Suicide Prevention among Older Adults with Depression

Abstract

Purpose: The purpose of this quality improvement project was to present the Collaborative Care Model (COCM) for adoption as part of the suicide prevention efforts for depressed older adults at a facility located centrally in Arizona. Background: Rates of suicide among older adults age 65 and over continues to remain a significant concern in the United States. Outcomes of suicide prevention efforts have been marginal because of the challenges in addressing the complex risk factors unique to the older adult. One in five older adults experience symptoms of depression, and if unaddressed, may result in suicide. The factors include living alone with limited family/social support, depression stress disorders [Approx. 80%] (CDC, 2017), loneliness (becoming a widow or widower), decreased health and physical functioning (cardiac, respiratory, musculoskeletal, kidney disease and others), and chronic mental illness. A treatment model that has been tested and remains effective is the Collaborative Care Model (COCM). The COCM includes suicide screening, monitoring of the medications ordered, psychotherapy such as Cognitive Behavioral Therapy (CBT), proactive telephonic follow-up calls and referral to inpatient care when indicated. Protective impacts of an effective COCM implementation may take up to 12 months of consistent intervention and follow up. Method: This QI project was a descriptive study that utilized the Plan Do Study Act (PDSA) model for quality improvement. A pre-test survey was implemented before an educational intervention followed by two posttest surveys. Licensed Health Care Providers including the Medical Director (MD), Psychiatrist, PMHNP, FNP and Therapists at Bayless behavioral healthcare in Arizona participated in this QI project. Results: Twenty (n=20) providers attended the educational session. 17 respondents completed the initial post-test immediately after the educational session (85%). Thirty days post the educational intervention, 17 people were sent the questionnaire forms based on the previous attendance record, and 12 responded (70.5%) to the second post-survey. The majority of the responses from clinic providers indicated the COCM is an effective and efficient mechanism for preventing suicide among depressed older adults. Conclusion: The COCM is a useful tool to address suicide risks among depressed older adults and there appears to be support for use of the model by outpatient clinic providers at a local Arizona clinic. Long-term sustainability of the use of models like the COCM is a foreseeable challenge in busy clinic settings.