INTRODUCTION
1. Background
The suicide rate in Korea is among the highest in the world. In particular, the suicide rate per 100,000 people is 67.4 for elderly people aged 80 and older, and 46.2 for those aged 70~79 years, indicating that suicide rates increase with age, among which the proportion of elderly people living alone is higher than that of elderly people living in other household types [1]. Korea has been predicted to become a post-aged society by 2025, whereby people aged 65 and older will account for approximately 18% of the total population, and a significant number of elderly people will live alone, making them vulnerable in many aspects of their lives. Elderly people who live alone are a high-risk group for suicide [1].
Suicide is a phenomenon that occurs through a series of processes: suicidal ideation, attempted suicide, and suicidal behavior. Based on this, suicidal ideation, the first stage of suicide, does not necessarily result in suicide, but is highly likely to lead to attempted suicide [2]. Therefore, understanding the factors associated with “suicidal ideation” in the elderly living alone is a priority for a preventive approach to suicide [2].
In this regard, the United Nations Economic and Social Commission for Asia and the Pacific reported on the challenges of aging in the Asia-Pacific region, outlining the social issues associated with the growing number of households with the elderly living alone [3]. They noted that experiences of economic insecurity and caregiving issues can lead to vulnerability in seeking healthcare. In addition, problems in caring for the elderly due to changing values, lack of age-friendly environments, spread of negative images of the elderly, lack of social participation opportunities and sense of isolation, loss of roles and shrinking social networks due to retirement, and ageism have been cited as problems in aging societies [3]. In particular, elderly people living alone are more likely to live in poor housing conditions, lack resources to help with daily living, have no one to care for them when they are sick, and are more susceptible to chronic illness, disability, and isolation [4].
In general, reports have shown that the elderly living alone are at high risk for suicidal ideation as they experience new and unprecedented crises in today’s social structure and life. Moreover, structural and functional support systems, such as family, friends, and special others, are strong sociodemographic factors associated with suicidal ideation. However, appropriate interventions are lacking [4]. This suggests that for older adults living alone, support from others is a powerful factor that strengths mental health and should be prioritized when exploring ways to predict and reduce suicidal ideation. In addition, ageism, which is experienced by three in every 10 elderly persons in South Korea, and a decline in formal social participation opportunities contribute to the increased time spent alone without interaction, causing exclusion from important decision-making [5].
Notably, these social structures and cultural backgrounds have a negative impact on the psychology of the elderly living alone, leading to suicidal ideation, as these sociological factors affect self-esteem, a psychological mechanism that enables people to take good care of themselves [2]. Above all, owing to the loss of support systems, such as the death of spouses and acquaintances, and negative experiences in social relationships, the elderly living alone are more susceptible to depression. Depression is not just a mental pathology but leads to suicidal ideation, making it one of the most important mental health issues to be carefully examined [6]. In addition, the sense of isolation experienced by community-dwelling seniors is a psychological factor that deserves further attention, given their chronic perceived loneliness in rapidly changing social situations.
As issues related to the lives of the elderly living alone have been raised in the mainstream discourse of society, the government is taking various measures to support them by establishing and improving services for the elderly living alone, such as enacting relevant laws, and local governments are conducting suicide prevention projects based on mental health welfare centers and senior welfare centers. However, a few programs are specific to the characteristics of the elderly living alone in Korean society, and suicidal ideation among the elderly living alone is still higher than that of the elderly who are not living alone [7]. This suggests a need to validate factors related to suicidal ideation in the elderly living alone, classifying them into sociological and psychological dimensions, and identifying their relationships in a systematic context.
Based on the sociological theory, which believes that an individual’s surrounding environment or environmental characteristics is a decisive trigger to suicide [2]; the psychological theory, which believes that suicide is caused by an individual’s psychological atrophy [2]; and related previous research, this study categorized the factors related to suicidal ideation among the elderly living alone into social and psychological factors, and introduces each factor step by step to further clarify their influence. These validation efforts are expected to provide the basis for effective interventions for suicidal ideation among the elderly living alone, as well as for policy formulation.
