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Why Older Adults Face Higher Suicide Risks and the New Toolkit to Start the Conversation · Voices For Suicide Prevention

• 0:04
  SPEAKER_01: Welcome everyone to this episode of Voices for Suicide Prevention.
• 0:08
  SPEAKER_01: As we like to say, our conversations are real talk, real honest, real life.
• 0:12
  SPEAKER_01: I'm Scott Light.
• 0:13
  SPEAKER_02: And I'm Stephanie Booker.
• 0:15
  SPEAKER_02: By 2030, one in four Ohioans are projected to be age 60 and older.
• 0:22
  SPEAKER_02: Today, we're talking about something that really doesn't get a lot of attention, and that is suicide prevention among older adults.
• 0:29
  SPEAKER_02: We're also sharing a new statewide resource that's designed to help professionals, caregivers, and communities better recognize and respond to risk among older Ohioans.
• 0:40
  SPEAKER_02: This guide identifying and reducing suicide risk in older Ohioans developed by a statewide group of partners across aging services.
• 0:48
  SPEAKER_02: We had behavioral health representation, veteran services, and suicide prevention.
• 0:53
  SPEAKER_02: And we are certainly glad to have three members of that steering committee who helped build it with us today.
• 0:59
  SPEAKER_02: Dr.
• 1:00
  SPEAKER_02: Jessica Haberman, a psychologist with the U.S.
• 1:03
  SPEAKER_02: Department of Veterans Affairs in Northeast Ohio.
• 1:06
  SPEAKER_02: Lisa Castro is the Assistant Chief of the Elders Connections Division at the Ohio Department of Aging.
• 1:12
  SPEAKER_02: And also from the Ohio Department of Aging, Tim Leonard, a licensed independent social worker and caregiver and cognitive health manager in the Elders Connections Division.
• 1:23
  SPEAKER_02: Welcome to all three of you.
• 1:24
  SPEAKER_01: Yeah.
• 1:25
  SPEAKER_04: Thank you.
• 1:25
  SPEAKER_01: Thanks.
• 1:26
  SPEAKER_01: Jessica, why don't we start with you?
• 1:28
  SPEAKER_01: Something really simple, but this is obviously layered and obviously really important.
• 1:32
  SPEAKER_01: Older adults often aren't the first group of people that we think about when we think suicide prevention.
• 1:39
  SPEAKER_01: Why do you think that is?
• 1:40
  SPEAKER_01: And why is it so important to focus on that now?
• 1:43
  SPEAKER_04: I think there are several reasons for this, but some of the greatest are related to aging biases.
• 1:48
  SPEAKER_04: Loss of any life is sad.
• 1:50
  SPEAKER_04: We have to acknowledge that.
• 1:51
  SPEAKER_04: But we also do tend to process grief differently when the loss is of a child or a younger person compared to when it's an older adult.
• 2:00
  SPEAKER_04: So the value of the different lives really is no different, but the shock and the sadness tend to be heavier when the deceased is younger compared to someone who's lived what many would consider a long or a full life.
• 2:13
  SPEAKER_04: The reality is that suicide is more frequent in older adults than any other age group in the United States.
• 2:20
  SPEAKER_04: There's a lot of data over the last several years that show that people who are 85 and older have had the highest rates of suicide, followed by folks in the 75 to 84-year-old range.
• 2:31
  SPEAKER_04: And as a group, older adults do tend to make fewer suicide attempts, but they have more completions than their younger counterparts.
• 2:39
  SPEAKER_04: And also, many people do have opinions about things like death with dying as an acceptable response to what they consider to be markers of old age.
• 2:48
  SPEAKER_04: So there are these erroneous perceptions that things like dementia, changes to driving ability, decreased sexual activity, depression, burdensomeness.
• 2:59
  SPEAKER_04: People do think that those types of experiences constitute normal aging.
• 3:04
  SPEAKER_04: But what many people don't know or appreciate is that successful aging is normal aging.
• 3:11
  SPEAKER_04: And that doesn't mean that there's an absence of different health issues or syndromes that are common to the aging process.
• 3:17
  SPEAKER_04: But most of us as we age do experience challenges and losses in later adulthood, even things like those that I just mentioned.
• 3:25
  SPEAKER_04: But successful and normal aging is successful adjustment to those changes.
• 3:30
  SPEAKER_04: And I think that there has been a push culturally and in the world of healthcare that we just appreciate all of this a bit more.
• 3:37
  SPEAKER_04: And that I think is at least part of the reason why there's now more of a focus on older adult suicide prevention.
• 3:44
  SPEAKER_02: And along those lines, um, Tim or Lisa, what are some of those bigger, bigger risk factors that we are seeing in older adults today?
• 3:53
  SPEAKER_00: Well, to go along with what Dr.
• 3:55
  SPEAKER_00: Jessica was talking about over there, um I think the the components that are important to think about are gender, uh social isolation, loss, or even substance abuse use, as well as medical conditions.
