Tag Archives: AGE-u-cate Training Insitute

Suicide and Older Adults – Risk Factors and Warning Signs

September is National Suicide Prevention Month. This year, World Suicide Prevention Day will be observed on September 10.  The following information will help readers understand risk factors and warning signs of suicide in older adults.  

Suicide is a serious public health issue and an immeasurable tragedy for the surviving families, friends, and communities. Many of us may not realize that older adults are at particularly high risk for suicide. According to the Centers for Disease Control and Prevention (CDC), adult males age 65 and up, were the group with the highest suicide rate in 2016. Older adults appear to have a unique set of factors that place them at high risk for suicide. 

Suicide is often related to mental health conditions, such as depression, anxiety, and substance use disorders; particularly if undiagnosed or untreated. A mental health condition alone; however, is not necessarily an indicator of suicidal behavior. It is estimated that over 50% of people who die by suicide do not have a known mental health condition. Furthermore, many people with diagnosed mental health conditions engage in treatment and are able to live full lives. There are many other risk factors in addition to mental health conditions, including: 

  • Brain injuries or disorders 
  •  Prolonged exposure to stress 
  •  Chronic pain 
  •  Life and role transitions 
  •  Access to lethal means 
  •  History of abuse or neglect 
  •  A family history of suicide 
  •  Previous suicide attempts 

After contemplating this list, we can see how several risk factors may be elevated for older adults, specifically the area of life and role transitions. Older adults typically experience changes in their function and the roles they serve in their family or community. They may also experience the death loved ones, health decline, and loss of independence. Older adults face unique challenges, including functional decline, fear or becoming a burden, and concerns about long-term care and loss of independence. 

Older adults are typically more isolated, more frail, more likely to have a plan, and more likely to use lethal means when attempting suicide; therefore, a suicide attempt is more likely to end in death for an older adult than for a younger adult. That being said, suicide CAN be prevented! Some of the warning signs include: 

  •  Marked change in behavior or entirely new behaviors 
  •  Increased use of drugs or alcohol 
  •  Feelings of hopelessness and/or helplessness 
  •  Talking about suicide or not wanting to live 
  •  Isolating from family and friends 
  •  Visiting or calling people to say goodbye 
  •  Giving away prized possessions 

If you observe these warning signs, or if you or someone you know is thinking about suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). 

Let’s observe National Suicide Prevention Month by increasing awareness and reducing stigma! 


Dr. Gabriela Frederick is a Clinical Psychologist, with a geriatric specialization. She is a Certified Master Trainer for AGE-u-cate Training Institute and is dedicated to improving care and services for older adults. Dr. Frederick may be reached at Gabriela@AGEucate.com 


American Foundation for Suicide Prevention (AFSP) https://afsp.org/about-suicide/suicide-statistics 

Centers for Disease Control and Prevention (CDC): Data & Statistics Fatal Injury Report for 2016. https://www.cdc.gov/injury/wisqars/fatal_injury_reports.html 

Mental Health America (MHA) http://www.mentalhealthamerica.net/preventing-suicide-older-adults 

National Institute of Mental Health (NIMH) https://www.nimh.nih.gov/health/statistics/suicide.shtml 

Is it Delirium or Dementia – Learn the Differences

Delirium is an acute disorder of attention and global cognition, including perception and memory, and is treatable.  Learning the differences between delirium and dementia is important for professional and family caregivers, as the diagnosis is missed in more than 50% of the cases.

According to the Alzheimer’s Association, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.

Persons who have dementia are at an increased risk of delirium, however, it is important to learn the differences.  Risk factors for delirium include dementia, pre-existing brain disease, medications, and age.

Delirium has serious implications for older adults, especially those who are at higher risks.  Sometimes referred to as hospital delirium or post-operative confusion, dementia-like symptoms can be alarming to families and often misdiagnosed by healthcare professionals.

Patients who experience hospital or post-operative dementia may exhibit symptoms such as agitation, experience hallucinations or delusions, and often extreme confusion.  Conversely, they may become extremely quiet.  Often this is accompanied by a rapid decline in one’s mental state.

Older adult patients in hospitals or in rehabilitation facilities who have undergone surgery, had an infection, experienced trauma, or spent time in ICU are more vulnerable to experiencing delirium.

Examples of delirium causes (or aggravators) may be untreated pain, dehydration,  constipation, fear, and anxiety of a changed environment (such as a hospital setting).   Unfortunately, delirium can be aggravated even more in older adults that are hospitalized, then moved to a skilled nursing facility, where they may be at higher risks of infection and other health complications.

