Suicide risk in LTC: Effective protocols may not be what you think (McKnight’s LTC News)

Posted by Dr. El - August 11, 2013 - Depression/Mental illness/Substance Abuse, Stress/Crisis management - No Comments

Here’s my latest article at McKnight’s Long-Term Care News:

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Suicide risk in LTC: Effective protocols may not be what you think

According to researchers, 11% to 43% of LTC residents have thoughts of suicide1-3, with higher rates in larger facilities and in those with more staff turnover4. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors5 – factors that frequently affect our residents.

The MDS 3.0 requires that facilities ask residents questions regarding their risk of suicide. If a risk is identified, then effective protocols should be employed. In a June 2013 Annals of Long-Term Care review article, Challenges Associated with Managing Suicide Risk in Long-Term Care Facilities6, authors O’Riley, Nadorff, Conwell, and Edelstein offer alternatives to the procedures frequently in place in LTC settings – close observation or transfer to a psychiatric facility. These methods are often used unnecessarily, the authors note, due to staff fear of legal liability, concerns regarding their perceived competence in handling suicide risk, and the personal fear of losing a resident to suicide.

Essential for immediate risk

The authors argue that while close observation and hospitalization are essential when residents have the means, intent, and ability to end their lives at any moment (high risk situation), they’re ineffective in situations where there is a minimal or low risk of imminent death by suicide. For example, a resident may express thoughts of suicide but have no access to a means to do so or no ability to make use of an available means, making suicide very unlikely or virtually impossible. Other times a resident may have thoughts of suicide but no plans to do it any time soon. “If things get worse down the road,” they’ll sometimes say, “then I’m going to end it all.”

Ineffective for minimal risk

While a low or minimal risk should still be taken seriously, there is no evidence that it’s effective to put a resident on 15-minute checks or to send him or her to the psychiatric hospital.

For the entire article, visit:

Suicide risk in LTC: Effective protocols may not be what you think

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2. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2009;25(8):843-849.
3. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2-3):97-116.
4. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav. 1992;22(1):98-106.
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-468.
6. O’Riley A, Nadorff MR, Conwell Y, Edelstein B. Challenges associated with managing suicide risk in long-term care facilities. Annals of Long-Term Care. 2013;21(6):28-34.