Term Paper: Suicide Rates Among Geriatric Persons

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[. . .] The questionnaire shall consist of questions regarding general welfare and general feelings of contentment vs. dissatisfaction in relation to services being provided, family involvement, independence, and general health. I will model the questionnaire on that performed by Lawton in 1984:

The most detailed attempt to differentiate aspects of subjective well being was made by Lawton (1984) who administered a large number of questionnaires for different scales to 285 U.S. subjects. Two general factors emerged, which Lawton argued represented interior well-being, including self-esteem, satisfaction with past life and positive attitudes to present health, and exterior well-being, including satisfaction with accommodation and social contacts. (Coleman, 1995, p. 56)

Additionally for the needs of this study there will be a standardized diagnostic questionnaire for depression which will include an in depth question about suicide.

1. Have you contemplated suicide in the last year, yes or no, and if so:

on how many occasions did you contemplate suicide?

A were your thoughts fleeting or concrete e.g. did you contemplate ways in which you could take your own life?

I do you feel that these thoughts are severe enough for you to need assistance from a mental health professional in this matter?

A follow up assessment will be administered to the same individuals wherever possible to determine if their general mental state has improved and if they feel they are better informed about the issues surrounding depression and suicide.

There are normal constraints associated with self-assessment tools and there is also some evidence of special consideration with elderly individuals:

Most research involves self-assessment: Self-reports are subject to certain problems including social desirability, memory distortions, and cognitive biases. There is some evidence that increasing age is associated with a tendency to give conventional or socially desirable responses to questions (Spanier & Cole, 1975). (Mares & Fitzpatrick, 1995, p. 186)

This tendency among the elderly to answer questions to please the questioner is a hard constraint and the only possible solution is careful creation and administration of the assessment tool. Patients must be informed that the answers to the questions will be anonymous and unknown to the facility or organization administering the assessment. The actual care facility and the home assistance company will receive only completed statistical findings upon publication. Patients should be informed that if they wish to follow up their assessment with questions about the process or a counseling referral that they may do so by calling a telephone number provided by the administering agency on the signed consent form provided before the assessment.

Other normative constraints would be associated with the ability to administer the assessment to a large enough test group to show a significant statistical result over a five-year period. Though the suicide is the 14th leading cause of death among the elderly the actual numbers of incidence might not be significant enough to provide a true statistical tool for evaluation. This possible constraint can be dealt with by lengthening the actual total time that the test as a whole is performed as a way to increase the number of assessments garnered from the test population or by increasing the number of locations studied with the same result.

With this information the needs of the target group will become more apparent. As the research shows the needs of this particular group are particularly strong in the areas of acceptance and communication. The recognition of a mental health problem such as depression and/or suicidal thoughts is crucial to an individual or family attaining effective treatment in time. Additionally the systems in place presently must continue to expand to provide greater access to care.

Achieving this goal is more easily said than done. Problems arising in the interaction of physical and mental symptoms, in developing mental illness in old age or growing old with mental illness, and in addressing elder depression, anxiety, and substance abuse all highlight issues associated with recognition. (Holstein & McCurdy, 1999, p. 174)

The target population of this assessment fall into a category of individuals who by some standards have better access to mental health treatment than do clients who have little to no repeated contact with the health care system and especially contact with a system that is tuned to the needs of a geriatric population.

Of the two groups addressed the individuals still residing at home would again be at greater risk for lack of access to mental health treatment or even awareness of the severity of their symptoms. Once again this is associated with the general lesser opportunity for frequent social interactions. Symptoms of depression are often long-term, causing some individuals who are suffering from organic and/or situational depression to become accustomed to the symptoms and the subsequent lifestyle change. Occasionally, in a worst-case scenario an individual and his or her family may actually believe that their suffering is a normal aspect of the aging process, unaware that there are reasonable and effective treatments for this condition. Depression is often marked by an inability to evaluate ones self in a realistic manner.

Yet as a group the target population has some advantages to access. The first as I pointed out previously is the mere exposure to a health care system tuned to their needs. Furthermore, clients of services such as an assisted living facilities or home assistance agencies are often served on a long-term basis. This length of service allows repeated points of contact for comparison and assessment of general mental health. Home assistance agencies often have contact information for family and other concerned persons who can be made aware of a possible problem and help the individual attain access to mental health treatment.

Assisted living facilities often employ trained health care professionals both nurses and social workers that assist clients with the transitions of relocation including everything from address changes to medication administration. The staff is often trained to observe and intervene when an individual has a dramatic change in the level of care required. Like home assistance agencies they are also usually in contact with family and/or other concerned persons who might assist the client with access to mental health treatment.

The one factor above all others in regards to the advantages of clients of these two types of services in the socioeconomic status they often represent. Access to either service, regardless of subsidies that are often available, especially to assisted living residents requires the economic ability to retain such services in the first place. This factor plays heavily into the ability for any person to obtain access to needed health care, be it treatment for depression or any other health care need. These clients often carry health care insurance that covers health care needs to a large degree and shelters personal assets as well as those of their family, from the average health care expenditures that sometimes grow exponentially with age. The individual may not be someone who would be considered wealthy but they are lacking nothing of their basic needs and would not be in danger of doing so if they were to have a health catastrophe. Yet, the issue of financial well-being may also be a double edged sword for the target population because:

Changes of home and removal from friends and associations are often poorly tolerated in old age. Those who have lost much in social status, financially or otherwise, particularly if the blow has been sudden and unexpected, are more likely to commit suicide than those who have always been used to little. (Menninger, 1957, p. 147)

Often assistance both in the home and in an assisted living facility can be very costly and it is many the aging individual who considers their own longevity based on financial resources. Though it may seem strange some elderly individuals actually plan a budget based on how long they expect to live and in the event that a person outlives available resources stressors become greatly increased. Fear of dependency on ones family seems to be forefront. This is not to say that a majority of elderly individuals experience financial stressors as they age, statistically speaking this is not the case. Yet, financial concerns have been shown to be a significant factor in environmental depression among all populations.

Access to mental health services under conditions of lower economic abilities becomes largely an issue of state vs. private care. Many states differ greatly in what outreach or out patient care they offer and are willing to subsidize. Another factor of coarse is severity of symptoms. Most inpatient mental health treatment facilities, especially those that are state funded are dictated by the question: "Is the patient a danger to his/herself or others?" In other words has this patient exhibited suicidal behaviors or had a psychotic episode severe enough to endanger others? Private inpatient care is often out of reach to individuals who do not have mental health coverage as part of a… [END OF PREVIEW]

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Suicide Rates Among Geriatric Persons.  (2002, October 31).  Retrieved May 20, 2019, from https://www.essaytown.com/subjects/paper/suicide-rates-among-geriatric-persons/7456989

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