• 4:08
  SPEAKER_00: And to go a little bit further into those, per the National Council on Aging, um, men die at a rate seven times higher than older women.
• 4:18
  SPEAKER_00: And that's particularly older white males.
• 4:20
  SPEAKER_00: I think the other part about social isolation and loss can be significant too.
• 4:25
  SPEAKER_00: Isolation due to mobility, retirement, or the loss of having daily routines or even a sense of purpose.
• 4:32
  SPEAKER_00: Um, but along with the isolation may also be the use of substances to hide or to mask the feelings of loneliness or the despair that they might experience due to the changes in their life.
• 4:44
  SPEAKER_00: Um, and I think the other piece to consider also is the recent or chronic medical conditions.
• 4:51
  SPEAKER_00: A new diagnosis can alter your life and it can create uncertainty as well as a chronic medical condition having medical appointments, multiple medical appointments, multiple medications that come along with this, as well as potentially living in chronic pain and needing to live with that on a daily basis.
• 5:12
  SPEAKER_00: So I think when I think about medical conditions, it's important to also be mindful about the risk of suicide and the experience of hopelessness and helplessness related to medical conditions.
• 5:26
  SPEAKER_01: Jessica, let's come back to you.
• 5:27
  SPEAKER_01: Your work also includes supporting veterans.
• 5:31
  SPEAKER_01: What unique experiences may affect suicide risk among older veterans?
• 5:36
  SPEAKER_04: Yeah, so after we adjust for things like age and sex, U.S.
• 5:41
  SPEAKER_04: veterans are 50% more likely to die by suicide compared to their civilian counterparts.
• 5:46
  SPEAKER_04: Um, for our veterans specifically, we do see greater risk of suicide for folks with higher levels of baseline loneliness, lower levels of adaptive psychosocial traits.
• 5:56
  SPEAKER_04: So that's things like practicing gratitude, um, stress management, those sorts of things.
• 6:01
  SPEAKER_04: And then also greater trauma exposures.
• 6:04
  SPEAKER_04: In general, there is a higher risk of fatal suicide attempts for older veterans with conditions like what Tim was just mentioning, chronic pain, osteoarthritis, really physical health problems that lead to functional limitations are associated with suicide risk among the general older adult population.
• 6:22
  SPEAKER_04: But those conditions are just more prevalent among older adults, especially based on their, you know, their service experiences.
• 6:30
  SPEAKER_04: And then we can't ignore the fact that U.S.
• 6:33
  SPEAKER_04: veterans are trained in lethal means.
• 6:35
  SPEAKER_04: Um, the odds of using a firearm and a fatal suicide attempt are nearly three times greater for veterans who are over the age of 65 than they are for any other younger cohort.
• 6:45
  SPEAKER_02: The COVID pandemic, we're still talking about that now, some six years later.
• 6:50
  SPEAKER_02: It might be kind of in the rearview mirror, but we're still talking about it's a very important part of our conversation when we're talking about some of the real issues that came along with that, like the isolation that we've talked about, um, triggering the isolation among older adults, especially.
• 7:06
  SPEAKER_02: Um, two-part question.
• 7:08
  SPEAKER_02: Um, where are we now, a half decade later beyond COVID?
• 7:12
  SPEAKER_02: What are we still learning as it relates to mental health challenges and specifically, obviously, suicide risk?
• 7:19
  SPEAKER_04: We've talked a little bit so far about social isolation.
• 7:22
  SPEAKER_04: It really is a significant risk factor for suicidality, especially in our older adults.
• 7:29
  SPEAKER_04: On average, older Americans spend about half of their waking hours alone.
• 7:33
  SPEAKER_04: And in general, the older the person is, the greater the amount of time that they spend by themselves.
• 7:38
  SPEAKER_04: Comparatively, folks who are under 60 spend much less time alone.
• 7:42
  SPEAKER_04: And that's for a variety of reasons, right?
• 7:45
  SPEAKER_04: Some differences among the age groups can be at least in part due to the fact that older folks are less likely to live with another person.
• 7:52
  SPEAKER_04: Um, although there is a lot of like census data research coming out that suggests that there is a rising number of US adults in their middle ages who are living alone, also.
• 8:04
  SPEAKER_04: So we are potentially going to be dealing with the issue of social isolation and loneliness in even greater numbers as our population continues to age.
• 8:13
  SPEAKER_04: But even before COVID, we were seeing that older adults were starting to spend more time alone and engaging with digital devices than they were with, you know, in-person social connections.
• 8:24
  SPEAKER_04: And that just increases the risk of social isolation and loneliness and their adverse effects.
• 8:29
  SPEAKER_04: So we have this kind of double-edged sword, the beauty of technology, right?
• 8:34
  SPEAKER_04: It can connect us geographically when we're separated, but it can also become a barrier to having those in-person interactions.