METHODS
Ethic statement: This study was approved by the Institutional Review Board (IRB) of Korea University (IRB No. KUIRB-2024-0030-01). Informed consent was obtained from the participants.
1. Study Design
This is a cross-sectional correlational study to determine the effects of sociological (social support, experience of elderly discrimination, and social participation) and psychological factors (self-esteem, depression, and sense of isolation) on suicidal ideation in the elderly living alone. This study was performed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines (https://www.strobe-statement.org).
2. Participants
The study was conducted targeting seniors aged 65 and older living alone in six regions in Gyeonggi Province. Eligibility criteria included a Subjective Memory Complaints Questionnaire score of 5 or less, no cognitive impairment with the ability to communicate and understand sentences, and an understanding of the purpose of the study and voluntary written consent. The sample size of this study was calculated using the G-power 3.1.9.7 program [8]. According to previous research [9], the calculated minimum sample size was 153 based on an effect size of .15, a significance level of .05, a power of .85, and 15 predictors. Therefore, 183 questionnaires were used considering a 20% dropout rate; however, 154 questionnaires were included in the analysis of this study, excluding 29 incomplete questionnaires.
3. Measurements
1) Sociodemographic Factors
In this study, subjects were asked to indicate their age, gender, education, marital status, duration of living alone, economic status, health status, occupation, and area of residence. This information was collected through a questionnaire.
2) Social Support
Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) scale developed by Zimet et al. [10] and translated by Shin and Lee [11]. The MSPSS scale consists of 12 questions: four questions about support from family, four questions about support from friends, and four questions about support from special others. Each question was based on a 5-point Likert scale, with higher scores indicating higher social support. As regards the reliability of the tool, Cronbach’s α was .85 in the study by Shin and Lee [11], and .93 in our study.
3) Experiences of Elderly Discrimination
The experience of elderly discrimination was measured using the ageism scale developed by Palmore [12], which was supplemented by Won [13] to suit the Korean reality. The Elderly Discrimination Experience Scale consists of 20 items, including six items on ignoring, seven items on avoidance, and seven items on alienation. Each question is on a 5-point Likert scale, with higher scores indicating higher levels of experience with ageism. As for the reliability of the tool, Cronbach’s α was .88 in the study by Won [13], and .94 in our study.
4) Social Participation
Social participation was measured using an instrument adapted by Kim [14] from the social participation scale developed by Weiss [15]. The social participation scale consists of nine questions. Each question was based on a 5-point Likert scale, with higher scores indicating higher social participation. As for the reliability of the tool, Cronbach’s α was .91 in the study by Kim [14], and .91 in our study.
5) Self-Esteem
Self-esteem was measured using the Self-Esteem Scale developed by Rosenberg [16] and translated into Korean by Jeon [17]. The self-esteem scale consists of 10 questions, five positive and five negative. Each statement was scored on a 4-point Likert scale, with 1 being “rarely true,” 2 being “generally not true,” 3 being “generally true,” and 4 being “always true,” with higher scores indicating higher levels of self-esteem. As for the reliability of the tool, Cronbach’s α was .85 in the study by Jeon [17], and .73 in our study.
6) Depression
Depression was measured using the Center for Epidemiological Studies Depression (CES-D)-10 Andresen form instrument developed by Andresen et al. [18] and validated by Park et al. [19]. This tool is a shortened version of the CES-D scale originally developed by Radloff [20]. The depression scale consists of 10 questions: two about positive mood and eight about negative mood. Each question is scored on a 4-point Likert scale, with 0 for “never or briefly,” 1 for “sometimes,” 2 for “often,” and 3 for “always,” with higher scores indicating higher levels of depression. As regards the reliability of the tool, Cronbach’s α was .85 in the study by Park et al. [19], and .78 in our study.
