Suicidal behavior in the nursing home and a postsuicide intervention

The suicidal elderly patient in the nursing home has been the focus of inadequate attention. Given the longer life expectancy, we can project that the nursing home as a context of end-life care will be utilized by increasing numbers of elderly. This article presents a case of a suicide in a nursing home and a review of the relevant current literature. A mental health consultation to the administration and staff of the nursing home following the suicide is presented as an effective way to promote healing and limit adverse sequelae. In addition, a view of the concept of institutional care to the elderly is discussed. Relocation to a nursing home as a catalyst for suicidal behavior and the notion of "goodness of fit" as it applies to resident adaptation to the nursing home is posited. A continuum of suicidality is proposed. Suicidal ideation and Intentional Life Threatening Behaviors (ILTBs) are described as adapting to the context of the nursing home, and examples are offered. The article concludes with a model of suicide probability in the nursing home resident.