• 8:44
  SPEAKER_04: Even before COVID, after COVID, the causes of social isolation can really vary.
• 8:50
  SPEAKER_04: Sometimes it's a really direct and apparent cause, like some of the things Tim was mentioning earlier, right?
• 8:55
  SPEAKER_04: Death, divorce, retirement, move to a different community.
• 8:59
  SPEAKER_04: But other times it really just comes on more gradually and it's more a symptom of another issue, like sensory deficits or physical or functional impairments that keep a person from engaging in their community the way that they used to.
• 9:12
  SPEAKER_04: Could even be a lack of transportation or even just caregiving responsibilities that take up a lot of that person's time.
• 9:20
  SPEAKER_04: But one of the things that we have been learning, and I really do think we were learning this before COVID, but even more so in the aftermath, if you will, is that how best to intervene to help our older adults cope with social isolation, that's really encouraging more and more of that activity, more and more of that social engagement and that connectedness, whether on the screen or in person, but ideally in person.
• 9:46
  SPEAKER_00: I think one of the things that we we experienced during the COVID pandemic was a loss of trust, also a sense of safety.
• 9:55
  SPEAKER_00: And so with those come those two being combined, um, I think it also enhanced the social isolation, the not wanting to do simple tasks, whether it was going to the grocery store or it was uh, you know, maybe just going to your place of faith.
• 10:11
  SPEAKER_00: And so I think part of what we're still learning from COVID is regaining that trust and people feeling safe, uh, and feeling safe not just within their home, but but within our communities too.
• 10:24
  SPEAKER_01: Let's talk about this new guide.
• 10:25
  SPEAKER_01: Let's talk about this new toolkit.
• 10:27
  SPEAKER_01: All three of you and and plenty of others were just knee deep in this.
• 10:32
  SPEAKER_01: So if we start broad, what specific needs or gaps did the committee aim to address?
• 10:38
  SPEAKER_04: I would say that our goal was really to just address the rates of suicide among older Ohioans specifically, really targeting issues like social isolation, access to resources, and combating the factors that increase the rates of suicide.
• 10:53
  SPEAKER_04: And we started by structuring listening sessions to better understand what the perceptions and the needs really are for our older adults.
• 11:01
  SPEAKER_04: Um, we asked questions about what their thoughts were about factors that impact mental health, barriers preventing them from accessing mental health and crisis resources, what makes it easier to access those things, what puts somebody at risk for suicide, in their, uh in their opinion, issues around lethal means safety and what we can do as a community, not just to raise awareness around the topic, but really to help keep people safe.
• 11:25
  SPEAKER_04: And it was through the listening sessions that we wanted to create the playbook for really anybody in the state of Ohio to help address suicidality and prevention.
• 11:34
  SPEAKER_04: And we really wanted it to be accessible for anyone, not just people in the helping professions.
• 11:40
  SPEAKER_04: So the language was really important, um, the readability, the accessibility.
• 11:45
  SPEAKER_02: So who specifically are we targeting with this guide to be able to put that kind of information in their hands?
• 11:52
  SPEAKER_00: Well, I think we would want to obviously not just target older Ohioans, but we also want to target the places where they may um they may go and socialize, whether it's with our senior centers, uh the area agencies on aging, uh, or or and I mean anywhere within a space where somebody is going to be able to see this, have it be visible, accessible.
• 12:15
  SPEAKER_00: And I think the readability component does make that um very purposeful and intentional in the way that it's been delivered.
• 12:24
  SPEAKER_01: This is also a big resource.
• 12:26
  SPEAKER_01: How how in in again to all of you, how does this stand out from the other suicide prevention materials and resources that are out there?
• 12:36
  SPEAKER_04: I think what it really makes it stand out is that the information, yes, it comes from areas of clinical expertise, but we didn't sit and say this is what we think is important for older folks.
• 12:51
  SPEAKER_04: We asked them.
• 12:52
  SPEAKER_04: Um, and so we really wanted it to be a data-driven toolkit, but we wanted that data collected from the people that it's meant to serve.
• 13:02
  SPEAKER_04: Um, so we really did want to focus on what their concerns are.
• 13:07
  SPEAKER_04: And the other piece of that is that the people who participated in those listening sessions came from different regions of the state.
• 13:16
  SPEAKER_04: So it wasn't just folks in Columbus or Cleveland or Toledo or Dayton.
• 13:20
  SPEAKER_04: It was folks in more rural areas as well, because we know that there are differences in the needs.
• 13:25
  SPEAKER_04: I mean, there are a lot of themes that do come out, but we wanted it to be as culturally sensitive as well.
• 13:33
  SPEAKER_04: And I think that that is one of the things that makes the toolkit so much different is because we identified the themes that are important to the people it's meant to serve.
• 13:42
  SPEAKER_00: I think the other part that I like about the toolkit is its practicality.
• 13:46
  SPEAKER_00: I like that it addresses safety planning and that it's supposed to be personalized, it's supposed to be practical, it's supposed to be accessible to the individual.
