1 

2018 Grantee

Supporting Older Adults At Risk 

of Suicide Through Nutrition 

Services in Georgia

Summary:

To enhance identification and support of older adults with 

elevated suicide risk or mental health distress (ESR/MHD), the 

Atlanta Regional Commission (Atlanta Area Agency on Aging), in 

partnership with affiliate nutrition service providers and Georgia 

State University researchers, developed a standardized and 

manualized suicide intervention to be delivered by nutrition 

services volunteers. Through a series of related studies, they found 

that nutrition services volunteers and providers can develop 

suicide intervention skills, and when they do, use those skills as 

part of their job role and provide life assisting suicide interventions 

to the older adults they serve.
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Table of Contents

Caregiver Tips During COVID-19........................................... 3

More Than a Meal: Facts, Stress, and Coping 

Information for Home Delivered Meal Volunteers 

During COVID-19 ............................................................................4

Quick Tips for Social Distancing............................................5

Caring for Wellbeing of Older Adults during COVID19.............................................................................................................6

Enhancing Socialization through Making Meaningful 

Volunteer Connections During COVID-19........................ 7

Suicide Intervention Response Inventory (SIRI 2) with 

Scoring.................................................................................................8
3 

Caregiver Tips During 

COVID-19

Suggestions and resources for protecting yourself 

and those you care for.
 

 

 

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 Needs Assessments Interventions

Caregiver Tips During COVID-19: 

Building Resilience, Protecting Yourself and 

Those You Care For 

Caregivers are among the most resilient, capable, and competent people in this 

country. At a time when many are struggling to cope with the new reality of social 

ADDITIONAL 

RESOURCES 

Caregiver Help Desk: distancing at home, uncertain of what tomorrow brings, caregivers live in this 855-227-3640 reality on a daily basis. https://www.caregiveracOne of the strengths caregivers have is resilience to take each day as it comes. tion.org 

As a caregiver, the skills you have accrued (and your innate compassion for oth- Eldercare Locator: ers) will serve you well at this difcult time. And remember, there is strength in 800-677-1116 seeking help. https://eldercare.acl.gov/ 

Public/Index.aspx THE PROBLEM 

Many older adults are canceling in-home services, and caregivers may be hesitant Administration for 

due to concerns about spreading COVID-19. However, caregivers can do concrete Community Living:

things to support older adults in need. Here are some guidelines that may be helpful: https://acl.gov/COVID-19 

Protect Your Health to Protect Your Loved Ones AARP: 

U Take everyday steps to ensure that you reduce the odds of getting sick. As time 877-333-5885 

permits, sanitize your home as thoroughly and often as you can, with an efective 

disinfectant. This is particularly important after a visitor enters your home. See 

the CDC’s FAQs for specifcs on how the virus can and cannot be transmitted. 

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If you are concerned that you may be sick with COVID-19, please review these helpful tips from the 

CDC. Click here for a self-checker. 

Even if you’re feeling healthy, wash your hands frequently, and ask visitors to do the same. The CDC 

has a 2-minute video on best hand-washing techniques. In fact, wash your hands every time you 

walk by a sink. 

Social distancing is okay. If family members visit, but are reluctant to be close to you or to your 

loved one, that is perfectly normal. Normal, but not easy. We all appreciate hugs and physical closeness from our friends and family, but this is a time to use caution. 

Maintaining Your Loved One’s Access to Food and Healthcare 

If you or your family employs a caregiver, continue to foster that relationship. Unless that caregiver 

has been exposed to the virus, there’s no reason to end their services. However, caution and service 

modifcation are prudent. 

Ask about their recent travels/activities, and about their hand-washing practices. 

Ask them to use personal protective equipment (PPE; e.g., gloves, mask, etc.) if they have it available. 

This is most important for direct contact care. 
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If allowing a necessary service provider into your home makes you feel uncomfortable for any reason, call the Caregiver Help Desk or visit their website (https://www.caregiveraction.org) and they will 

help you navigate the situation. 

