The emergency telephone conversation in the context of the older person in suicidal crisis: a qualitative study.
BACKGROUND
Suicide in older people is a significant public health issue with a predicted future increase. Contemporary research directs considerable attention toward physical, mental, and social risk factors that contribute to suicidality in older people; still, little is understood about the fundamental meanings that older people in suicidal crisis attribute to these factors.


OBJECTIVE
The aim of this qualitative study was to describe, analyze, and compare counselors' and older peoples' perceptions of the suicidal crisis during an emergency telephone conversation.


METHODS
Data collection consisted of individual interviews with telephone counselors (N = 7) working within an emergency mental health triage service, and listening to telephone calls (N = 14) received by the service responding to people aged 65 years and over in suicidal crisis. Triangulation of the two data sets resulted in the emergence of three key themes.


RESULTS
We found (1) congruence in the way risk factors were perceived by counselors and communicated during telephone conversations, (2) dissension between counselors' perceptions of end-of-life issues and older people's feelings of ambivalence about wanting to die and not knowing what to do and (3) the need for working side-by-side with the older person, exploring acute changes and immediate capacity for change.


CONCLUSIONS
An explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person's life. This research has begun to capture and illuminate how telephone counselors can deliver effective crisis intervention as older people struggle and make meaning through their suffering.
School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, Australia kate.deuter@unisa.edu.au
Kate
K
Deuter
Nicholas
N
Procter
John
J
Rogers
D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001315:Australia; D003142:Communication; D003376:Counseling / Q000379:methods*; D003419:Crisis Intervention / Q000379:methods*; D005260:Female; D015277:Hotlines; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D012307:Risk Factors; D000092864:Suicide Prevention