About Preventing Suicide in Older Adults
Our Calling and Our Mission
There is an epidemic in our older adults. The rate of suicide in the 65-84, and the 85 and above age groups are higher than any other age group. Our older and productive adults are depressed, giving up and committing suicide. These golden-agers deserve our help, support, and love.
New Screening Tools for Depression and Suicide
Our screening tools used to detect depression and its severity
and progression have improved. The use of these tools is
growing, finding earlier symptoms that can lead to earlier
treatment, before our elders become suicidal.
Education to Save the Lives of Family, Friends
Our goals are to decrease by 50%+ the number of suicides,
through education for family, friends, neighbors, and institutions that are designed to help those under it's care: churches, businesses, and governmental programs to improve health in all age groups.
Learning about Suicide in Older Adults
Section 1 Preventing Suicide in older adults
The Problem: Older Adult Groups, age 65-84 and 85 and above, have the highest rates of suicide of any other age groups.
The Source: Depression can lead to suicidal thoughts, self-harm, planning to commit suicide, and completing a suicidal plan.
The Reasons: Loss of a spouse, difficult health issues, pain, poor nutrition, lack of family support, drug or alcohol use or addiction, expensive health costs, problems with transportation, misuse of medication or side effects, poverty, inability to find a medical provider, and many more issues.
The Solution: Improved routine screening for depression/suicide, family education, improved physician, nurse, hospital, nursing home, home health, adult day-care center care, along with other supportive programs offered by churches, social clubs, conferences, state provided programs, and federal support through Medicare and Medicaid, CDC, DEA, FDA, SAMSA and other agencies.
Our goal is to reduce suicide attempts 50% in the next five years
PHQ 1 - Screening for Depression/Suicidal Thoughts
Depression: The first test, PHQ 1, is a simple set of questions to see if there are symptoms of depression or thoughts of suicide. We should encourage our older adults who have symptoms of depression to seek help? Most often this will be a family member or caretaker, who can see the changes from normal to depressed, expressing concern to the patient, helping them to seek care from their family health provider.
Physicians and Nurse Practitioners may also see these symptoms when in the office. Screening the older adult for depression/suicide symptoms, who may need treatment, such as counseling, medication, or even hospitalization for severe depression. Using PHQ 1 will help us see the need in those depressed/suicidal persons. We have included three screening tests that can be printed and given to a person who is wondering if they are depressed. All of these screening tests have been tested and used to make sure they are effective. The addition of the questions about suicide combined make this an easier and more complete test to prevent suicide in older adults.
PHQ 2 - RISK Screening for Depression/Suicidal Thoughts
Risk of Suicide: The second test, PHQ 2 is a simple, one page Depression/Suicide Screening test that are filled out by the patient (or a person that reads the questions and marks down the answers). PHQ 2 is a screening test about the patient’s lifestyle, the issues that make them angry, upset, confused, hopeless, depressed with suicidal thoughts or actions. The questions encountered on PHQ 2 will help the family physician or nurse practitioner to see how the patient’s home can be made safer, that medications given for all physical and emotional illnesses are used appropriately, and some other mental health issues, such as misuse or addiction can be treated to relieve the stress this causes. The loss of a long time companion can be very hard on the surviving spouse, and grief counseling, attending church, and getting more physically active can shorten the grief process.
If your family member, friend or neighbor has symptoms and risks for depression, you should encourage them to make an appointment and discuss these issues with their healthcare professional.
PHQ 3 - Depression, History of Suicide, Suicidal Plans, and Suicidal Attempts
(Physician or Psychiatric Nurse Practitioner should fill out this screening test)
Suicide Assessment: The last test is very helpful for the Physician or Psychiatric Nurse Practitioner to fill ou (PHQ 3) with the patient in the room, or via telephone-health appointment, so that a more complete and accurate diagnosis and treatment plan can be offered by the practitioner.
PHQ 3 looks at the varying forms and complications of depression, the ways depressed patients try to act on their suicidal thoughts, the process of planning how to end their life, how many different plans they have used, and more. Studies show that most men use a gun to end their life, while women use medication to overdose. The differing forms of depression are important to find and treat, and may include psychosis, personality issues, or other forms of emotional disturbance. This “PHQ 3 fill-out form” may be used, or the full interview format, C-SSRS Columbia-Suicide Severity Rating Scale for those who have cognitive impairment and for baseline screening.