Families must be diligent to note any changes in mental state and discuss these immediately with healthcare professionals.  Because families will be more familiar with their loved ones’ “normal” state (whether that includes any level of pre-existing dementia or not), sharing a baseline of that person’s behavior is important to determine changes that are not normal.

Non-pharmacological management of delirium should be the first approach in treatment.  This may include having someone sit with the person to aid in helping him/her feel secure, utilizing soft music and touch to provide reassurance and calm.  Bring in photographs of loved ones or special memories that may help the person divert attention from strange or new surroundings.

Families should always discuss non-pharmacological treatment before a loved one is administered medications.  If they have had any drug previously for such conditions, such as antipsychotic or sleeping aids and their loved one has had an adverse reaction, be sure to let healthcare professionals know this.  Your goal is to avoid aggravating the condition and potential side effects of withdrawal.

While dementia and delirium differ, it is important to note that behaviors may be similar and that proper communications tools for care partners will prove critical in responding to their unmet needs and determining a safe treatment plan with the best outcomes possible.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those who serve them.  She is the creator of the internationally recognized Dementia Live® Simulation Experience and co-developer of Compassionate Touch® training for professional and family caregivers.   Pam may be contacted at pam@AGEucate.com.


Johns Hopkins Medicine


Grief, Guilt, and Anxiety – How We can Help Caregivers

As a long time family caregiver and professional in this field, I can tell you that the myriad of emotions that caregivers face on a daily basis is complex and ever-changing.  That said, grief, guilt, and anxiety are certainly at the top of the list.   How can we, as professionals in this field, better understand family needs and partner alongside them on this difficult journey?

Let’s talk first about the emotions that family members experience in deciding to move their loved one into assisted living or another level of care.  First, families are often focusing a tremendous amount of attention on helping their loved one cope.  This can be overwhelming in itself, and certainly where the grief, guilt, and anxiety begin to kick in.  Grief may be the sadness of realizing that their loved ones are aging.  If there is chronic or serious illness, anticipatory grief might be the realization that death is in the foreseeable future.  If a loved one is living with dementia, grief is felt over the loss of who that person once was.

Families, especially primary caregivers live with guilt.  I often tell caregivers this is an added benefit of the job.  Often second-guessing decisions,  caregivers tend to be overly sensitive to their loved one’s own emotions.  At the same time, juggling family, job responsibilities, and caregiving duties can leave a person feeling like they are not doing a good job in any of those areas.  When guilt piles up, it often spills to feelings of unfounded fear and doubt.

Anxiety, like grief and guilt, can be caused by and can cause a snowball of other emotions.  When a family member is the one “in charge” of taking care of the many tasks associated with moving their loved one to a care facility, anxiety kicks in quite easily.  What often happens is that when one is under stress, rational decision making sometimes goes out the window.

It’s important that as professionals we assure families that, as hard as this process is, it is normal to feel these emotions.  Helping them with resources (movers, real estate professionals, support groups, etc. can ease some of the burdens and also provide a network of people who are experienced and trusted).

While family members, especially primary caregivers are learning, most have not walked this path before.

If there is one piece of advice that professionals need to remember it is that families know far less about the complex world of caregiving, levels of care, chronic illness, Alzheimer’s and other dementia, legal and financial planning and dealing with stress and burnout – than we expect them to!  This is not to diminish the admirable responsibilities that caregivers take on.  There is just so much to learn.  I was years into caregiving myself before I even realized what I needed to know – and then under stress, I’d forget the things I did learn!

Professionals can be a much-needed gentle guide through this process.  Here are a few tips that may benefit the family:

  1.  Give them a checklist of things to do before their loved one moves.  This list may include what to bring in the way of furniture, clothing and personal items.
  2. Invite them for lunch and go over the list and any concerns.  This is a good time to get to know a bit more about their future resident, but also the relationships of the family.
  3. Assure the family that as difficult as this time is, it will get easier and that staff is there to ease the transition for everyone.
  4. Make sure the family feels comfortable with the staff that will be most involved in the initial move and transitioning their loved one.  Knowing and discussing any questions upfront will save day-of moving confusion.
  5. Encourage the family to give their loved one a few days to settle in.  They will benefit by the break, and many times it helps the new resident get acclimated to their new home.

A smile goes a long way, a hug calms fears, and humor eases tension.  

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.