7) Sense of Isolation
Isolation was measured using the Emotional Social aspects of Loneliness and Isolation scale developed by Vincenzi and Grabosky [21] and adapted by Hong and Yoo [22]. The isolation scale consists of 16 items, eight for social isolation and eight for emotional isolation. Each question was scored on a 4-point Likert scale, with 1 being “not at all,” 2 being “sometimes,” 3 being “often,” and 4 being “always,” with higher scores indicating higher levels of isolation. As regards the reliability of the tool, Cronbach’s α was .91 in the study by Hong and Yoo [22], and .91 in our study.
8) Suicidal Ideation
Suicidal ideation was measured using the Suicide Ideation Scale (SIS) developed by Harlow et al. [23] and modified by Kim [24]. The SIS consists of five questions: “Have you ever thought about suicide?”, “Have you ever wanted to die?”, “Have you ever talked about wanting to die?”, “Have you ever felt like your life would end in suicide?”, and “Have you ever tried to commit suicide?”. Each question is on a 5-point Likert scale, with higher scores indicating higher suicidal ideation. As regards the reliability of the tool, Cronbach’s α was .84 in the study by Kim [24], and .84 in our study.
4. Data Collection
Data collection for this study was conducted between February 2, 2024 and February 29, 2024, at five general social welfare centers and one senior welfare center in Gyeonggi-do, Korea, after obtaining prior permission, posting recruitment notices for study participants, and following a schedule agreed upon with the institutions. Data were collected using a structured questionnaire in a separate room with the cooperation of each institution. Only those who expressed their willingness to participate voluntarily after explaining the overall process, including the purpose and method of the study as described in the participation information sheet before the questionnaire, were included in the study. We informed them that it would take approximately 20~30 minutes to complete the questionnaire, provided them with the opportunity to ask questions and enough time to complete the questionnaire considering their age, and provided additional explanations to help them understand the content of the questionnaire. In addition, the researcher read the questionnaire and the participant answered, as necessary. Participants who expressed interest in participating but could not visit the institution were visited at home with a life support worker from the welfare center to collect data.
5. Data Analysis
The collected data were subjected to statistical analysis using SPSS/WIN 26.0 program (IBM Corp.) as follows:
1) The demographic characteristics of the subjects were analyzed using frequency analysis and descriptive statistics.
2) The degree and normality of the major variables were analyzed by descriptive statistics.
3) Differences in suicidal ideation according to demographic characteristics were analyzed by t-test and one-way ANOVA, with the Scheffé test for post hoc tests.
4) Correlations among the major variables were analyzed using Pearson’s correlation coefficients.
5) The effects of sociological factors (social support, experience of elderly discrimination, and social participation) and psychological factors (self-esteem, depression, and sense of isolation) on suicidal ideation among the elderly living alone were analyzed by hierarchical regression analysis.
6. Ethical Considerations
This study was approved by the Institutional Review Board (IRB) of Korea University University (IRB No. KUIRB-2024-0030-01). The researcher explained the following to the subjects who met the selection criteria for this study and wanted to participate in the survey: the purpose and method of the study, that anonymity is guaranteed, that they can withdraw their participation at any time without any disadvantages, that the results of the survey will be used only for research purposes, and that the survey will take approximately 20~30 minutes to complete. The study was conducted after the subjects voluntarily signed an informed consent form, and each participant was given a small gift. To protect privacy, the collected data were encrypted, coded, and statistically processed on the researcher’s PC, and stored in a locked location and will be completely destroyed in an irreversible manner after 3 years of storage.
RESULTS
1. Sociodemographic Characteristics of Participants
The sociodemographic characteristics of participants in this study are shown in Table 1. Of the 154 total respondents, 68 (44.2%) and 86 (55.8%) were men and women, respectively, 72 (46.8%) were aged 65~74 (young-old adults), and 82 (53.2%) were aged 75 or older (old-old adults). The mean age was 70.08±2.57 years in the younger elderly and 82.29±5.86 years in the older elderly. In terms of education, 55 (35.7%) were elementary school. As for marital status, 84 (54.5%) were widowed. The highest number of participants (n=74, 48.1%) lived alone for more than 20 years. As for the economic status, the majority of the participants (n=68, 44.2%) had an income of less than 500,000 to 100,000 won per month. In terms of health condition, 51 (33.1%) participants answered “normal”; 50 (32.5%), “bad”; 20 (13.0%), “very bad”; 19 (12.3%), “good”; and 14 (9.1%), “very good.” In terms of current job status, 145 (94.2%) had no job and 108 (70.1%) and 46 (29.9%) participants were living in urban and rural areas, respectively.