Family members or friends should not try to score the testing unless they are properly trained. This should be done by the medical professionals including counselors, physicians, social workers, trained nurses, psychiatrists, and nursing staff.
Preventing Suicide in Older Adults
Section 2
Medical Professionals and Caregivers Information
The important information about the screening tools, section 1, and the rest of this project is included in Section 2, 3, 4 and more. We will be adding informational topics as we progress over the next few years. We will be adding other experts in blogs, classes, videos, develope a newsletter/blog to keep you up to date on our progress. PHQ 1, 2, and 3 are available on PDF, and we suggest getting the PDFs (free of charge) to copy and keep in your office.
Patient Health Questionnaire (1)PHQ-9, NIMH
Over the last 2 weeks, how often had
the following symptoms: FILL IN THE DOTS
No Few More Than Most
Days Days Half the Days Days
1. Little Interest or pleasure in activities 0 0 0 0
2. Feeling down, depressed, without hope 0 0 0 0
3. Trouble falling, staying, or excessive sleeping 0 0 0 0
4. Feeling tired, reduced or absent energy 0 0 0 0
5. Reduced appetite, or overeating 0 0 0 0
6. Feeling down, that you are a failure, 0 0 0 0
or let your family down
7. Trouble concentrating, at work, 0 0 0 0
or at home watching TV, or reading
8. Moving or speaking slowly 0 0 0 0
or too much energy, fidgety, restless
9. Thoughts about hurting yourself, dying 0 0 0 0
CIRCLE THE YES or NO
10. Recently, have you felt that you or your yes no
family would be better off if you were dead
11. In the past few weeks, have you thought yes no
about killing yourself
12. Have you ever tried to kill yourself? yes no
13. If yes, how?
_______________________When? __________________________
14. Have you though about killing yourself today? yes no
Let the nurse know if you want to discuss this
questionnaire with someone. Thank you.
Preventing Suicide in Older Adults
Section 2 Medical Professionals and Caregiver Information - Letter
Sitting Well Counseling
2811 Linkhorne Dr. Suite D
Lynchburg, VA 24503
434-582-9061
Dear Medical Professional and Caregiver:
We have a problem!
The rate of older adult suicide has increased, and is now at the highest rate compared with all other age groups. These include men and women age 85, with a suicide attempt rate of 21%. Men, 90% use guns, while women use medication for most suicide attempts.
Older Adults are a unique group with many life-changes and losses; retiring or losing a job, health problems of aging, death of a spouse or older friends, increased use of drugs and alcohol, using multiple medications, often with access to guns and pills. Most are living on a fixed income, many in the poverty range. Some have supportive family members, but other members are marginally able to help, and a few have no support. Loneliness becomes overwhelming after loss. Depression leads to suicidal thoughts as an answer to this dilemma, as they fall deeper into despair and hopelessness.
We must make an attempt to fix this problem!
We have upgraded our TESTING for depression and suicidal thoughts, and plan to make them accessible for home-care programs, adult-care programs, clinics and offices. TESTING regularly may reveal relapsing depression, or damage to their support system. Annual Wellness Visits should be required to take a depression screening test(s). Drug or alcohol treatment may be needed through their physician, in or out-patient treatment. For those at risk, TESTING may be needed more often, every three to six months to follow treatments.
We need to offer prevention!
After screening, they will be seen by their provider who will grade the level of depression and suicidal thoughts, treat with medication, add counseling, or refer to psychiatry as needed for more severe depression, suicidal thoughts, plans, and actions. We need to catch this early, and get it treated.
We need to offer education to family, friends, and neighbors!
We need to offer programs of support, to help families, friends, or neighbors to help these depressed patients, and to meet their emotional, physical, financial and medical needs.They will need education and encouragement to use Medicare and Medicaid to meet their medical needs. For many, this care is not easy to access, and may be refused as “welfare”. They need regular screening for depression, suicidal thoughts and plans, and screening for risk factors that are common in older adults.
We Need family and friends to join with us to catch depression/suicide earlier!
