New Program Aims to Link Older Adults to Prevent Suicide

The Centers for Disease Control (CDC) has awarded $2 million to the University of Rochester Medical Center to test whether linking lonely and socially disconnected seniors with other caring older adults reduces the risk of suicide.

Volunteers—who will be recruited, trained and supervised by Lifespan Inc., the largest aging services agency in the Rochester region and the Medical Center’s partner in the research—will establish a consistent schedule of contacts with the at-risk seniors, visiting or talking by telephone at least once a week and perhaps helping with some household chores.

“Older adults in the United States have the highest rate of suicide and are the fastest growing segment of the population,” said Yeates Conwell, M.D., professor of Psychiatry and the principal investigator for the project. “Our project starts with the premise that people who are lonely and who feel they are a burden on others have increased risk factors for poor health, depression and suicide.

“We already have a system in place to recruit older people for service,” Conwell said. “These volunteers can provide peer support for isolated older people and can help break through to them. If we show this is effective in reducing suicide-related outcomes, this program can rapidly be disseminated as a preventive intervention throughout the country at a low cost.”

Four hundred older adults will be recruited for the project, which is called “The Senior Connection.” Those who take part in the project will be followed and assessed for at least two years. Researchers will study the impact on reducing the factors associated with suicidal behavior in those who receive the intervention by the older adults with those who receive care as usual or no intervention other than a risk assessment. Researchers also will examine whether response to the intervention differs by gender.

Extensive research has linked social disconnectedness to suicide in older adults, and interventions designed to bolster seniors’ connections to others should be expected to reduce suicide related morbidity and mortality, the researchers said. “The Senior Connection” project is the first known randomized and controlled trial to test this premise.

The new project builds on the work of the Senior Health and Research Alliance, or the SHARE Alliance, a partnership of the Medical Center’s Department of Psychiatry and Eldersource Care Management Services, which is a joint venture of Lifespan and Catholic Family Center.

Almost five years ago, the National Institute of Mental Health awarded $2.57 million to the Medical Center’s Department of Psychiatry to develop a community-based system to identify and treat older adults with depression and other mental illnesses. The result is the SHARE Alliance.

SHARE Alliance activities have included: training agency care managers in the detection and basic management of late-life mental illness and the assessment and management of suicide risk, adopting a routine of screening for mental disorders in agency clients, revising the data management systems of the agencies to support research, and conducting research studies. Thousands of people in the Rochester region have been assessed for depression and other issues.

One study assessed almost 400 older adults. More than 80 percent were white and almost 70 percent were female. Half lived alone and had incomes of less than $1,500 a month. Twenty-six percent met the criteria for a current major depressive episode, of which only 25 percent were seeing a mental health provider. About 27 percent said they felt that life was not worth living at some point in the previous 12 months.

Older adults have higher rates of suicide than other segments of the population. In 2007 in the United States, there were more than 34,000 deaths by suicide, of which 15.7 percent were among people over age 65 years. Older adults made up 12.6 percent of the population in 2007.

In the United States, the growth in the older population group is fueled by the aging of the “Baby Boom” generation, an estimated 78 million people born between 1946 and 1964. The “Baby Boom” group has had higher rates of suicide than earlier or subsequent birth groups throughout its development.

“We can anticipate a large rise in the number of older adults who die by suicide in coming decades,” Conwell said. “This project is one way to begin to address this looming crisis.”

The project will utilize the Retired Senior Volunteer Program (RSVP), which is a national program that also is a part of Lifespan. These volunteers usually provide help based on their skills, addressing, for example, financial or nutritional issues.

“We think they can easily fit the role of peer companion,” Conwell said. “The work the volunteers provide is good for the volunteer, for the older adult and for the community. These programs are vulnerable to budget cuts without evidence that they are doing a lot for people and improving health. We hope to provide that evidence.”

Ann Marie Cook, Lifespan’s chief executive officer, said she is very hopeful about the outcomes of the CDC-funded project.

“This is another way to help frail older adults remain independent,” Cook said. “I think this also will show the value of volunteerism and get people more engaged and connected to the community.”

The Senior Alliance adds to the programs serving older adults that are supported by the Department of Psychiatry.

A departmental partnership with the Rochester-area organization Jewish Senior Life and Jewish Family Services called the Geriatric Medical and Mental Health Care Collaborative (GEMM) provides integrated care to frail and homebound seniors and often their equally homebound caregivers receive treatment.

Jewish Senior Life physicians had targeted the homebound for much-needed medical services as part of their House Calls program, but they now also screen for mental disorders. If the screen is positive for a mental or cognitive issue, a Medical Center nurse practitioner or a social worker get involved. Since 2008, GEMM has served 189 homebound elders, with about a third identified as having significant mental health or cognitive problems.

In addition to GEMM, the department has helped launch PEARLS, or the Program to Encourage Active and Rewarding Lives for Seniors. Started earlier this year, this is a project with Eldersource that is based on a national model.

The department trains Eldersource social workers and care managers to screen for depression and to utilize a therapy, known as problem-solving therapy, that has been shown to help older adults with depression. Many depressions are related to unsolved problems and an inability to engage in meaningful activities. The agency staff member works with the older adult to learn a method for identifying and solving a problem. The client also agrees with the agency counselor to do something pleasurable, social and physical each week. It could be as simple as calling a relative, speaking to a neighbor or lifting a soup can as a daily workout. The goal for PEARLS is treatment of as many as 150 people a year.