This week’s post doesn’t open with the usual cute dialogue I share with my residents on the daily. This post is going to be a bit more serious as it is shining light on a topic that warrants more awareness.
I evaluated a woman this past week who was admitted after being hospitalized with ‘AMS.’ Admittedly, this was an acronym I hadn’t seen in a while, and I had to do a quick Google search to find that this means Altered Mental State. While experiencing this AMS, my patient attempted to take her own life by overdosing on aspirin pills. Per the psychiatrist’s notes, my patient had reported that she felt as though she was becoming a burden on her family and she wanted to end her life as to no longer be a burden. Upon the time of his evaluation, the psychiatrist felt that she was at a point where she was not a threat to herself or others, so he found a discharge to a SNF as opposed to an inpatient psychiatric unit would be more appropriate.
I must say this is the first case I have seen (firsthand) where an older adult felt so depressed that they resorted to attempting to end their life, but this is actually far more common than one might expect. According to the American Foundation for Suicide Prevention, in 2015, the second highest suicide rate (19.4%) occurred in the older adult population, or adults 85 years and older. When one expands the age range a bit, you find that every day in the United States, 17 adults over the age of 65 commit suicide — and this would be the highest suicide rate of any demographic group (Rand-Caponey, 2002).
As for the reasons why, these vary as they do in any age group, but some of the most commonly cited are: diagnosis of complex medical illness, loss of loved ones, loss of independence and feeling like a burden to caregivers and/or family, financial struggles, feelings of isolation and purposelessness. Substance abuse, depression and other undiagnosed mental health issues can also be key factors. It is unfortunate that we continue to live in a world where seeking out help for mental illness is stigmatized, but this truth is even more prevalent for the demographic of individuals we are examining. I don’t know about y’all, but my grandparents and dad definitely come from the school of thought that when something bad happens, you pull yourself up by your bootstraps and move on. I think many of the hardworking individuals in my grandparent’s generation and my dad’s generation share this same ‘toughen up’ attitude, which is good in some instances, but not so good as it relates to mental health. With this attitude, the likelihood of a person reaching out when they need help the most is low.
This is where prevention comes in and paying attention to any warning signs. According to the American Association for Marriage and Family Therapy, here are some warning signs to look for: loss of interest in occupations or activities previously enjoyed; decrease in social interaction, self-care and grooming; breaking medical regimens; giving things away, making changes in wills; stock-piling medications or other lethal means; making remarks such as, “This is the last time you’ll see me”; lastly, the most significant indicator would be the direct expression of suicidal intent.
Occupational therapists can play a big role in helping older adults suffering from major depression or suicidal ideation as we have the knowledge and skills to assist older adults with regaining a sense of purpose through participation in desired occupations and promoting/increasing independence with the completion of activities of daily living (ADLs). Knowing that my patient feels like a burden to her family and that she can’t take care of herself helps me to reason that working on ensuring such activities as toilet transfers, dressing, performing grooming and hygiene tasks while standing at the sink, etc are things my patient can do independently prior to discharge from therapy. OTs are holistic healthcare practitioners and we pride ourselves in getting to know our patients psychologically and physically, but on a spiritual level, as well. I noticed my patient had a card from a local Lutheran pastor in her room the other day, so sometime this week, I plan to casually bring up spirituality and see if this is something she would like to talk more about. Additionally, I know from conversations with my patient that she enjoys word searches, so I will be printing some out so she can complete them while standing in order to promote activity tolerance and increase her ability to perform the aforementioned hygiene and grooming tasks while standing at the sink.
I’m not sure what lies ahead for my patient, all I know is that I’m going to do my best to check in with her as often as I can and build the kind of rapport with her that supports meaningful conversations and makes her feel like she can confide in me if she so chooses to. She has a very supportive family and I know they will be very thoughtful in helping her to decide where she may live after she leaves our SNF.
I’m going to end this week’s post with this: call your grandparents. I don’t intend for this to seem patronizing in the least, but if you’re one of the lucky ones who still has living grandparents, seize the opportunity to get to know them better and to let them know that you care. You never know the struggles they may be facing and how much a 15 minute phone call could mean to them.
Blessings on your week and (as always) thanks for reading! ♥
American Association for Marriage and Family Therapy. (ND). Suicide in the elderly. Retrieved from: https://www.aamft.org/imis15/AAMFT/Content/Consumer_Updates/Suicide_in_the_Elderly.aspx
American Foundation for Suicide Prevention. (2017). Suicide statistics. Retrieved from: https://afsp.org/about-suicide/suicide-statistics/
Rand-Caponey, Roberta. (2002). Depression and suicide in the elderly. Retrieved from: http://www.focusonthefamily.com/lifechallenges/life-transitions/aging/depression-and-suicide-in-the-elderly
Worthington, Barbara. (2017). Elder suicide: a needless tragedy. Retrieved from: http://www.todaysgeriatricmedicine.com/news/exclusive_03.shtml