Gerontology and Suicide Prevention: EBP Project
Abstract
The issue of geriatric suicide ideation is currently underresearched. The current research project revolves around the existing evidence on the subject of both pharmacologic and nonpharmacologic treatments that can help geriatric patients overcome the desire to commit suicide. The researcher will conduct a quasi-experimental study so as to combine practical and theoretical perspectives of the investigation and obtain as much evidence as possible. The research project will be conducted within a healthcare facility, and the sample will only include individuals that are older than 65. The researcher expects to see numerous improvements in the overall state of the participants and reduce suicidal ideation that is characteristic of the chosen sample.
Introduction
The interest in gerontology and suicide prevention programs in gerontologic patients sparked due to the fact that the importance of this particular area of nursing was realized only throughout the last two decades. This issue can be characterized as pivotal because the treatment of gerontologic patients majorly contributes to the perception of public health and eminence of the latter. One of the other possible reasons why this issue is important is the development of modern technologies that allow us to approach the treatment process in a number of different ways that were not available 10-15 years ago. This issue perfectly fits within my area of specialization as I am a nurse practitioner working with adult gerontologic patients. To me, the issue of an increased number of suicides among geriatric patients who go through the initial stages of such diseases as dementia is critical because it is necessary to find the ways to mitigate the adverse psychological and physical implications of this disease and help the patients. One of the research projects in the area that contributes to the controversy was conducted by Kim and Yang (2017). They performed a preventive test and two posttests in order to evaluate the benefits of employing a suicide prevention program. The obtained evidence suggests that the latter significantly influenced the overall state of the observed gerontologic patients and reduced their suicidal ideation (Kim & Yang, 2017). The nurses were able to provide social support and maintain the patients’ health status. The existing project will improve outcomes because it will take into account the risk factors associated with suicide and gerontologic patients and become a community-based program intended to preserve gerontologic patients’ health.
The practice issue that is reviewed within the framework of this assignment is the development of a preventive community-based program that will allow the nurses that work with gerontologic patients decrease the number of suicides committed on the early stages of terminal illnesses. The severity of the problem can be explained by the critical damage that terminal illnesses do to the brain and how these illnesses are perceived by the patients (Kennedy-Malone, Fletcher, & Plank, 2014). On a bigger scale, reviewing this issue within the existing health care environment seems to be an informed decision that is supported by evidence. The research project is aimed at developing a community-based program that will decrease the number of suicides among gerontologic patients. Also, the nurse expects to eradicate the patients’ health illiteracy and provide them with the required knowledge regarding their illness. One of the supporting aims of the project is to observe how psychological assistance and involvement in different activities can minimize the occurrence of suicidal thoughts. The current project reflects the ideas of evidence-based practice by means of its unique approach to the issue with gerontologic patients and their self-perception (Kennedy-Malone et al., 2014). The intervention that is proposed by the researcher revolves around the idea that the problems transpire at the cognitive level, so a simple research project will not answer all the questions. Addressing the issue of an increased number of suicides by means of a community-based program is widely discussed in the existing gerontologic literature, so I believe that there is enough evidence to come up with a decent solution to the problem and my specialization will be a perfect fit for solving this issue. The expected outcome is a decreased number of suicides in terminally ill gerontologic patients.
PICOT: In gerontologic patients (P), what is the effect of a community-based intervention (I) on the occurrence of suicides (O) compared with conventional interventions (C) within the early stages of terminal illnesses (T)?
