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Some Communities Have Provided Telephone Lines And This Has Been Associated ...

Some communities have provided telephone lines and this has been associated with a significant reduction in the completed suicide in the elderly (Fischer L R et al. 2003)

To return to specific nursing interventions, one can also suggest measures aimed at reducing access to, or availability of the means for suicide such as restricting access to over the counter medicines. (Skoog I et al. 1996),

Some sources (Cattell H 2000) point to the possibility of introducing opportunistic screening in the primary healthcare setting. The rationale behind this suggestion is the realisation that there is a high level of contact between the suicidal elderly person and their primary healthcare team in the week before suicide (20-50%) and in the month before suicide (40-70% make contact). This is particularly appropriate to our considerations here because of the progressively increasing significance of the role of the nurse within the primary healthcare team particularly at the first point of contact. (Hogston, R et al. 2002)

The evidence base for this point of view is strengthened by reference to the landmark Gotland study (Rutz W et al. 1989) which examined the effect of specific training in suicide awareness and prevention in the primary healthcare team by providing extensive suicide awareness training and measures to increase the facilitation of opportunistic screening of the population. Prior to the intervention, the authors noted that, when compared to young adults, the elderly were only 6% as likely to be asked about suicide and 20% as likely to be asked if they felt depressed and 25% as likely to be refered to a mental health specialist. This balance was restored almost to normality after the intervention.

Suicide in the elderly is a multifaceted and complex phenomenon. It appears to be the case that the elderly tend to be treated with different guidelines from the young suicidal patient insofar as the increased risk is not met with increased assistance. (Lykouras L et al. 2002). We have presented evidence that the factors included in this discrepancy may include the higher overall number of young suicides, the higher economic burden that society appears to carry for each young suicide together with ageist beliefs about the factors concerning suicide in the elderly.

From the point of view of nursing intervention, both in a hospital and in a community setting, there should be greater emphasis placed on measures such as screening and prevention programmes targeted at the at risk elderly. There is equally a need for aggressive intervention if depression or suicidal feelings are overtly expressed, particularly in the relevant subgroups where additional risk factors may be active, for example those with comorbid medical conditions or social isolation or recent bereavement. (Harwood D et al.


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