NSW Health Education and Training Institute, North Parramatta, NSW, Australia.
The University of Newcastle, Callaghan, NSW, Australia.
Australas Psychiatry. 2022 Jun;30(3):294-297. doi: 10.1177/10398562211054039. Epub 2021 Dec 13.
Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation.
The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.
实施针对老年人的预防自杀“迈向零自杀”（Towards Zero Suicide，TZS）方法需要基于证据的适应性调整。本文旨在强调与实施相关的老年人在医疗保健服务使用方面的重要差异和机会。
TZS 方法可能会预防老年人自杀，但前提是实施必须与老年人医疗保健利用的系统差异相匹配。对老年人来说最重要的是：（1）大多数心理健康护理是在专门的心理健康服务之外提供的；（2）身体状况和残疾是导致自杀的主要可改变因素，必须在 TZS 中加以解决；（3）老年人很少使用医疗保险资助的心理服务。初级保健提供者可能会看到有自杀风险的老年人，但他们通常既没有能力为通常复杂的需求提供专家评估和护理计划，也可能不认为这是他们的角色。然而，他们在提供护理途径方面至关重要，这可能会预防自杀。领导者必须认识到，针对老年人的 TZS 通常需要多次过渡。这需要有明确角色的关键服务的参与、有针对性的培训、快速获得专门的老年人心理健康支持以及开发新的 TZS 元素：导航员。