• 13:57
  SPEAKER_00: And I also like the language that's utilized in regards to the do's and don'ts.
• 14:03
  SPEAKER_00: So I think just the language that has been provided within this toolkit is incredibly helpful.
• 14:09
  SPEAKER_03: Yeah, and I just wanted to add what um Tim said.
• 14:12
  SPEAKER_03: This is um a very overwhelming topic, and uh this toolkit allows it to be actionable.
• 14:18
  SPEAKER_03: So you don't have to be a mental health professional to recognize that someone's struggling.
• 14:23
  SPEAKER_03: Um, this toolkit allows you to um recognize warning signs, um, have those difficult conversations and get somebody the support they need.
• 14:32
  SPEAKER_02: Yeah, I think we've we've kind of talked about one of the areas that I really like about this resource guide is that practical information and and easy to read as well.
• 14:42
  SPEAKER_02: And that includes strategies that can be implemented pretty quickly.
• 14:46
  SPEAKER_02: So, how can organizations start using that guide right away?
• 14:50
  SPEAKER_02: What are some of the tools that are within that guide that might be helpful?
• 14:54
  SPEAKER_04: It starts with that practicality piece.
• 14:57
  SPEAKER_04: Um, I know, like at least in healthcare, um, you know, I I train a lot of our uh residents in psychology.
• 15:05
  SPEAKER_04: And a lot of folks are really uncomfortable asking about suicidal ideation.
• 15:11
  SPEAKER_04: Because if the answer is yes, then as a provider, that person sits there going, well, what do I do next?
• 15:18
  SPEAKER_04: And that's the question that I think the toolkit helps to really answer well.
• 15:23
  SPEAKER_04: It doesn't stop at here are all the warning signs, here are the things to look for, which are incredibly valuable.
• 15:29
  SPEAKER_04: But then the meat and potatoes come into how do I help this person?
• 15:34
  SPEAKER_04: Not just how do I keep them alive, but how do we access the services that are meant to actually be of benefit to that individual?
• 15:43
  SPEAKER_04: So I look at suicidality as a symptom of another issue, right?
• 15:48
  SPEAKER_04: Whether it's a symptom of depression or loneliness or um the social isolation piece.
• 15:54
  SPEAKER_04: How do we address the barriers that are keeping them from getting the things that they need that are then feeding into, well, suicide must be the only option.
• 16:03
  SPEAKER_04: And that's what I think the toolkit does really well.
• 16:05
  SPEAKER_04: It answers the question of what do we do now?
• 16:09
  SPEAKER_04: Well, here are a whole bunch of resources and how to access them.
• 16:14
  SPEAKER_04: It's not just a list of, well, this would be helpful.
• 16:16
  SPEAKER_04: It's here to go, here's where to go to find it.
• 16:18
  SPEAKER_02: I think that we've we've really have talked about some of the some of the risk factors involved with older adults and suicide risk.
• 16:26
  SPEAKER_02: But Tim, I just kind of wanted to get in a a little bit more like specific warning signs when it comes to if I'm concerned about someone, um, like what are some of the things that I should be looking for as the person who is supportive of that person?
• 16:43
  SPEAKER_00: I think warning signs that would be of of of notice to me is uh whether there's a change in somebody's behavior, uh, whether they used to be somebody who loved doing book club or they loved doing their golf league, uh, and now they've started to withdraw, remove themselves from those activities.
• 17:06
  SPEAKER_00: Uh also individuals who are possibly losing weight or on the opposite, potentially gaining weight.
• 17:12
  SPEAKER_00: So do you see a shift in somebody's sleep, their energy?
• 17:16
  SPEAKER_00: Uh also I do have concerns over the use of medications in older Ohioans and whether or not those medications are causing complications.
• 17:25
  SPEAKER_00: So I think being very open and clear and concise with your medical providers about the health care that you're receiving is very critical.
• 17:35
  SPEAKER_00: So I I think when you see somebody changing their behaviors uh or experiencing life-altering events, I think it's always important and appropriate to be intentional with your conversations about suicide.
• 17:49
  SPEAKER_00: And just as Dr.
• 17:50
  SPEAKER_00: Jessica stated, uh, this is an uncomfortable conversation for many people.
• 17:55
  SPEAKER_00: And one of the things that I like to always encourage when I notice or see something and I ask someone if they are contemplating suicide is to practice the pause.
• 18:04
  SPEAKER_00: I like practicing the pause to give that person a chance to talk, gather their thoughts, collect what they want to say, and then be able to open up the conversation.
• 18:14
  SPEAKER_00: How do you start that practical but hard conversation?
• 18:17
  SPEAKER_00: I like to identify the changes.
• 18:18
  SPEAKER_00: I like to be able to be clear with them that I can turn to to the individual and I can say, I've noticed that you do not attend book club as much as you used to.
• 18:30
  SPEAKER_00: Can you tell me why?