We need families, friends, neighbors, churches, social groups, day-care programs, and all able-bodied adults, to rise up and help. We must provide the transportation as needed, provide services in the home when not available to help them get the treatments, the nutrition and medications needed to maintain their health. Meals on Wheels, designed to send a friend into the home while providing a meal may be an alternative. Neighbors, church and social group friends are needed to visit, to call, to provide companionship, emotional support, and a ride to the adult-daycare center, the doctor, the counselor, the food store, and to church.
We can fix this problem?
With improved testing, more often, and in all venues available. We need to get those with moderate depression, suicidal thoughts and planning to be seen by their medical provider, and treated with medication, counseling, or psychiatric care as needed. Then we need to build local, state, and federal programs of awareness, Medicare and State Older Adults programs that provide education about needed care, financial education and aid, medical treatments and care centers. We need to get churches, medical providers for older adults, social clubs, and educational venues such as computer APPs and Mature Adult groups, such as AMAC, AARP, VA and others to continue with this education.
OUR GOAL: Over the next ten years, we hope to see 50%+ who have not committed suicide due to the interventions and programs that identify, offer treatment options and educate about this topic.
Sincerely,
Gregg R. Albers MD FAAFP
Family Medicine, Addiction Medicine
30 Years of Inpatient, Outpatient, Psychiatric Medical Consultation
Preventing Suicide in Older Adults
Medical Professionals and Caregivers Information Section 2
General Information
General Information - Depression as it worsens can lead to suicidal thoughts, planning, and attempts to hurt or kill themselves or loved ones. It can be exacerbated by medical illness, injury from an accident, complicating psychiatric issues, and if the thoughts, plans and previous attempts have occurred, should be considered for hospitalization or emergency room for holding and protection.
Risk Factors - In older patients, many risk factors are unique to this group, such as aging issues, loss of a spouse, loss of bodily function, pain issues, memory loss, early dementia, arthritis in the extremities, neck and back and arthritis pain. Loneliness and lack of family support can severely exacerbate these issues. Other risk factors include keeping a firearm at home without locks, use of alcohol, misuse of medications, which may quickly cause a downhill spiral of emotions with severe suicidal thoughts and attempts.
Protecting Older Adults from Suicide - Each of us needs an emotional support system such as family, pets, friends, coworkers, neighbors, church with friends, social clubs and to be a part of a group of friends. Without this support simple problems can expand to become overwhelming. We all need to be vigilant when we see our family, friends, neighbors having problems getting food, calling family or friends, transportation for medical care, paying bills. We need to offer help with tasks, our support through conversations and encouragement, dropping by regularly to check on our neighbor. Help with daily needs, food, medicine, rides for health care, church, fitness clubs or drug store. Be a part of a support system, especially when family or neighbors are unable or unavailable help with their problem or need. .
Helpers to build support: Pastoral phone call, family members phone calls, your call, transport for doctor’s visits, shopping for groceries (or just pick it up and delivering). Meals on Wheels if the older adult cannot cook, as the meal deliverer will also try to support by spending time, playing cards, doing some simple clean up, and keep and eye out for the older disabled adult.
Preventing Suicide in Older Adults
Scoring for Screening Tests
Medical Professionals Information - Scoring for PHQ 1, 2, and 3
PHQ (1) Patient Mental Health Questionnaire
Combination of PHQ-9, and NIMH Suicide Risk Screening
(last four questions).
PHQ-9 Not at all 0 points
Several Days 1 points
More then Half 2 points
Every Day 3 points
NIMH Yes or no answers, 4 questions only.
Each question shows increasing intent, planning
to commit suicide
Questions 3 and 4, if yes, needs referral today
PHQ (2) Risk Factors for Depression, Suicidal Thoughts
Designed to help identify correctable risk factors for depression,
suicidal thoughts, planning, attempts. Provider should go over each
positive question to discuss the reason for the risk, and to give direction
on how to remove, delete, or treat.
PHQ (3) Initial Screening Test for Suicidal Thoughts, Intent, History of
Suicidal Attempt, and Current and Previous Treatments.
NOTE: A psychiatrist, physician, psychiatric NP or PA should ask the
questions, discuss them with the patient and treat to their level of
expertise.
C-SSR Columbia-Suicide Severity Rating Scale, Cognitively Impaired Baseline/
Screening. The physician will use the screening test, and the C-SSR test
through interviewing, the extent and seriousness of the patient’s depression.