2. Socio-Psychological Factors and Level of Suicidal Ideation of Subjects
The socio-psychological factors and level of suicidal ideation of the subjects are shown in Table 2. First, the mean of each variable according to descriptive statistics was 2.96±0.79 out of 5 for social support, 2.41±0.68 for experience of elderly discrimination, and 3.52±0.66 for social participation. Scores of self-esteem, depression, and isolation were 2.74±0.39, 2.27±0.35, and 1.82±0.52, respectively, out of 4. Suicidal ideation was scored 5.00 out of 1.50±0.60.
3. Differences in Suicidal Ideation by Sociodemographic Characteristics
Differences in suicidal ideation by the sociodemographic characteristics of subjects are shown in Table 1. Suicidal ideation was statistically different by economic status (F=3.14, p=.027), health condition (F=4.36, p=.002), current occupation (t=-4.44, p<.001), and area of residence (t=-2.75, p=.007). Suicidal ideation was higher among those without a job than among those with a job, and higher among those living in urban areas than among those in rural areas. The Scheffé test also showed that those earning less than 500,000 won per month were more likely to have suicidal ideation than those earning 1,000,000~1,500,000 won per month, and those who were “bad” and “very bad” were more likely to have suicidal ideation than those who were “very good.”
4. Correlations Between Major Variables
Correlations between the major variables in this study are shown in Table 3. Suicidal ideation was positively correlated with experiencing elderly discrimination (r=.29, p<.01), sense of isolation (r=.57, p<.01), and depression (r=.37, p<.01). However, suicidal ideation was negatively correlated with social support (r=-.50, p<.01), social participation (r=-.42, p<.01), and self-esteem (r=-.60, p<.01).
5. Validation of Factors That Influence Suicidal Ideation
The factors that influence a subject’s suicidal ideation are shown in Table 4. To analyze the factors affecting suicidal ideation, we conducted a hierarchical regression analysis based on previous studies and theories related to suicidal ideation, using economic status, health condition, current occupation, and demographic factors of residence as control variables, and sociological factors (social support, experience of elderly discrimination, and social participation) and psychological factors (self-esteem, depression, and sense of isolation) as independent variables. The tolerance limits between the independent variables ranged from 0.252 to 0.863, and the Variance Inflation Factor values ranged from 1.159 to 3.971, indicating no multicollinearity among the independent variables. The Durbin-Watson statistic was 2.038, indicating no autocorrelation.
The first-stage model was statistically significant (F=2.60, p=.005), with economic status, health condition, current occupation, and area of residence identified as significant factors in the differences in suicidal ideation across gender, age, and sociodemographic characteristics. The significance test of the regression coefficients showed that for health condition, being bad (t=2.38, p=.019) or very bad (t=2.96, p=.004) has a significant effect on suicidal ideation. This means that suicidal ideation was higher in the bad and very bad groups than in the very good group. The regression analysis showed that the model had an explanatory power of .17 (adjusted R2), meaning that the regression model had approximately 17% explanatory power for the effect of the control variables on suicidal ideation.
The second-stage model was statistically significant (F=13.16, p<.001) when sociodemographic factors (social support, experience of elder discrimination, and social participation) were added as independent variables. The significance test of the regression coefficient showed that social support (t=-3.86, p<.001) and experience of elderly discrimination (t=1.99, p=.048) had a significant effect on suicidal ideation, with the relative influence being higher following the order of social support (β=-.36, p<.001) and experience of elderly discrimination (β=.15, p=.048). This means that suicidal ideation decreases with higher social support and increases with higher experiences of elderly discrimination. Regression analysis showed that the model had an explanatory power of .36 (adjusted R2), meaning that the regression model had 36% explanatory power for the influence of control variables and sociodemographic factors on suicidal ideation. The explanatory power of the model increased by 19% from that of stage 1.