• 18:31
  SPEAKER_00: Why have you made that change?
• 18:33
  SPEAKER_00: And then I want to be, I want to be quiet, I want to practice the pause, and I want to let them be able to answer.
• 18:39
  SPEAKER_00: So I think by identifying the behavior that you see being changed gives them a chance to also be reflective of what they already probably know is happening, that they know they've stopped going to book club, they know that they've changed some of their eating habits.
• 18:53
  SPEAKER_00: And I think being very clear and concise, and I think the other word that I always want to use, I want to be intentional with my conversation.
• 19:01
  SPEAKER_00: I want to have an intent that I'm letting them know that I'm I'm paying attention to them, I'm aware of what's happening, and I want them to know that I'm intentional about my caring about them.
• 19:13
  SPEAKER_04: Those behavioral indicators are huge, and we need to be paying attention to them.
• 19:17
  SPEAKER_04: But I I love how you said that it is an intentional conversation because we cannot look at a behavior and assume that we know what's driving it.
• 19:26
  SPEAKER_04: So when we're talking about suicide risk, it's risk, right?
• 19:31
  SPEAKER_04: And we're we're pushing for risk mitigation.
• 19:33
  SPEAKER_04: And so, you know, things like uh purchasing a firearm, making funeral arrangements, um, you know, giving away possessions toward the end of life, those are all potential signs of suicidality, but they're not absolute markers.
• 19:51
  SPEAKER_04: But we don't know that unless we ask the question and allow people to respond and giving them the time to for that reflection.
• 20:00
  SPEAKER_04: Because people, especially older adults, um, I mean, some of our younger older adults do tend to be a bit more psychologically minded than some of our older adults.
• 20:10
  SPEAKER_04: Um, but even so, not many people are gonna come flat out and say, I'm thinking of killing myself and this is how.
• 20:17
  SPEAKER_04: Um, most folks are gonna give more like indirect indicators, right?
• 20:23
  SPEAKER_04: Um, more often than not, I'll hear things like, I'm ready to go when the Lord's ready to take me.
• 20:29
  SPEAKER_04: Right.
• 20:30
  SPEAKER_04: And I mean, that could just be an indicator that they themselves feel that they've lived a long and, you know, full life and they're happy with it.
• 20:38
  SPEAKER_04: But that could also indicate that maybe there are some passive thoughts of death that are leading more toward the suicidality realm.
• 20:47
  SPEAKER_02: And we just need to explore it.
• 20:49
  SPEAKER_02: I I've also heard other people talk about how a loved one said, I don't want to be a burden anymore.
• 20:55
  SPEAKER_02: Um, and and also they will hear things like, you'll be fine after a few weeks or a few months after I'm gone.
• 21:04
  SPEAKER_04: Yeah, those coded indicators they're really cryptic.
• 21:07
  SPEAKER_01: Can I ask a question about prevention?
• 21:09
  SPEAKER_01: What role do healthcare providers, social workers, aging services professionals, what role do all those folks and many more play in prevention?
• 21:18
  SPEAKER_00: Well, healthcare workers, social workers, and the aging professionals, they're critical in the process of preventing suicide.
• 21:28
  SPEAKER_00: Uh they offer the ability to do screenings, assessments.
• 21:32
  SPEAKER_00: They also, just as Dr.
• 21:34
  SPEAKER_00: Jessica had talked about, the ability to talk about restricting access to lethal means.
• 21:39
  SPEAKER_00: They make referrals and also can intervene when medically necessary.
• 21:44
  SPEAKER_00: Um, I think it's also important for the healthcare professionals to understand and know the suicide statistics and understanding that older Ohioans and older adults uh do complete suicide more frequently than our younger population.
• 21:59
  SPEAKER_00: Um And I think additionally, helping professionals have the opportunity to recognize older adults' physical health as well as their mental condition.
• 22:09
  SPEAKER_00: And I think mental health is important to discuss, but healthcare are encouraged to screen and discuss suicide prevention throughout the stages of medical care as we age.
• 22:21
  SPEAKER_00: So I think the other part that we also want to think about is what is the training that healthcare professionals are receiving.
• 22:27
  SPEAKER_00: And that's an important role, too.
• 22:29
  SPEAKER_00: We want our healthcare professionals to feel very comfortable and understand what it means and what it's like to ask somebody if they're contemplating hurting themselves.
• 22:40
  SPEAKER_00: Because it does create an anxiety, just as we've talked about, because the potential of hearing somebody say, yes, I do want to do harm to myself is anxiety-provoking.
• 22:51
  SPEAKER_00: And that's also part of what this toolkit does is helps with the practicality.
• 22:55
  SPEAKER_00: And that's part of what we keep talking about.
• 22:58
  SPEAKER_00: And so I think not only do we want to make sure that this is out there for social media consumption, but we also want to make sure that healthcare systems have access to this too.
