Indirect self-destructive behavior among elderly patients in nursing homes - A research agenda

Although suicide is rare in nursing homes, indirect self-destructive behaviors (ISDBs), such as the refusal to eat or take life-sustaining medications, are commonplace. For some, ISDB represents a cry for help, whereas in others it is a reasoned behavioral expression of legitimate preference for an earlier death. This article reports on the proceedings of a workshop held in May 1994 to discuss ISDB in long-term care settings. After a historical review, issues discussed by workshop participants are presented and a research agenda proposed. Future studies are advocated with regard to correlates for ISDB that are relevant to the patient and characteristic of the nursing home environment.