Some of the suicidal stats out recently seem to want to point that suicide for the group of elderly over the age of 85 y.o. is the highest percentage of suicide in the U.S. Is that long term in firmed person choosing to lay down and refusing treatment and nourishment doing it because they want to make that decision? Or could they be confused because of some other symptom related to one of their long standing illnesses? The observations made by the caregiver whom has the understanding of knowing this person is typically the knowledge of that evidence and making decisions upon this knowledge. For suicidal polls claiming that 1 out 4 men over the age 85 y.o. commit suicide seems so randomly stated as myself worked for many years in these environments and even though I may have an opinion, it may not be factually accurate. That stated suicidal fact I am very curious as to the process of making it a fact.
Do all in firmed, nursing home residents demonstrate psychological stability at all times? Generally not, and many behaviors are peppered with emotions directly related to their realistic situations. Like all of us. At the same time the malady structure commonly seen in the elderly directly related to that environment has the influences needed to be ruled in or out when evaluating these stats of suicide. I mean a teenager shooting themselves in the head is much less confusing the stat database than an 85 y.o. diabetic who openly refuses treatment and or nourishment; and may in fact state that it is their time to die. Do diabetic health issues confuse the situation just as much as diabetes can confuse the resident? Quite possibly. Do medications and blood values disturb the elderly enough to bring forward a long suppressed emotion of a death wish? Not impossible. At the same time it may in fact be an accurate assessment that the case is as we think, and the person is simply at that point and has decided it is time to die. For myself and the time spent with these residents I actually know of few whom I could say came to that suicidal decision and followed through with it. It would seem to me very difficult to cultivate this suicidal state from what my own experiences have been in these situations. I often wonder what we believe on the internet is real or propaganda related to issues for other reasons.
The professional caregiver needs to implement all the tools they have and come to a decision of which road to take. My direction from experience has been to first rule out those multi-system maladies known to that resident. There are certainly very many illnesses that can unduly be the cause of emotional behaviors not conducive to life itself. Cardiac and vascular issues and dementia and certainly renal insufficiently come to the top of the list. Trying to rule out a diabetic cause may take a very diligent caregiver as symptoms can not only be vague but could easily cover long periods of control considered just above the symptomatic range. A blood glucose of 50 maybe OK, but not always.
Bringing forward the legal issues that many people in the nursing home environment have well established living wills to make the decision much less of a problem. I would definitely point this out as something for the caregiver to hang their hat upon, however do not be confused with the reality of those illnesses that can be confusing the resident. The caregiver needs ambition of a certain level as sometimes it could be very easy to let somebody go to the great beyond. The professionalism at this point belongs solely with that caregiver. A final expression of professionalism and care will be within that caregiver to which they will undoubtedly always have knowledge of that perhaps few others can contribute.