Free Caregiver Help Desk (open 8:00am-7:00pm ET) 855-227-3640 

Chat available on website as well 

U If you need help fnding eldercare, resources can be found at: 

U Administration for Community Living: https://eldercare.acl.gov/ 

U Eldercare Finder Toll-Free Number: 800-677-1116 

Utilize grocery and meal delivery services. Consider these helpful tips about how to make these 

services a part of your routine. 

The Importance of Self-Care for Caregivers 

Stress can decrease your immunity and use up emotional resources, both of which are critical to 

protect during this time of uncertainty. These are challenging circumstances and you are doing 

the best possible job you can for yourself and your loved one. The CDC ofers suggestions to 

reduce stress and maintain wellness during this precarious time. 

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First and foremost, take care of yourself and prioritize your own well-being. 

Take a deep breath and know you will get through this. If you become overly anxious or depressed, it may impact your ability to care for your loved one. Take care of your own emotional 

health. 

Engage in daily physical activity, prayer, or meditation. 

Sometimes caregivers feel guilty when they take time for themselves—this is normal when you’re 

caring for someone you love. 

It’s important to take the time daily to seek out the little things that bring you joy ... maybe 

savoring a morning cup of cofee, or listening to the birds sing as they greet the day. Allow yourself these joyful moments. 

If you live with someone, let them know when you need respite care. Caregiving is 24/7 challenging work, and everyone needs a break to recharge and renew. 

Another option for support is to ask for care packages from loved ones rather than in-person 

visits; that may ease your stress and protect your household. 

AARP has a support line for caregivers to call during this time if you have questions or need 

local resources: 1-877-333-5885. 

The Family Caregiver Alliance also has online support groups to ensure that you can stay connected to other people facing similar challenges. 

LOVE WINS 

There are many people in your community, city, state, and country that want to help others right 

now. Our country has a strong volunteer spirit, and people really want to help. You will likely be 

receiving more calls at this time from your family, friends, and faith communities who care about 

you in this time of crisis. Tell them what you need. Remember the strength in seeking and accepting 

help. Allowing others to help you in this way is a gift to them as well. 

Don’t forget to tell your loved ones, “I love you,” “I’m here for you,” and “We’ll get through this.” 

Look for people who will give you the same type of support that you are providing to others. 

While social distancing measures can feel isolating, it can be helpful to remember: you are not 

alone in the unique challenges presented by the pandemic. 

Contributors: 

Connie Tomlin, M.A. Matthew Fullen, Ph.D., M.Div. Laura Shannonhouse, Ph.D.

Mary Chase Mize, M.S. Jordan Westcott, M.S. Paul Delaughter, B.S
4 

More Than a Meal: Facts, 

Stress, and Coping 

Information for Home 

Delivered Meal 

Volunteers During 

COVID-19

Guidance on how to identify signs of stress and 

mental health trouble or suicide risk in seniors 

receiving Home Delivered Meals.
 

 

 

 Needs Assessments Interventions

More than a Meal: 

Facts, Stress, & Coping Information for Home Delivered 

Meal Volunteers (HDM) during COVID-19 

As a HDM volunteer, YOUR work with the older adult population is having a monumental impact on their lives. They are the demographic most heavily hit by this 

pandemic, and through your caring and giving nature, YOU are providing human 

connection and promoting life through home delivered meals. 

CREDIBLE 

RESOURCES 

Center for Disease 

Control & Prevention:

FACTS 1-800-CDC-INFO 

HOW IT SPREADS1

: (1-800-232-4636) 

Many older adults are canceling in-home services, and caregivers may be hesitant https://www.cdc.gov 

due to concerns about spreading COVID-19. However, caregivers can do concrete World Health things to support older adults in need. Here are some guidelines that may be helpful: Organization Office of 

Protect Your Health to Protect Your Loved Ones the Americas: 

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There is currently no vaccine to prevent COVID-19. 202-974-3000 

The best way to prevent illness is to avoid exposure to this virus. http://www.who.int/en 

The virus is thought to spread mainly from person-to-person: Substance Abuse and 

• Between people who are in close contact (within about 6 feet). Mental Health Services 

Administration : • Through respiratory droplets from a cough or sneeze by an infected person. 

