Elderly Americans, sometimes sick, lonely and isolated, have the nation's highest rate of suicide -- a rate 50 percent greater than that for young people. Although researchers long have known that the elderly are at high risk for suicide, prevention has been difficult because the elderly seldom seek help.
Now, a program involving George Warren Brown School of Social Work students, alumni and faculty is bringing free telephone counseling and support into the homes of older Americans who have been identified as suicide risks by friends, family and the medical community.
Known as "Link Plus," the program was developed by Nancy Morrow-Howell, Ph.D., associate professor of social work, and two alumni who now work at Life Crisis Services Inc., a well-established telephone hotline program in St. Louis.
Lee Judy, who holds three Washington University master's degrees, including one in social work, is director of Life Crisis Services. Susan Becker-Kemppainen, a 1994 master's of social work graduate, runs the elderly counseling program and made most of the telephone calls during the program's research phase, which ran from July 1994 through July 1996. The research was supported by a $65,000 grant from the Retirement Research Foundation in Chicago.
"Life Crisis hotline volunteers have a proven track record of providing critical counseling to people considering suicide, but only 3 percent of calls to the well-known hotline program are from people over the age of 60," Morrow-Howell said. "Older people who needed help were not coming to us, so we found a way of going to them."
Becker-Kemppainen tested the concept during the two-year research phase by making routine phone calls to at-risk elderly participants and talking them through day-to-day problems. She made about 30 calls to each client, often using conference calling to include friends, relatives and service providers. Calls continued for about eight months, or as long as a client deemed necessary.
Now that the research funding for the program has expired, social work students have stepped in to continue the counseling service as a component of field-education practicum projects at Life Crisis. Students receive specialized training on issues facing the elderly and learn how to link older adults with resources and programs that can help them continue living independently.
"We try to match each 'Link Plus' client with a particular student so that the two of them can get to know each other and develop a rapport," Becker-Kemppainen said. "It really helps the students get a broad-based understanding of issues affecting the elderly. And for a lot of people, it helps them determine if working with the elderly is something they want to do."
Most students work as unpaid volunteers and receive academic credit based on hours of service -- about one credit hour for every 100 or 120 hours of fieldwork. All practicum students work under the direction of trained master's of social work field supervisors, some of whom are graduates of the social work school who now work at Life Crisis. Field supervisors are responsible for monitoring student work with clients and providing evaluations of student progress.
In a recently submitted journal article on the pilot project, the researchers provide data showing that the program significantly has improved the outlook of its older participants. Most clients report a decrease in depression, increased social contact and fewer unmet personal needs.
"We feel strongly that the telephone is very much underutilized when it comes to providing therapeutic services to people, yet it remains one of the most effective ways to reach people, especially the elderly and others who can have problems with mobility," Judy said. "It's been a surprise to us how quickly older clients open up to us on the phone. On the phone, they don't have to worry about how they look, they don't have to worry about being embarrassed or whether someone they're talking to will recognize their face in the grocery store. And they're in control of the conversation because they can always hang up at any time."
While it is difficult to determine how many of those in the study truly were on the verge of suicide, the research team found through surveys that many of the participants fit a profile for persons at risk of suicide. More than 70 percent of the clients met geriatric screening criteria for classification as "possibly" or "probably" suffering from depression. Nearly 30 percent reported having once considered suicide, and about 10 percent had thought of suicide recently.
The study was designed to explore whether a proactive counseling service could be effective in reaching elderly people at risk of suicide, but the service itself is by no means limited to senior citizens who might be considering suicide.
"Anybody over the age of 60 who has unmet needs of daily living or problems with isolation and depression is let into the counseling program because our goal also is to help people not get to the point where they might consider suicide," Becker-Kemppainen said.
After spending two years on the phone with older clients, Becker-Kemppainen has plenty of examples that illustrate the program's effectiveness in reaching once-isolated and discouraged seniors. One older man, for instance, was referred to "Link Plus" because a number of seemingly small day-to-day living challenges were making his life extremely difficult and unrewarding.
During a series of phone conversations, Becker-Kemppainen learned the man was unable to find transportation to the grocery store and that poor vision resulting from diabetes made it impossible for him to read most food labels and prepare balanced meals, an important health concern for those with diabetes.
She helped the man solve these problems by putting him in touch with a senior group that offers free transportation services and by arranging for Missouri Rehabilitation Services for the Blind to visit his home and organize his pantry using a system of large, color-coded labels. She also got the man involved with a poor-vision support group operated by the St. Louis Society for the Blind and Visually Impaired and arranged for him to receive newspapers, magazines and books on audiotapes.
Life Crisis plans to distribute information about the program to hotline operations across the country, and the research team is hopeful the service soon will be making a difference in the lives of seniors nationwide.
"The people who know best about older people who are struggling most often are that person's family and friends," Judy said. "We very much would like to encourage these third parties to call us and let us know about people who might benefit from the 'Link Plus' service."
Life Crisis phone operators are trained to treat all calls with sensitivity, and if requested, they will preserve the anonymity of those making a referral to the service.
For more information on the program and for referrals of senior citizens needing assistance, call Life Crisis at (314) 647-HELP (4357).
-- Gerry Everding
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