• 23:08
  SPEAKER_02: In the title of the resource guide, we talk about how communities also have a role in this.
• 23:13
  SPEAKER_02: And Lisa, I'm wondering how can communities reduce isolation and increase that connectedness that is needed for our older Ohioans?
• 23:21
  SPEAKER_03: To me, communities play a tremendous role because connection is a strong protective factor against suicide.
• 23:27
  SPEAKER_03: As we age, life changes, and we think we're ready for the change, but as we know, change is very difficult.
• 23:33
  SPEAKER_03: We've previously mentioned these life-changing events like retirement, loss, health changes, and any of these changes can contribute to your shirk the shrinking of your community, of your circle, which could lead to loneliness and isolation, impacting your mental health.
• 23:50
  SPEAKER_03: An important tidbit to remember is creating a connected community can be large or small, whether it's asking somebody for a cup of coffee, going to check on your neighbor, or creating a space where older adults feel welcomed and valued.
• 24:04
  SPEAKER_03: There's already established programs that involve communities like senior centers, libraries, adult day services.
• 24:10
  SPEAKER_03: And these communities already exist and foster that sense of belonging and support for older adults.
• 24:16
  SPEAKER_03: Communities and the people who support them play an important role in reducing the stigma surrounding mental health.
• 24:22
  SPEAKER_03: And just creating conversations about emotional well-being, as common and as accepted as discussions about physical health, will create an environment where seeking help is viewed as a sign of strength.
• 24:35
  SPEAKER_03: And then when people know it's okay to ask for help and they understand where to find it, they're much more likely to reach out for that help.
• 24:42
  SPEAKER_03: Talking more about suicide prevention is something all of us can contribute to in your community.
• 24:48
  SPEAKER_04: I know one thing that we've been doing in the VA for like 35 years now is primary care mental health integration.
• 24:56
  SPEAKER_04: And what that means is that we integrate, not just co-locate, we integrate mental health onto the primary care teams of all ages, but especially in our geriatric centers because of that stigma piece that Lisa was just talking about.
• 25:13
  SPEAKER_04: If I am where they are, they don't have to seek me out.
• 25:18
  SPEAKER_04: They can get a referral from a doctor who they already know and trust and say, hey, this is my colleague.
• 25:24
  SPEAKER_04: Do you mind chatting with her for a couple of minutes?
• 25:26
  SPEAKER_04: And I think that we want to be doing more of that.
• 25:30
  SPEAKER_04: We want to be having those referral systems in place, even informally, right?
• 25:36
  SPEAKER_04: So, you know, if someone goes to their pastor and they say, This is some of the stuff that I've been struggling with, and the pastor can say, Hey, I have this colleague.
• 25:46
  SPEAKER_04: Or, you know, they go to the senior center.
• 25:48
  SPEAKER_04: And I just I think that integrating the conversations and the supports and the services into the areas where the older adults are already going or have access to, that's vital.
• 26:00
  SPEAKER_01: Stephanie and I had had a lot of time in the car uh these last several months.
• 26:04
  SPEAKER_01: We were going around to various parts of the state doing some media training, and we're both empty nesters.
• 26:10
  SPEAKER_01: And we were talking about that change.
• 26:13
  SPEAKER_01: And it's a change.
• 26:14
  SPEAKER_01: There are times uh in Empty Nested where it is greatly liberating.
• 26:20
  SPEAKER_01: And then there are other times it's like, oh yeah, I miss my kids.
• 26:23
  SPEAKER_02: I know.
• 26:23
  SPEAKER_02: You know it happens all the time.
• 26:24
  SPEAKER_01: I know.
• 26:25
  SPEAKER_01: So anyway.
• 26:26
  SPEAKER_04: Yeah, I'm not there yet.
• 26:29
  SPEAKER_04: But my patients are.
• 26:30
  SPEAKER_04: Um, but yeah, no, I think that that's what we were talking about earlier, and just that idea that we go through these different changes.
• 26:37
  SPEAKER_04: And if we're being honest, any change has an element of loss to it, right?
• 26:43
  SPEAKER_04: Um, my kids in middle school, I have lost the snuggle phase of like, you know, early elementary and toddlerhood, right?
• 26:50
  SPEAKER_04: It's a loss.
• 26:52
  SPEAKER_04: Um, I'm gonna retire.
• 26:54
  SPEAKER_04: I look forward to that joyfully.
• 26:56
  SPEAKER_04: I love my job, y'all.
• 26:57
  SPEAKER_04: But I look forward to that joyfully, but it'll still be a loss, right?
• 27:02
  SPEAKER_04: And I, you know, clinically, I work with folks who are trying to navigate those things.
• 27:07
  SPEAKER_04: Normal life transitions, even though we look forward to them even joyfully, still contain an element of loss.
• 27:14
  SPEAKER_04: And kind of going back to what I was saying earlier, successful aging doesn't mean that I don't have those experiences of loss.