These droplets can then be inhaled by others. 1-877-SAMHSA-7 

(1-877-726-4727) When caring for older adults, be sure to physically distance yourself adequately https://www.samhsa.gov/ 

STRESS 

WHAT SHOULD YOU KNOW 

Fear and anxiety about the COVID-19 pandemic can be overwhelming and cause strong emotions and 

reactions. Those who receive delivered meals ARE having stress reactions right now. With new restrictions in place for the services seniors rely on and for their visitors, it is highly likely they feel even further isolated than usual. This, combined with their increased risk when exposed to the disease, makes it 

more likely you will see increased mental health symptoms. 

Seniors you encounter may be feeling anxiety, worry, or fear related to2: 

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Their own health status. 

Monitoring themselves or being monitored by others for symptoms of the disease. 

The challenges of securing things they need such as groceries, medication, personal care items. 

Concern about being able to efectively care for themselves, pets, or others in their care. 

Uncertainty or frustration about how long they will need to remain in this situation, and uncertainty 

about the future. 

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Loneliness associated with feeling cut of from the world and from loved ones. 

Anger if they think they were exposed to the disease because of others’ negligence.
 

 

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routines and regular day-to-day activities. 

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Uncertainty or ambivalence about the situation. 

A desire to use alcohol or drugs to cope. 

WHAT TO EXPECT: SIGNS OF STRESS3 

Some of the normal stress reactions you will see in seniors during an infectious 

disease outbreak are: 

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Changes in energy level, sleep patterns, and eating habits. 

Increased irritability. 

Crying more frequently. 

Blaming others for everything. 

Difculty fnding pleasure or having fun. 

Headaches and digestive issues. 

Difculty concentrating; feeling confused. 

TIPS FOR COMMUNICATING WITH SENIORS 

As an HDM volunteer, YOU are in a unique position to notice a senior who is struggling at a moment where support is most needed. 

If possible, listen and allow extra time for them to express their feelings and 

thoughts. 

Validate their experience with simple, refective statements such as: “You feel 

afraid and that makes sense.” Or “You are feeling a lot of anxiety right now.” 

Or “This situation feels new and scary and out of your control.” 

Use a calm, even tone of voice. People often unconsciously imitate our level of 

energy and tone of voice. Your calm tone may help a senior stay calm. 

Ask them what they need and direct them to resources as appropriate. 

Encourage them to engage in the stress reduction and self-care tips listed here. 

SIGNS & SYMPTOMS OF INCREASED MENTAL HEALTH 

TROUBLE OR SUICIDE 

Don’t be afraid to connect with seniors about their mental health and suicide—asking 

directly is helpful and needed! Be on the lookout for: 

Symptoms of depression: feelings of hopelessness, changes in appetite or hygiene, 

sleeping too little or too much, and difculty concentrating that persist for 2-4 

weeks. 

Death of loved ones. 

Financial or legal hardship. 

Increased use of alcohol, tobacco, or medications. 

Worsening of chronic health symptoms. 

HOTLINES 

SAMHSA’s Disaster 

Distress Helpline TollFree: 

1-800-985-5990 

(English and español) 

SMS: 

Text TalkWithUs to 66746 

SMS (español): 

“Hablamos” al 66746 

TTY: 1-800-846-8517 

National Suicide 

Prevention Lifeline TollFree: 

(English): 

1-800-273-TALK (8255) 

(español): 

1-888-628-9454 

TTY: 

1-800-799-4TTY (4889) 

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Symptoms of Post-Traumatic Stress Disorder (PTSD): intrusive distressing memories, fashbacks (reliving 

the event), nightmares, and being easily startled. 