The significance of this issue can be explained by the fact that a major number of gerontologic patients simply give up and lose hope when they find out that they are terminally ill. Therefore, the mitigation of poor outcomes of dementia or any other terminal illnesses is crucial. If we understand the basic psychologic premises of these illnesses, we will be able to adjust the nursing practice to dealing with this type of problems (Moyle, Parker, & Bramble, 2014). In perspective, this should minimize healthcare costs and reduce negative outcomes in gerontologic patients throughout the early stages of their terminal illnesses. The current project proposal will revolve around the development of a community-based intervention program that will include numerous activities intended to reduce the willingness to commit suicide within a sample of gerontologic patients with terminal illnesses (Richardson & Barusch, 2013). This program is expected to improve general outcomes in gerontologic patients and become an efficient part of the proposed evidence-based nursing project. The problem seamlessly reflects the issues that are inherent in my area of specialization because I am a nurse practitioner and work with adult gerontologic patients. Within the framework of this project, I will address the process model proposed by John Hopkins because it is one of the easiest to understand and it can be employed step by step with regard to both internal and external factors that are backed by education and research.
Evidence Review and Synthesis
Throughout the process of research, I have addressed a number of databases that contained many articles regarding the proposed topic of discussion. I have also found several search engines that helped me to discover quite a few medical articles that perfectly reflected the topic of my research proposal. The very first search engine that I have used is PubMed. It is one of the most popular search engines that features an extensive database containing free medical journal articles. I was able to access MEDLINE and go through numerous records to find the articles that were of interest to me. The concept of MESH can be easily applied within the framework of this online database and help the end user to narrow the search results. I was also able to identify several relevant meta-analyses in Cochrane Library. Even though this database is subscription-based, I was able to gain access to several articles regarding my proposal topic. The most important medical article database is Google Scholar. Here, I was able to find every single article I was looking for. The system was easy to navigate, and I had no trouble finding the most relevant evidence that could support my evidence-based research project.
By means of a search query, I was able to identify a series of results. The majority of research studies aligned with the exact PICOT question so overall, the results are satisfactory. To my mind, a correctly posed question can make it much easier for the researcher to find the necessary articles and conduct an accurate research project. According to what I have witnessed, MESH terms did not contribute to my research at all. To be more specific, I have gone through MESH terms related to persons, health care, and psychology but was not able to identify any additional information that could be helpful within the framework of this research. The search queries were “community-based intervention geriatric patients” and “community-based intervention suicide elderly patients.” Luckily, I did not have to modify the search to gain access to a better set of articles. I have used PubMed, Cochrane, and Google Scholar. From these three, the latter turned out to be the best in terms of pulling the most relevant articles from the database. The articles from Cochrane and PubMed libraries were not acceptable in terms of reliability and the overall quality of evidence. The problem of availability also impacted my decision regarding the eminence of these databases. The articles that I have found represent an extensive amount of relevant evidence and should be used in the final research project.
One of the articles that were found during the search session was the one written by Brodaty and Arasaratnam (2012). They evaluated the psychological aspects of dementia and studied the community-based intervention that involved the use of nonpharmacological interventions. Overall, the article is rather thorough, and the evidence that is presented by the researchers can be characterized as useful. I have synthesized the evidence in accordance with the PICOT question of my research project and tried my best to identify the key variables that could be transferred to my study. The variables that were of interest to me included the performance of the community-based intervention, patient outcomes and satisfaction, nurses’ involvedness in the process, and the overall costs of the project (Kim & Yang, 2017). Both of the articles that I have identified during the previous step perfectly reflect the core objective of my proposal and the methods that I am willing to employ when completing the assignment. The article written by Brodaty and Arasaratnam (2012) presented a great deal of evidence related to the implementation of nonpharmacological medications in geriatric patients with dementia with the intention of reducing the occurrence of suicides and raising the patients’ awareness concerning their illness. The evidence showed that this kind of community-based intervention positively affects psychological health of the patients (Moyle et al., 2014). The rigor of the evidence can be supported by the statistics presented by the authors. The adverse reactions in both patients and caregivers were also minimized. The article written by Coburn, Marcantonio, Lazansky, Keller, and Davis (2012) supports the evidence offered by the previous authors and expands the knowledge regarding the reduction of mortality among terminally ill geriatric patients that are inclined to commit suicide during the early stages of their illness. The level of evidence supported the major role of nurses in the development and implementation of a community-based intervention (Coburn et al., 2012). The patients were satisfied with the program but had a hard time adjusting to it.