Please get the PDFs and download them to your computer. Print them as needed.
Preventing Suicide in Older Adults
Section 2 Medical Professionals and Caregiver Information
Providers: Psychiatrists, Family Physicians, Psychiatric NPs, Family NPs, PAs
Locations: Nursing Staff, Home-Nursing, Nursing and Rehab, Adult-Daycare,
Home Nursing, Home PT, Home Counseling, Telephonic Medical visit, Mental
Health visit, Social Worker visit
Community: Sponsored Group Functions, Church outings, County Fairs (booth),
Social clubs, Activities for Aging Adults, Car Shows, and many other activities
Medical Clinic/Office, Urgent Care, Store-clinic, Federally-Funded Clinics,
City and or County Health Dept.
Patient with depression - at first visit PHQ (1), (2), every 3-6 months with med
refills PHQ (1), worsening of depression, immediately and 8 weeks - PHQ (1),
(2), (3) and referral (Hospital or Psychiatric Office with moderate to severe
depression).
Patient for Annual Wellness Visit - yearly, and for follow-up if depression
New patient, depression diagnosed - at first visit, with meds 8 weeks, every 6
months. On meds, every 3-6 months - PHQ (1), (2), (3) and referral?
Psychiatric Patient - as follow up above, include other screening per physician.
Nursing Staff, Hospital, Rehab, Nursing Facility, Adult-Daycare
General activity - PHQ (1) for a group activity, general screening
Rehab - at beginning and end of rehab - PHQ (1), (2) before going home
Nursing Facility - admission, with or without depression, when has changes of
depression, has early dementia, (do not use PHQ 1, 2, or 3 for patients with
moderate to severe dementia) sending to hospital for inpatient with increased
symptoms of depression..
Home-Nursing, Home-PT, Home-Counselor, Home-Social Worker Home
nursing visit - initial PHQ (1) with any history or symptoms of depression, 1 month
follow-for depression PHQ (1), (2), (3) if much worse and referral to Hospital or
Psychiatric clinic, clinic visits for medication check, and new signs of depression,
crying, sadness, “wish I were dead”, “no use to anyone.”
Telephonic Medical Visit, Mental-Health or Counseling Visit, Social Worker
Medical Visit - go over medications, if has depression, document with PHQ (1),
increased medications if needed, follow-up in 1-2 weeks (side-effects), and 6-8
weeks for medication effect. Alternate visit to medical office for follow-up.
Mental-Health Visit - PHQ (1) at initial visit, stable on medication, PHQ (1), (2)?
every 3-6 months. If new onset of depression, PHQ (1), (2), if minimal to mild,
counseling is recommended, worsening, referral to clinic, psychiatrist.
MSW Social Worker - any history of depression, family history with psychiatric
admissions, multiple, or suicide attempt, would start with PHQ (1), (2) on phone,
and refer to medical, sending the screening tests to the physician or Psychiatrist
office. Other referral may be made MSW for counseling, follow up and community
programs referral.
Community Use of Screening Tools - Follow-up Referrals
Group Outings - church outings, county fairs (booth), hospital outings,
day-care outings - football games (booth), community adult-daycare outings,
and other outings where a table with signage, a booth, are available.
Anywhere people can be educated about the increase in suicides in older adults.
Older Adults have an increased risk of suicide, more than any other age groups.
(85 and above - HIGHEST, 65-84 second HIGHEST.
Tell them about the PHQ (1) screening and offer a copy of the test.
OPTIONS: Anonymously, no names, but take to their doctor at next visit.
NAME/PHONE NUMBER: Make sure you have a referral resource (counselors,
physicians, social workers) who will score the testing and make appropriate
referrals. If needing referral for moderate to severe depression, they should be
given and take PHQ (1), (2), (3), and sent to ER or Hospital or Urgent Care to be
evaluated. There is no cost for the screening tests or information. Cost of
copying/group.
Screening for depression with mild dementia is approved, but not for moderate
to severe depression
Preventing Suicide in Older Adults
Section 3 PREVENTING SUICIDE
Phase 1 Origin of project, started in October 1, 2022
Prevention Starts with Testing - family, friends, neighbors, nurses, physicians, counselors, physical therapists, administrators - all those who love and desire to serve others.