Statements about wanting to die or harm themselves. For example: “My bags are packed ... I’m ready to 

go.” OR “I just wish it would end.” OR “It’s hard to go on.” OR “You shouldn’t be worrying about me when 

there is so much going on. I don’t matter as much.” 

If you notice a senior experiencing any of these reactions, encourage them to contact 

their health care provider or one of the hotline resources on this tip sheet.
SELF-CARE FOR HOME DELIVERED MEAL VOLUNTEERS 

Things you CAN control include your self-care and health practices2

: 

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Move your body safely. One way to release stress and anxiety is through physical movement. 

Find ways to move, stretch, or exercise that are safe for you! 

Take deep breaths—deep breathing can help you manage anxious feelings. 

Stay hydrated, work on getting enough sleep, and do your best to eat nutritious food. 

Relax your body often by doing things that work for you—take deep breaths, stretch, meditate or pray, 

or engage in activities you enjoy. 

Maintain a sense of hope and positive thinking; consider keeping a journal where you write down things 

you are grateful for or that are going well.

Notes: 

1. “Prevention of Coronavirus Disease 2019 (COVID-19): How to Protect Yourself,” Centers for Disease 

Control and Prevention (U.S. Department of Health & Human Services, March 18, 2020), https://www.cdc. 

gov/coronavirus/2019-ncov/prepare/prevention.html) 

2. “Taking Care of Your Behavioral Health During an Infectious Disease Outbreak: Tips for Social Distancing, Quarantine, and Isolation.” Taking Care of Your Behavioral Health During an Infectious Disease Outbreak: Tips for Social Distancing, Quarantine, and Isolation. Rochville, MD: SAMHSA: Substance Abuse and 

Mental Health Services Administration, 2014. 

3. “Coping with Stress During Infectious Disease Outbreaks.” Coping with Stress During Infectious Disease 

Outbreaks. Rockville, MD: SAMHSA: Substance Abuse and Mental Health Services Administration, 2014. 

Contributors: 

Hannah Carter, B.A. | Brittany Jones, M.S.W. | Madison Lord, B.S.

Laura Shannonhouse, Ph.D. | Mary Chase Mize, M.S. | Matthew Fullen, Ph.D., M.Div.
5 

Quick Tips for Social 

Distancing 

Dos and Don’ts for social distancing.
 Needs Assessments Interventions

Quick Tips for Social Distancing: 

Dos and Don'ts 

Social distancing refers to physical distancing—you can (and should) 

maintain contact with friends, family, and others via text, email, 

CONTACTS & 

UPDATES 

HDI's website and social 

media accounts provide 

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Engage in meaningful activities at home, such as prayer, knitting, art, and ongoing updates and 

mindfulness activities. resources for preparMake a plan to keep your home ready for shelter in place. ing your church for 

COVID-19. If possible, get a three-month supply of your medications to have on hand at 

home. This will help you avoid crowds of people at the pharmacy and ensure Email: hdi@wheaton.edu 

that you are not impacted by any medication shortages. Facebook: facebook. 

phone, or video calls. 

Call your doctor if you or your loved one begin to exhibit symptoms com/WheatonHDI 

consistent with COVID-19. Twitter: twitter.com/ 

WheatonHDI 

DO Maintain six feet of distance from anyone with whom you do not live, Instagram: particularly in public places (i.e., grocery stores, public parks, etc.). @wheaton_hdi 

DO Wash your hands regularly for at least 20 seconds. 

DO Go for walks in places that are not crowded (as long as you are not in an area 

with a shelter in place order). 

DO Attend medical appointments by phone or video conferencing when possible. 

DO Go to the grocery store once a week at the most, preferably during less busy hours. Many grocery 

stores are opening for an hour specifcally for older adults and people that are immunosuppressed, if 

you are able to go during that time. 

DON'T Travel. Traveling by plane or by car outside of essential trips (such as medical appointments, 

trips to the grocery store, or trips to the pharmacy) places you at signifcantly higher risk of contracting the virus. 