The third-stage model was statistically significant (F=11.63, p<.001) when psychological factors (self-esteem, depression, and sense of isolation) were added as independent variables. The significance test of the regression coefficients showed that social support (t=-2.18, p=.031), self-esteem (t=-5.31, p<.001), depression (t=3.69, p<.001), and sense of isolation (t=5.18, p<.001) had a significant effect on suicidal ideation, with the relative influence being higher following the order of self-esteem (β=-.39, p<.001), sense of isolation (β=.39, p<.001), depression (β=.22, p<.001), and social support (β=-.17, p=.031). This means that higher self-esteem and social support are associated with lower suicidal ideation, whereas higher depression and sense of isolation are associated with higher suicidal ideation. Regression analysis showed that the model had an explanatory power of .59 (adjusted R2), meaning that the regression model had 59% explanatory power for the influence of the control variables and sociodemographic and psychosocial factors on suicidal ideation. The explanatory power of the model increased by 24% from that of stage 2.
DISCUSSION
This study was conducted to determine the extent of suicidal ideation among the elderly living alone and to identify the impact of socio-psychological factors on suicidal ideation. Here, the major variables that influence suicidal ideation based on the results of the study are discussed.
First, the level of suicidal ideation among the elderly living alone was relatively low, with a mean of 1.50 out of 5. These findings could be attributable to the fact that most of the study participants 1) were actively using programs and senior cafeteria run by welfare centers; 2) had been using personalized care services for the elderly for a long time; and 3) were accustomed to living alone for a long time, especially since 48.1% of them had lived alone for more than 20 years. Therefore, the relatively low level of suicidal ideation in this study is interpreted to be because most subjects were physically functional enough to go out and had been enrolled in welfare centers for a long time, participated in various services, and formed relationships with people around them. However, given that suicidal ideation is a psychological problem that is difficult to detect early because of its invisibility and that the characteristics of the elderly living alone put them at higher risk of suicidal ideation, suicidal ideation among the elderly living alone needs to be measured in a wider range of settings and analyzed in particular among the elderly living alone in sense of isolation.
Suicidal ideation by sociodemographic characteristics differed depending on economic status, health condition, current employment, and area of residence. In this study, suicidal ideation by economic status among the elderly living alone was higher among those with lower incomes, which is consistent with a study [25] that reported a higher suicidal ideation among the elderly living alone who were very poor. Economic status is a factor that can cause failure to receive appropriate medical treatment when needed. A study has reported that for every single “experience of not being able to go to the hospital because of lack of money” that an elderly person has, the risk of suicide increases by approximately 3.3 times [25]. Thus, the economic status of the elderly living alone is an important factor in their health condition. Therefore, identifying economic support measures for the elderly living alone and developing health promotion behavior education programs that can be practiced regardless of economic status are necessary.
This study supports previous research [1] that found that suicidal ideation was associated with a poor subjective health condition. Subjective health status is a self-assessment of one’s health and is likely related to psychological variables. To prevent suicidal thoughts in elderly people living alone with poor subjective health, identification of their various psychological health issues and implementation of interventions are considered a high priority strategy.
For the elderly living alone, occupation can also be a means to address negative self-image, such as feelings of alienation, powerlessness, and loneliness experienced in retirement, and a way for individuals to connect to society [26]. However, our study found that a whopping 94.2% of seniors did not have a job and were more likely to have suicidal ideation than those with jobs. Strategic skills are needed to formulate policies to expand and promote quality jobs for the elderly living alone, as job insecurity can cause economic problems for the elderly and has been shown to increase the likelihood of suicidal ideation. Positive effects are believed to only be expected if the individual characteristics of the elderly living alone are considered, for example, by providing them with opportunities to use the experiences and wisdom of their younger years.