The quality of the evidence presented in both Brodaty and Arasaratnam (2012) and Coburn et al.’s (2012) articles can be characterized as acceptable. I believe that the findings of their studies are rather noteworthy within the framework of my evidence-based project because they are relevant and accurate. The evidence presented by the authors reflects the community-based intervention that I am planning to implement. My proposal is to create a community program that will involve different activities such as physical exercises, games, spoken interaction, and many more interpersonal activities that are expected to motivate the patients and help them to live a happier life (Kennedy-Malone et al., 2014). Also, I would like to monitor the patients and counsel them so as to minimize the risk of committing suicide and raise their self-awareness. In perspective, this is expected to create a positive environment and help the patients better cope with their illnesses.
Purpose of the Project
Elderly individuals comprise one of the most vulnerable populations due to the frailty resulting from their old age. In addition, elderly people, often being incapable of caring about themselves and protecting themselves, often may become the victims of neglect and abuse. Thus, it is unsurprising that they often may commit suicide. For instance, Coburn et al. (2012) state that in 2005, 5,404 suicides were committed by individuals aged 65 and older; while older adults of that age accounted for only 12.4% of the total population, they represented nearly 16.6% of all the suicides committed in the U.S. in 2005. Therefore, it is paramount to implement suicide prevention programs and interventions to help geriatric patients reduce their suicidal ideation, consequently lowering their rates of suicide.
Thus, the current project is aimed at providing elderly individuals with community-based interventions for reducing the rates of suicide of such individuals. It is hoped that utilizing these interventions may help geriatric patients with suicidal ideation to decrease the latter, restoring their desire to live and lowering the rates of suicide among these patients. The significance of this issue is conditioned by the fact that in case when the suicidal ideation of geriatric patients is not addressed, it may lead to a suicide of these patients, or at least significantly worsen their quality of life over their estimated lifespan.
Methods
The clinical problem that will be considered in the proposed research consists of the challenge of suicide prevention in older patients, especially those suffering from terminal illnesses. In general, suicidal thoughts in older people can be viewed as a significant health concern; for example, in the US, over 6,000 older people commit suicide per year, and illnesses are proved to be a major predictor of such events. Therefore, the prevention of suicide in the population is major concern and aim of modern healthcare, and the proposed study intends to test an intervention that can assist in resolving the issue.
The proposed study is going to be community-based, which defines its settings as those of my community; the population includes the older patients with the early stages of terminal illnesses who live in the community. People are typically viewed as older adults after the age of 65, and this criterion can be used to determine potential participants. It is noteworthy that the population is a vulnerable one, and a careful consideration of the ethical implications of the study is required.
The proposed intervention is a comprehensive community-based program that should incorporate multiple non-pharmacological activities, including exercises, games, and discussions; also, it will involve counseling. A preliminary investigation shows that there is some evidence to the mentioned interventions being helpful for the resolution of the problem and the improvement of the quality of life of the population (Coburn et al., 2012). Therefore, their use in the proposed study is justified.
The suggested type of research is the experimental one because the exposure of the participants to the treatment can be randomized and controlled, which enables the use of a randomized controlled trial (RCT) in the project. The lack of exposure to the intervention does not presuppose the lack of treatment (the patients from the control group will be treated as usual), and the presence of exposure should not carry risks (due to the program being evidence-based). Therefore, no major ethical issues rule out an RCT.
Data Analysis
The mentioned PICOT question implies that the proposed study is to test the intervention with the help of a control group, which indicates that it can be carried out as a quasi-experiment or an experiment. According to Coburn et al. (2012), both approaches can help to determine the effects that treatments can have. The former type of research is easier to conduct, but the latter one is more controlled and produces more reliable results, which makes it particularly attractive. Coburn et al. (2012) state that an experiment requires the randomization and control of the exposure to treatment, which is achievable in the proposed study. Thus, it is suggested to carry out a randomized controlled trial with a rigorous control of the process in order to employ a more powerful and accurate research method.