DON'T Invite friends or family to visit. Try to maintain social relationships via phone or other 

technolo-gy, such as Skype or FaceTime. Even people who are not obviously ill may be carrying the 

virus. 

DON'T Eat out at restaurants or bars. 

DON'T Physically attend large gatherings, such as church. Many churches are offering services online 

to protect their congregations. While engaging in faith is critical at this time, it is equally important to 

protect yourself, your loved ones, and others. 

DON'T Panic. While these are frightening times, safe social distancing can protect you and your loved 

ones. Stay informed and stay well.

Contributors: 

Connie Tomlin, M.A. Matthew Fullen, Ph.D., M.Div. Laura Shannonhouse, Ph.D.

Mary Chase Mize, M.S. Jordan Westcott, M.S. Paul Delaughter, B.S.
6 

Caring for Wellbeing of 

Older Adults during 

COVID-19

Tip for ways to connect with seniors while social 

distancing.
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 Needs Assessments Interventions

Caring for Wellbeing of Older Adults 

During COVID-19: 

Connecting While Social Distancing 

Millions of older adults already struggle with loneliness, isolation, and lack 

regular companionship. Now, imagine them being fooded with messages that 

“elders with underlying medical conditions are most at risk of death from inperson transmission of COVID-19,” and in Italy hospitals are “prioritizing the lives 

of young persons and those more likely to recover.” These messages coupled with 

social distancing is further isolating older adults. 

What can I do? How can I help? 

Loneliness and isolation are dangerous—but we can connect while 

social distancing! 

Check in on the people in your life who live alone—call them! Regularly! 

Utilize social media to stay connected. 

Connect with your clergy and faith community to reach out together. 

Volunteer through the aging network! 

LET THEM HEAR YOUR VOICE. 

A simple phone call (or video call) may be a powerful way to combat 

social isolation. 

Creative ways to spend time on the phone (or Skype/Zoom/Google Hangout) 

Plan consistent times to “meet”—make calls part of your regular routine. 

Read poetry or a book together. 

Play trivia or games (i.e. 20 Questions), or tell jokes! 

Ask the person to tell you about a favorite memory of their childhood. 

Pray with them or Read scripture. 

Read the Daily Ofce together from the Book of Common Prayer, available here: 

https://episcopalchurch.org/fles/book_of_common_prayer.pdf 

If you aren’t a big talker ... 

Plan to watch a favorite TV show during the call 

Plan to watch (and “play”) a TV game show such as Jeopardy! 

Listen and play music. 

Watch a movie together. 

Do a crossword puzzle together. 

ADDITIONAL 

RESOURCES 

Resources for family 

caregivers: https://www. 

aarp.org/caregiving/ 

How to make a 

household care plan: 

https://bit.ly/393BkOB 

Administration for 

Community Living: 

https://acl.gov/COVID-19 

ACL Eldercare 

Toll-Free Number: 

1-800-677-1116 

Eldercare Locator: 

https://eldercare.acl.gov/ 

Public/Index.aspx 
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What if the person is unable to talk? 

If someone in your life is at risk of social isolation and cannot communicate verbally, check with 

their care provider. Ask them to plan regular contact hours, or for assistance setting up video 

technology like FaceTime. Work together to plan out how to connect. 

Ask specifc questions for person’s the well-being: Are they eating meals? How is their mood? 

What activities are offered daily? 

VOLUNTEER 

Consider volunteering as part of the eforts underway with a local senior center. Faith based communities are one of the main sources of home delivered meal (HDM) volunteers. Services have 

been altered for safety regarding COVID-19; meals are being delivered through social distancing. The 

meal is dropped at the front door, the older adult is called, the volunteer steps back a safe distance 

(minimum of 6 feet). 

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Your church may already have a relationship with a local senior center. If not, you can develop 

one. It is pretty easy, requires a quick background check, and is most meaningful. 

Many deliver meals on a route, some do it during their lunch break. 

