Follow-up to the statewide model detection and prevention program for geriatric alcoholism and alcohol abuse.

A follow-up study was conducted to investigate the long term consequences of a statewide geriatric alcoholism detection and prevention effort in Virginia. High levels of knowledge had been retained seven years after the initial training. Quantitative and qualitative data provided by 64 of the volunteers, who were trained to conduct workshops in their communities, verified the program's ability to: 1) encourage further training or study in the area, 2) enhance the detection of alcohol problems, and 3) increase the incidence of assistance to individuals with alcohol problems. Ancillary data revealed the program's effects on personal drinking habits.

A statewide model detection and prevention program for geriatric alcoholism and alcohol abuse: increased knowledge among service providers.

To facilitate the professional development of service providers, the Virginia project on geriatric alcohol abuse and alcoholism developed and used an informational booklet, brochure, and video in a "train the trainer" model. A core group received extensive training, and then trained colleagues in their local communities. Knowledge gains were documented among both trainers and trainees. Follow-up interviews with agency personnel revealed substantial impact on a broad spectrum of service systems and improvements in interagency coordination. Results are discussed in terms of the educational needs of professional service providers regarding the unique aspects of alcoholism and alcohol abuse in the older population.

Hopelessness and suicidal ideation in older adults.

This study examined the role that hopelessness plays in geriatric suicidal ideation. Sixty institutionalized elderly males were recruited. Multiple regression analyses revealed that while hopelessness was strongly related to suicidal ideation, the relationship between hopelessness and suicidal ideation was dependent on level of depression. Participants who reported moderate or higher levels of depressive symptoms were more likely to have suicidal ideation with increasing hopelessness, whereas hopelessness had little effect on level of ideation at mild or lower depressive symptom levels. Unlike previous studies in younger adults, hopelessness did not predict suicidal ideation better than depressive symptoms, although the relationship between depression and suicidal ideation was stronger within higher levels of hopelessness. These findings highlight the importance of considering depression and hopelessness simultaneously when assessing and treating geriatric suicidal ideation.

Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.

Psychological factors in late-life suicide.

A number of psychological factors influence late life suicide, including dysfunctional family and family history of suicide; relational problems throughout life; history of drinking; numerous losses in middle and late life such as the loss of power and control, loss of spouse, and loss of work role; and increasing mental health problems in late life. Depression, the most common mental disorder in later life, is a major precipitating factor in suicide. Alcoholism is another major precipitating factor in late-life suicide. Approximately one-third of all suicides are alcoholics. Many of the same factors which contribute to depression also increase the risk of alcoholism and/or suicide. Loss, stress, loneliness, low self-esteem, and feelings of anxiety, rejection, helplessness, and hopelessness characterize late life alcoholism and depression. Alcoholism, depression, and suicide form a deadly triangle. Family, caregivers, and practitioners need to be aware of the deadly relationship between alcoholism, depression, and suicide in older adults.

The suicidal patient in long-term care institutions.

In comparison with older adults living in the community, elders who are institutionalized are older, sicker, and more likely to have no living family members, factors that place them at risk for suicide. Somatization, or physical suffering, is a frequently overlooked symptom of elderly depression, perhaps because it is falsely assumed that such symptoms expressed by the older adult are normal concomitants of aging. Strengthening and extending existing family roles in supporting the elder who is suicidal and depressed is vital to reducing loneliness, emotional pain, loss of independence, and to increasing self-concept. An expanded knowledge of mental health needs of older adults and their families is critical in suicide prevention. A major step toward prevention is the recognition of depressive symptomatology and key elements and clues to suicide in the institutionalized elderly.

Suicidal behavior in long-term care facilities.

Questionnaires were mailed to a random sample of administrators of 1,080 long-term care facilities, in order to obtain information on the extent and nature of overt suicide and intentional life-threatening behavior (ILTB). Rates were calculated for death for overt suicides and ILTB. In-depth case studies, involving observation, interviews, and examination of medical records, were conducted in four facilities. Quantitative analysis revealed that white males were most at risk. Refusing to eat or drink and refusing medications were the most common suicidal behaviors. Depression, loneliness, feelings of family rejection, and loss were significant factors.

The alcohol-suicide connection in late life.

The many losses and stresses of late life, often accompanied by feelings of loneliness and depression, make the elderly especially vulnerable to alcoholism and suicide. The elderly alcoholic is at significant risk for suicide. The major factors in geriatric alcoholism and suicide are depression (manifested by changes in sleeping and eating patterns, somatic complaints, and apathy), stress and loss, and helplessness and hopelessness. Alcoholism in the elderly can be detected and effectively treated, thus reducing the risk of suicide. Family and friends, physicians, and society all have a role in preventing alcoholism in the elderly.

Suicide in the elderly: are we heeding the warnings?

Old age is a time of losses--loss of social roles, of health, and of loved ones. Loneliness and severe depression often accompany these losses, making the elderly especially vulnerable to suicide. Among the warning signs to look for are changes in patterns of sleeping or eating, weight loss, extreme fatigue, increased preoccupation with bodily functions, increased alcohol consumption, mood or behavioral changes, and sudden interest or disinterest in religion. Many of these signal depression. Most of the elderly who commit suicide do so not long after visiting a physician. Thus, responsibility for prevention lies not only with family and friends of the suicidal elderly person but with the physician as well. Society also has a responsibility to value the status of its older members.