A theoretical framework that can be proposed for the project is the Johns Hopkins Nursing Evidence-Based Practice model. It contains a simple but detailed and comprehensive set of guidelines and tools that facilitate the process of the translation of evidence-based approaches into practice, which is necessary for my project because it requires the implementation of an evidence-based intervention. Thus, the three-step framework is appropriate for the proposed research, and the permission to use its tools for the project can be solicited from the Johns Hopkins University.
The researcher expects to make the best use of a quasi-experimental design within the framework of this study. It is chosen because the investigator is able to manipulate the study in a number of ways that can be beneficial to the ultimate outcomes of the research. For instance, it will allow the researcher to make the necessary generalizations after a relatively short period of time. The study will be conducted within a healthcare facility. The participants of the study will be elderly patients that are prone to committing suicide throughout the initial stages of their mental illnesses. So as to pick the participants, the researcher is going to filter them by age, gender, and health-related issues (Kennedy-Malone et al., 2014). The investigator will utilize the sample of convenience because quasi-experimental research design was chosen. So as to ensure that confidentiality of all the participants is protected, the researcher will keep all the results of the surveys in an anonymous format so as to eliminate a certain level of research bias as well (Coburn et al., 2012). Also, all the files that are going to be stored on hard or external drives will be protected by passwords so as to reduce the possibility of data modification or theft.
The intervention that is proposed by the researcher includes both a pharmacological and sociological approaches. First of all, the investigator is expected to utilize lithium treatment. The latter will be ultimately combined with social events that are expected to help seniors with suicidal thoughts get over the complications and get back to the normal life (Kennedy-Malone et al., 2014). The key objective of the research is to change the participants’ attitudes toward the treatment process and their surroundings. The researcher is going to use an adjusted version of the Suicidal Behaviors Questionnaire (that is also known as SBQ-R or Suicidal Behaviors Questionnaire – Revised). By means of this survey, the investigator will be able to collect the qualitative data on this matter (Moyle et al., 2014). The gathering of quantitative data is not expected within the framework of this research as the investigator is only interested in testing the proposed interventions and synthesize their effectiveness via the SBQ (Kim & Yang, 2017).
The number of tests that will be conducted within the framework of this research (also known as testing frequency) will not exceed two iterations. The first test will be needed to evaluate the existing state of affairs and revise the proposed intervention in terms of its pharmacological aspect (meaning lithium dosages and other related concepts). The second test is required to assess the outcomes of the research and see if the intervention was actually effective. The investigator is interested in conducting these two tests because the proposed intervention consisting of social events and lithium intake is expected to have a positive impact on patient outcomes. The demographic data that is going to be reported include age, gender, and race of the study participants. The researcher expects to see positive feedback from the patients and validate the efficiency of the proposed intervention.
Appendices
Table 1. Evaluation table.
Table 2. Synthesis table.
References
Brodaty, H., & Arasaratnam, C. (2012). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169(9), 946-953. doi:10.1176/appi.ajp.2012.11101529.
Coburn, K. D., Marcantonio, S., Lazansky, R., Keller, M., & Davis, N. (2012). Effect of a community-based nursing intervention on mortality in chronically ill older adults: A randomized controlled trial. PLoS Medicine, 9(7), 2-17. doi:10.1371/journal.pmed.1001265.
Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). Advanced practice nursing in the care of older adults. Philadelphia, PA: F.A. Davis Company.
Kim, J., & Yang, J. (2017). Effectiveness of a community-based program for suicide prevention among elders with early-stage dementia: A controlled observational study. Geriatric Nursing, 38(2), 97-105. doi:10.1016/j.gerinurse.2016.08.002.
Moyle, W., Parker, D., & Bramble, M. (2014). Care of older adults: A strengths-based approach. Port Melbourne, Australia: Cambridge University Press.
Richardson, V. E., & Barusch, A. S. (2013). Gerontological practice for the twenty-first century: A social work perspective. New York, NY: Columbia University Press.