TESTING
Better testing for depression, suicidal thoughts and actions, is now available and can be used in all settings: medical, social, and where older adults are being cared for, including family homes, with home nursing, in rehabilitation/nursing homes, in adult day-care centers, in medical offices and hospitals.
SCREENING
PHQ (1). Depression plus suicide screening (PHQ-9) plus NIMH added suicide
questions
PHQ (2). Risk factors that lead to depression and if changed, to prevent
suicide attempts.
PHQ (3). C-SSRS Columbia suicidal thought, intent interview. This screening
with yes and no questions has some of the information, and a full
test would be required by the and given by the healthcare provider.
TREATMENT
For those with a diagnosis of moderate depression, history of suicidal thoughts, should be re-screened every 6-12 months as part of their medical treatments and follow-up. They should be followed by a Psychiatrist, Physician, Psychiatric Nurse Practitioner, Family Nurse Practitioner, Counselor (LPC, MSW) while they are being treated, because of the above history. Depression can return when not expected, and again lead to suicidal thoughts.
Phase 2 This phase is in process, Started January 1, 2023
EDUCATION/ VOLUNTEER RECRUITMENT
We need to educate and spread the word. Education comes easily when people see a need and get involved. The people who love and care for others, whose life is to serve others, and those who know the spiritual importance of preventing others from killing or damaging themselves due to suicidal thoughts and actions - all of these people are likely to help.
These people are found in in families, friends, local neighbors, and in Churches, Day-care centers for older adults, home-care nurses and specialists, physician and nurse practitioner offices, counseling offices, adult day-care centers, social clubs, veterans clubs, and even in our government. They can be care-givers to others with depression/suicidal thoughts, and they can educate, publicize, find help for those in need recruiting others
Other groups, such as Meals-on-Wheels is already making a difference, providing nutrition and a caring person to deliver the meal. They can be mindful of changes in behavior and mood that can lead to depression.
Making the screening accessible to take at home, then taking their screening tests to their provider will be a help for your mental health, even more if you have depression or had suicide attempts in your past.
Phase 3 - Has already started with Website, Phone, and will include this discussion.
Media, Government, and Research Funding
REDUCE RISK
Screening is designed to catch the disease of depression and its sequela before the depression turns into a suicidal plan or attempt.
Most medical offices that see patients, especially older patients, screen these patients if they have any symptoms of depression. It is more effective to offer them screening material, fill it out, and then sit with the nurse, nurse practitioner or physician to ask again certain questions filled in or not. Medicare has recommended this to medical offices, but getting everyone involved in a research study is better, more compliance with these materials. We will be trying to offer this plan to any groups or companies, including pharmaceutical providers makers of some of these medications, to help get the screening to more people.
Many states and federal government programs provide information for older adults and can also put this information about self-screening/medical office visit as a public service, and possibly some advertisements on radio, TV, emails, and more.
RADIO, TV, ELECTRONIC, WEB SITES - MEDIA HELP
Making the screening accessible to take at home, and then take to their provider will be a help to keeping you healthy, even more if you have depression and are keeping track of your health. We are currently producing a web site, Preventing Suicide in Older Adults, and will also try to put a limited version on the iPhone. For Churches, Social Groups, home-health groups, and other organizations, we will be producing the educational materials to help encourage and train the family, friends, neighbors to look out for depression and help the older adult in their life to get the help that is needed.
Family members or friends should not try to score the testing unless they are properly trained. This should be done by the medical professionals including counselors, physicians, social workers, trained nurses, psychiatrists, and adult-care staff.
Preventing Suicide in Older Adults
Section (4) Training Our Volunteers
Prevention
Prevention Training: What is prevention? In the medical sense, preventing a disease or outcome is doing something, seeing a problem, or using healthy habits over the long term to prevent disease, debilitation, or premature death. Seeing a normal adult who starts feeling down, with no joy or happiness, who is tired all the time, has crying spells, poor appetite and concentration, reduced sexual desire and function, hides from friends and family, and then develops suicidal thoughts, plans, and desire to commit suicide. Prevention is catching the symptoms of depression in the early stages and discussing it with the person with symptoms. Ask them if they want help, if they are concerned about the changes, and if they are not functioning well at home, school, work. Dropping out of normal functions, such as church, eating meals, going to bed early, mean this is getting more severe.