As regards area of residence, this study found that suicidal ideation was higher in urban populations. This is contrary to a previous study that found higher suicide rates among the elderly in rural areas who are often geographically isolated and have difficulty accessing healthcare due to lack of transportation [27]. This suggests that further consideration should be given to the factors that determine emotional support and psychological satisfaction of the elderly living alone, even in the midst of “city” life.
In particular, this study showed no difference in suicidal ideation by gender and age, which can be attributable to the fact that improvements have been made in many areas, such as related programs and policies through continuous validation, demonstrating that the existing stereotypical gender roles are changing in the rapidly aging population. Nevertheless, how heterogeneity by gender and age and the different life trajectories of the elderly could influence suicidal ideation needs to be investigated through further attention to the nursing practice.
In this study, the sociological factors affecting suicidal ideation among the elderly living alone were analyzed by hierarchical regression analysis, finding that social support and experience of elderly discrimination had a significant effect on suicidal ideation. These results support previous studies [2,7], in which social support was the most frequently analyzed environmental factor for suicide among the elderly living alone, and had the largest effect size as a protective factor against suicidal ideation. The studies also showed that lower social support makes the elderly more vulnerable to suicidal ideation.
In addition, identifying non-family support resources and strengthening interventions for the elderly living alone, where the family system itself is unlikely to function as a protective factor against suicidal ideation due to rapid aging, is necessary. For the elderly living alone, non-family support resources may include neighbors, clergy, social workers, life support workers, care workers, and healthcare providers. Of these, healthcare providers are the ones who see suicidal people in the weeks before they commit suicide, and reports have shown that some patients who visited primary care providers had suicidal ideation within a month of their visit [28]. This suggests that suicidal ideation among the elderly who live alone should be assessed when medical services are provided. At the same time, more active case management in conjunction with the community may be an effective strategy to prevent suicidal ideation among the elderly living alone.
Above all, this study seems to have great significance for nurses who practice nursing and caregiving in the closest proximity to the elderly. In nursing practice, nurses must keep in mind that their attention and emotional support for the elderly living alone can serve as the first level of social support to prevent suicidal ideation. At the same time, trainings to enhance the competence of nurses in caring for the elderly seem to be highly important. For the elderly who are reluctant to be a burden on others and tend to seek institutionalized care rather than personal support, more specialized policies for the elderly who live alone need to be accompanied by a support system of “mutual care” between care recipients.
Experiences of elderly discrimination also had a significant impact on suicidal ideation among the elderly living alone. However, when psychological factors were included as control variables, the results were not significant for suicidal ideation among the elderly living alone. While ageism is a phenomenon that occurs in various regions, including the East and West [29], the majority of the subjects in this study seemed to have a general social welfare center in their living radius and were rarely exposed to unjust incidents due to their age.
In this study, psychological factors affecting suicidal ideation among the elderly living alone were analyzed by hierarchical regression analysis, which confirmed that all psychological factors, such as self-esteem, depression, and sense of isolation, had a significant effect on suicidal ideation in the final model. First, self-esteem was identified as the most influential factor in suicidal ideation among the elderly living alone, which is consistent with findings from a study that identified suicidal ideation in the same population [2]. Developing a program to improve the self-esteem of elderly people living alone and verifying its effectiveness as a nursing intervention to prevent suicidal ideation by maintaining a positive self-image and responding flexibly to various crises is essential. Ultimately, this will contribute to improving the quality of life for the elderly living alone.
We found that depression had a significant effect on suicidal ideation. This supports the findings of a related previous study [6]. In the case of depression in the elderly, approaching the psychological state of the elderly living alone in a sensitive manner and detecting the factors of depression in advance would be more effective than simply using medical methods such as drug treatment. This is considered the shortcut to preventing suicidal ideation. To this end, we believe that an urgent need exists to develop an easy and concise depression scale tailored to the characteristics of the elderly living alone, and a depression intervention program that reflects the situation of the specific group of elderly living alone. Community healthcare systems also need to be more proactive in counseling the elderly who live alone about depression.
