VA Boston Healthcare System, Boston, USA.
Harvard Medical School.
Clin Gerontol. 2020 Jan-Feb;43(1):126-131. doi: 10.1080/07317115.2019.1642974. Epub 2019 Jul 19.
Suicide rates are increasing in the United States and groups at elevated risk include older adults, veterans, and those with life-limiting illnesses. However, the treatment of suicidality at end-of-life has been little studied. There is emerging evidence that palliative care itself may be protective against suicide and there is some support for the use of Acceptance and Commitment Therapy (ACT) at end-of-life. The overlapping mechanisms of palliative care and ACT are especially well-suited for individuals struggling with suicidality in the context of life-limiting illness.A case from a Veterans Affairs Home-Based Primary Care (HBPC) team is used to illustrate the challenges and opportunities when providing end-of-life care to an older veteran with chronic suicidal ideation. Prior mental health treatment had limited impact on his suicidality. However, with an integrated ACT and palliative care approach, the HBPC team was better able to focus on the veteran's goals. This approach was helpful in reducing suicidal ideation and engaging him in end-of-life decision-making discussions. This case highlights the valuable role of palliative care in suicide prevention and how the addition of ACT can aid in the effective treatment of chronic suicidal ideation at the end-of-life.
美国的自杀率正在上升，处于高风险的群体包括老年人、退伍军人以及患有绝症的人。然而，临终前对自杀意念的治疗研究甚少。有新的证据表明，姑息治疗本身可能具有预防自杀的作用，并且姑息治疗在临终阶段的应用也得到了一定程度的支持。姑息治疗和接受与承诺疗法（ACT）的重叠机制特别适合那些在患有绝症的情况下与自杀意念作斗争的人。退伍军人事务部家庭为基础的初级保健（HBPC）团队的一个案例说明了在为有慢性自杀意念的老年退伍军人提供临终关怀时所面临的挑战和机遇。先前的心理健康治疗对他的自杀意念影响有限。然而，通过整合 ACT 和姑息治疗方法，HBPC 团队能够更好地关注退伍军人的目标。这种方法有助于减少自杀意念，并促使他参与临终决策讨论。这个案例突出了姑息治疗在预防自杀方面的重要作用，以及 ACT 的加入如何有助于在临终阶段有效治疗慢性自杀意念。