General Information about Depression: It is good have some information that you can carry with you in written form, or memorized it to give to the depressed person. These include:
Suicide Rates: Our older adults, age 65 to 84 years old, and 85 years old and
above are committing suicide at the highest rates, more than adolescents, and
more than any age group that has been studied.
Life Changes: Older Adults are a unique group with many serious and
disturbing life-changes; retiring or losing a job, health problems of aging, death
of a spouse or older friends, increased use of drugs and alcohol, often using
multiple medications, often with access to guns and pills, with many living on a
fixed income.
Depression: The emotional and physical changes are devastating for many in
this age group, leading to depression symptoms, crying, feeling down and
depressed, poor appetite, poor concentration, anger hopelessness, poor
tolerance to pain, increased sleep or insomnia, separation from family (want to
be left alone). They may not seek medical attention due to poor transportation
options, or concerns about the expense of medications and testing.
We all need to be vigilant when we see or hear a family member or neighbor
with depression symptoms and encourage them to get help. Using the
screening tests help educate those with depression and will help educate those
who are depressed/suicidal. Seeking help with them, calling them to see how
they are doing, might save their life. Give them your number and permission to
call as well.
Use of Depression Screening
Screening Materials: Screening for depression has been available for many years, some at a price, and others free to use. They started with very simple sets of questions, which are directed at the person with a potential mental health or addiction problem. They have developed through the years, have been studied, and have be found to be very patient friendly and easy to use. Not many who use a screening tool will have symptoms, and in the case of PHQ 1, has symptoms that could be from depression, or from other normal problems. Screening individuals will normally lead to seeing a lot of normal people. Screening those with symptoms, early to late, are much more likely to be found and referred for medical help or counseling.
Most physician and nurse practitioner offices will keep copies of the most used, easiest to get, easiest to read. When it comes to mental health problems, often physicians do not feel comfortable reading, grading, as they always refer to another mental health professional. As well licensed counselors will use these to identify the specifics of many of the mental health conditions while ruling out others.
PHQ 1 is an easy to read questionnaire that has questions about depression symptoms, both physical and emotional, and questions about suicidal thoughts and actions. The scale is a tabulation of yes or no responses, and the scale starts with normal, them mild depression, moderate depression, and severe depression with suicidal thoughts. The higher the number the more likely that person has more depression. Remember, as a lay person, you can ask the patient the questions and write the answers, but do not try to grade or count up the positive responses suggesting depression/suicide. Take them to their medical provider.
PHQ 2 is also easy to use, but it has a different purpose. We know that as we get older, certain things change in our life, and these changes, when then get more severe, and more numerous, can be helpful in identifying the severity of the home situation, and what thing need to change to make the home environment safe again.
Referral
Referral to Medical Professional: As a lay person, even if you have some training about depression and suicide, you can make a phone call for a family member, but only if that person gives you permission. The only exception is for a family member that has attempted suicide, and they are unable to talk or help themselves. Then calling 988 for suicide counseling for the family member or friend, 911 for the Emergency Ambulance for a patient that is not able to speak. As a non-medical person, you cannot call a doctors office, hospital or nursing home to give them medical information, to make a referral, or to make an appointment. If there is a question, call 911 to ask them what you can do, or to send out help.
If you have offered a friend or neighbor a screening testing and they refuse to fill it out, but tells you that he or she is suicidal and wants to kill themself, you can tell them to call 988 for suicide counseling, or 911 if they have taken pills to use to commit suicide.
If they tell you that they are no longer suicidal, make sure by staying with them until they have calmed down. You can give them the 988 or 911 number to keep with them. Ask if you can stay with them, or take them to a family members home so they can be watched by family.
DO WHAT YOU CAN, talk with them, encourage them to get help, to watch them if they took medication or alcohol. Letting them have your number to call you is helpful.
TRAINING MATERIALS: Recommended Materials
Suicide Prevention Resource Center - Online Access https://sprc.org/online-courses
SAMHSA - Suicide Training options, Addiction issues, Online Access. SAMHSA.gov.
Contact Us
Preventing Suicide in Older Adults
Education, programs, training, and finding a heart for older adults, parents, friends, neighbors is our mission. Getting others involved is our passion.
Getting in Touch
Email - greggralbers@mac.com