• 27:22
  SPEAKER_04: It means that I may be challenged by them, but I can adjust to them in a very healthy way.
• 27:27
  SPEAKER_01: Both my boys are in their 20s, Jessica, and I still will text them and call them my boo bears.
• 27:32
  SPEAKER_01: So that never goes away.
• 27:33
  SPEAKER_01: Even though I I have to.
• 27:35
  SPEAKER_01: I'm sure they love that.
• 27:36
  SPEAKER_00: Oh, I yeah.
• 27:38
  SPEAKER_00: To add on to that is um, but what you're already talking about is your adaptability.
• 27:44
  SPEAKER_00: So your ability to make change, to adjust to what is now a a different type of parenting to your kids, um, is that loss that we're talking about.
• 27:53
  SPEAKER_00: But what you're already what you're already doing is making a plan and a different roadmap for yourself with that adaptability.
• 28:01
  SPEAKER_00: And I think that's part of the conversation we we want to have with individuals when they experience that loss, whether it's the loss of a pet or it's the loss of a family member, you're you're making a new um opportunity for what your life is going to look like.
• 28:17
  SPEAKER_00: And I think we need to rethink what that roadmap is, but that's what you're doing.
• 28:21
  SPEAKER_00: And that's what we what I'm hearing from Dr.
• 28:23
  SPEAKER_00: Jessica is what is that successful aging?
• 28:26
  SPEAKER_00: And it's that adaptability.
• 28:28
  SPEAKER_00: We're highly adaptable, Stephanie.
• 28:29
  SPEAKER_01: We're doing it.
• 28:30
  SPEAKER_00: We're doing it.
• 28:31
  SPEAKER_00: We try every day.
• 28:32
  SPEAKER_02: It is definitely something that you have to work on uh some days.
• 28:37
  SPEAKER_02: I'm wondering, um, Jessica, if we could talk to community support of older veterans in Ohio.
• 28:45
  SPEAKER_02: What does that look like, in your opinion?
• 28:48
  SPEAKER_04: I mean, it's not gonna look too dissimilar from community support in a non-veteran older adult population, but the VA does have a lot of really great resources specifically for our older vets.
• 29:02
  SPEAKER_04: Um, we do a lot in both urban and rural communities.
• 29:05
  SPEAKER_04: Um, one of the things that uh I really appreciate about our services is they also cater to the caregivers.
• 29:13
  SPEAKER_04: And I'll talk about that in a second, but um, they go into the home.
• 29:17
  SPEAKER_04: Um, so we we have some temporary, but also uh depending on a patient's needs, some long-term care options that are home-based.
• 29:26
  SPEAKER_04: Um so we have a team of providers who will go out to the patient's home, see the physical environment, and it's a really great way to get an eyes on what the needs are.
• 29:37
  SPEAKER_04: You know, I'll have patients come into my office, and unless they have someone telling me that the story is actually a little different, I've got to take that patient's word for what the home looks like, what the needs are, how they're functioning within it.
• 29:50
  SPEAKER_04: But we have these home-based care teams that will go out and, you know, even just for assessments and say, this is what's actually going on, here are the holes.
• 29:58
  SPEAKER_04: Now let's find some different services to plug in and support.
• 30:03
  SPEAKER_04: Um, and we'll do that with, you know, home health aid support, um, like I mentioned, long-term care planning.
• 30:09
  SPEAKER_04: Um, and then, you know, we don't want to leave our caregivers behind, right?
• 30:14
  SPEAKER_04: We we value very much this idea that we can't care for our older veterans and our younger veterans, but we definitely can't care for our older veterans well if we're not caring for the people caring for them.
• 30:27
  SPEAKER_04: So the VA has had this booming caregiver support program um that they're really just trying to um kind of reach out and touch all of our veteran families that have those needs.
• 30:39
  SPEAKER_02: And in fact, the resource guide does address caregivers and how burnout can happen.
• 30:45
  SPEAKER_00: In in addition to what you what you're referring to, um Dr.
• 30:48
  SPEAKER_00: Jessica, the Ohio Department of Aging and through state and federal funding, we do also offer support to caregivers, um, whether that's adult day services, which Lisa has had had mentioned earlier about the community, but we also offer home health services.
• 31:07
  SPEAKER_00: So we do have the opportunity to provide that support to caregivers.
• 31:10
  SPEAKER_00: So whether it's a respite service for personal care coming in to just help maybe with doing dishes or making a meal.
• 31:18
  SPEAKER_00: Um, and then also sometimes a little bit more intensive if the individual may need assistance with bathing.
• 31:24
  SPEAKER_00: So there are those support and services that are available.
• 31:27
  SPEAKER_00: Um and it's important to make sure that we let older Ohioans know about those services.
• 31:33
  SPEAKER_01: That tees up um where we wanted to go to next.
• 31:35
  SPEAKER_01: So let's say someone's listening right now and and they're worried about an older adult in their life and they don't know what to do next.
