk: The research could lead to interventions for family members or residents who are transitioning into long-term care facilities to mitigate suicide risk. Many types of long-term care facilities are covered by insurance, but many are private-pay, and they’re expensive. As a result there can be a lot of tension that comes up when people are trying to make this transition, and that stress comes at the same time a loved one’s health is failing.

This is a potential place to develop interventions to help make this transition less stressful. As indicated by our findings about decedents who were anticipating moving into long-term care, we need a compassionate and comprehensive understanding of what this process is like for people. There are certainly things facilities and senior programs could do to ease the transition.

The other thing we need is better data. If you have family member who needs to enter a nursing home, you have quite a lot of information at your disposal to make a choice. But we don’t really have similar kinds of data for assisted-living facilities. In Virginia, the only publicly available data relates to facility size, licensing, and inspection violations. We don’t have data on quality, staffing, and other factors that may be relevant to quality-of-life in these facilities.

HCB: How did your experience as an RWJF Health & Society Scholar affect your work?

Mezuk: I would not be doing the work I’m doing without the support of the RWJF Health & Society Scholars program. It was tremendous. I wasn’t doing a lot of work in aging until I got the scholarship and connected with mentors who were working in this field. The program really encouraged me to think about important problems and to explore innovative, interdisciplinary approaches to understanding and addressing them. 

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.