In this study, sense of isolation was also identified as a factor influencing suicidal ideation among the elderly living alone. These results support previous studies [2]. Moreover, we emphasize that sense of isolation (β=.39) was a more influential factor than depression (β=.22) in suicidal ideation among the elderly living alone. Research on suicidal ideation has focused primarily on depression rather than sense of isolation. While depression clearly has a strong influence on suicidal ideation, sense of isolation is a highly important factor that should not be overlooked in community care for the elderly because it is closely related to loneliness, which is becoming a social issue. Sense of isolation is not only related to physical health but also to various other mental pathologies, and sense of isolation is an antecedent of depression [2]. Therefore, developing effective policies and raising nursing care awareness for sense of isolation, which has a mechanism of reducing the quality of life, is considered urgent.
In particular, a study [30] reported that the sense of isolation is measured in terms of multidimensional attributes that consider inter-organic relationships, and that the household structure of “living alone” increases social isolation. Considering this, efforts should be made to clarify the concept of “the sense of isolation of elderly people living alone” and to identify the elderly people living alone who are isolated and reclusive. In addition, a network should be established to systematically monitor the personal situation of the elderly living alone and the environmental conditions surrounding them.
Taking the above discussion into account, research should be continuously conducted to identify the relationship between the suicidal ideation of the elderly living alone by applying a wider range of psychological factors due to aging, and efforts should be made to determine the preceding sociological factors. In other words, a dynamic view of suicidal ideation, in which macro and micro aspects of suicidal ideation are interconnected, should be applied step by step to effectively respond to suicidal ideation among the elderly living alone.
As a limitation of this study, we cannot exclude the possibility that the study sample was drawn from a specific geographical area. Therefore, the results of this study cannot be generalized to all the elderly living alone and should be interpreted with caution. In addition, we were unable to include the elderly people who live alone because they are unable to leave the house, and the survey was performed in a superficial way of analyzing this serious and sensitive topic, “suicidal ideation.” These may have limited the ability to get more honest responses about suicidal ideation.
Nevertheless, this study is significant in that it approached suicidal ideation in the elderly living alone by dividing factors related to suicidal ideation into sociological and psychological levels by reviewing previous studies and suicide-related theories. It suggested the need to develop intervention programs for suicidal ideation in the elderly living alone in various areas of nursing practice. As the number of the elderly living alone is predicted to increase as Korea is becoming an ultra-aged society, this raised the need to establish a systematic network and various policy strategies to identify hidden elderly people living alone and detect their suicidal ideation early.
CONCLUSION
This study aimed to identify significant factors affecting suicidal ideation among the elderly living alone and provide a basis for effective nursing interventions and policy formulation. In the final model of this study, the sociological factors of social support and psychological factors of self-esteem, depression, and sense of isolation were found to have a significant effect on suicidal ideation.
Therefore, various social resources should be identified and support measures sought for the elderly living alone according to their individual circumstances. Moreover, efforts should be made to proactively screen and intervene in at-risk groups through preventive assessment of the psychological factors of elderly people living alone. In addition, high-quality policies should be put in place to enable elderly people living alone in the blind spot of care to be linked to community resources. This study is expected to aid in the prediction of social risk factors that may be experienced by the elderly living alone and prevent the risk of exposure to negative psychology. This may lead to early detection and intervention of suicidal ideation, and ultimately contribute to improving the quality of life of the elderly living alone by enabling the implementation of integrated community care policies.
Rapid aging and rapidly changing social conditions are expected to change the environmental and psychological factors surrounding the elderly living alone. Therefore, we recommend 1) a replication study to verify the relationship between suicidal ideation of the elderly living alone and more factors by applying them; 2) a study to further specify the area where the elderly living alone reside to ensure the representativeness of the sample; 3) a qualitative study to clarify the concept of suicidal ideation and examine the essence of the concept in depth; and 4) a study to develop and apply programs suitable for the characteristics of the elderly living alone and verify their effectiveness.
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