• 31:45
  SPEAKER_01: What's your best piece of advice?
• 31:47
  SPEAKER_03: I mean, my first piece of advice would be um it's it's pretty simple.
• 31:50
  SPEAKER_03: Don't ignore your concerns.
• 31:52
  SPEAKER_03: If you um feel something is off, trust your instincts and reach out to that individual.
• 31:58
  SPEAKER_03: Be able to start a conversation, ask how they're really doing.
• 32:02
  SPEAKER_03: Like Tim has had mentioned before, use that pause moment, really listen to them and don't jump into fixing the problems right away.
• 32:09
  SPEAKER_03: Um, let them know you're there for them.
• 32:11
  SPEAKER_03: And if you're concerned about them being suicidal, as mentioned earlier, just ask that question.
• 32:16
  SPEAKER_03: Have you been thinking about hurting yourself?
• 32:18
  SPEAKER_03: If they are struggling, help them by connecting them to supportive networks.
• 32:22
  SPEAKER_03: That could be a trusted family member, their primary care doctor, a mental health professional, um, or any local community resources.
• 32:30
  SPEAKER_03: You don't have to solve the problem alone.
• 32:32
  SPEAKER_03: So I think that's important to know that there is support out there for you if you don't know where to turn.
• 32:36
  SPEAKER_03: Um, and if you believe somebody is in danger, immediate danger, don't just leave them alone.
• 32:41
  SPEAKER_03: Um, there are um suicidal hotlines out there like 988 uh that is available for that immediate support.
• 32:49
  SPEAKER_03: Um, and your presence matters to them.
• 32:51
  SPEAKER_03: So sometimes simply just showing up, listening, and reminding them that they're not alone can make an incredible difference.
• 32:59
  SPEAKER_01: Before we close, we'd like to ask each of you for let's say one message you'd like our listeners to remember when it comes to suicide among older adults.
• 33:10
  SPEAKER_04: I think that it's important, like what we've been saying, is to just have the open conversation, give people space to share their thoughts, um, to tell us what's driving the behaviors that we see that are concerning.
• 33:25
  SPEAKER_04: But um I also want to um leave room for normal death ideation.
• 33:33
  SPEAKER_04: Um I think that oftentimes when people talk about death and dying, especially in helping professions, we jump to thinking that they must be suicidal.
• 33:44
  SPEAKER_04: Um, but again, this is where that open conversation comes in, right?
• 33:48
  SPEAKER_04: We need to give people the opportunity to say, no, I'm just doing my advanced directives because if something were to happen, I want you all to know what my wishes are.
• 33:56
  SPEAKER_04: Um, so there is a difference between normal ideation, right?
• 34:01
  SPEAKER_04: Contemplating my own mortality and thinking about killing myself.
• 34:05
  SPEAKER_04: And in order to really distinguish between those things, whether we're helping professionals or we're family members or friends, is connecting with people and giving them the opportunity to have the conversation.
• 34:18
  SPEAKER_04: Lisa?
• 34:19
  SPEAKER_03: Um, to me, depression is not a normal part of aging.
• 34:22
  SPEAKER_03: Don't assume that because you're feeling sad, hopeless, withdrawn from others.
• 34:27
  SPEAKER_03: It's just something that happens because you're aging.
• 34:29
  SPEAKER_03: The reality is these feelings are treatable, there's support available, and no one should have to face these challenges alone.
• 34:36
  SPEAKER_03: Um, connection can save lives, and everyone has the power to make someone feel valued, heard, and seen and supported.
• 34:44
  SPEAKER_00: I think the message I want people to hear today is that having a conversation about suicide does not increase the risk of the individual doing harm to themselves.
• 34:56
  SPEAKER_00: Again, it opens the door, it opens the conversation.
• 34:59
  SPEAKER_00: And what I ask to individuals who who would be listening today is to be intentional with your conversation, to be intentional with your compassion, but then also to be intentional with your intervention, with how you intervene and show support.
• 35:16
  SPEAKER_02: The identifying and reducing suicide risk in older Ohioans resource guide for professionals, caregivers, and communities is currently available on the Ohio Suicide Prevention Foundation resources page, and you can go to ohiosp.org to find that.
• 35:34
  SPEAKER_01: Our thanks to our three guests, Dr.
• 35:36
  SPEAKER_01: Jessica Haberman, Lisa Castro, and Tim Leonard, for joining us today and for helping to lead this really important effort.
• 35:43
  SPEAKER_01: Thanks to all of you, and we always say thanks to our listeners.
• 35:47
  SPEAKER_01: When you listen to these episodes, you're out there, you're making those connections.
• 35:50
  SPEAKER_01: As Lisa said, you break stigmas, break barriers, you care about mental health and saving lives.
• 35:56
  SPEAKER_01: This is Voices for Suicide Prevention, brought to you by the Ohio Suicide Prevention Foundation, and I'm not sure if you're not going to be able to do this.