HDM volunteers have a unique opportunity to connect with the older adult from a distance. 

Go to https://eldercare.acl.gov/Public/Index.aspx to fnd your local Area Agency on Aging 

or county senior services ofce. Ask them for volunteer opportunities with homebound 

members of your community. (Try to have one representative do this for an organized group.) 

Finally, please know you have all you need in this moment to promote life with a socially isolated 

senior. All that is needed is a caring heart, and desire to connect. 

Prayer for the Aged, from the Book of Common Prayer 

“Look with mercy, O God our Father, on all those whose increasing years bring them weakness, 

distress, or isolation. Provide for them homes of dignity and peace; give them understanding 

helpers, and the willingness to accept help; and, as their strength diminishes, increase their faith 

and their assurance of your love. This we ask in the name of Jesus Christ our Lord. Amen.” 

Contributors: 

Mary Chase Mize, M.S., APC, NCC 

Laura Shannonhouse, Ph.D., LPC, NCC
7 

Enhancing Socialization 

through Making 

Meaningful Volunteer 

Connections During 

COVID-19

Tips on building and strengthening connections 

with seniors.
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Enhancing Socialization through Making Meaningful Volunteer Connections during COVID-19

June 3, 2020

Social interaction is essential for physical and mental health and well-being. The health benefits 

of human social interaction are plentiful; delaying memory loss, improving mood, stimulating 

appetite, and decreasing mortality. Aging experts have known the value of socialization for a 

long time, which is why the Older Americans Act (OAA) nutrition programs has three primary 

goals: 

• reduce hunger, food insecurity and malnutrition,

• promote socialization, and

• delay the onset of adverse health conditions

Unfortunately, social isolation and loneliness are nonetheless prevalent among older adults, 

and can lead to functional decline and death. A recent ACL funded study of older adults 

receiving nutrition services before COVID-19 revealed 1 in 5 meet key suicide predictors 

(thwarted belongingness and perceived burdesomeness), and 15.6% were at increased risk of 

suicide. Experts expect feelings or social isolations, loneliness, and potentially suicidality to be 

exacerbated by this crisis; however, the Aging Services Network (ASN) is well positioned to 

foster meaningful social interactions that help decrease social isolation and promote life with 

older adults during this trying time. 

The OAA congregate and home delivered meal programs have functioned as “more than a 

meal” for many years. These programs provide an essential means for connecting older adults 

with each other and the community, and have been found to provide many benefits. A recent 

evaluation of the OAA nutrition program found that (in comparison to non-participants) 

congregate meal participants were more satisfied with their social interactions, and less likely 

to be depressed (among other benefits).

Both the nutrition and regular connection that the OAA nutrition programs provide are now 

more important than ever since some form of social distancing interventions will be needed for 

a prolonged period due to COVID-19, which disproportionately impacts older adults. It is 

important to consider how nutrition programs can effectively promote socialization while social 

distancing. As nutrition services programs look for ways to return to a “new normal”, 

volunteers are a critical resource for helping make warm calls/connections that will help older 

adults feel supported and engaged. The ASN has been innovative in equipping big-hearted 

volunteers to promote the health and well-being of at-risk older adults in novel ways. Here are 

some tips for your volunteers (many of which you are likely already doing) to build and 

strengthen these important connections:
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1. When possible, use the same volunteers each time to increase familiarity and build 

rapport. It may take a few iterations of the check-in calls to develop sufficient trust

between the volunteer and older adult. Be patient, and persistent.

2. Use active listening. Active listening is a helpful way to demonstrate your care and 

concern. Active listening is hard work. It requires listening with your ears and with your 

heart. The older adult (or anyone for that matter) can tell when someone is really 

listening. Try to minimize distractions and make contacts when you are present and 

available.

3. Be aware of euphemisms that may indicate an older adults is feeling lonely, depressed, 

or anxious. They may not flat out say they are struggling, but instead they may allude to 

feeling "tired," "blue," or "not myself." Try to listen for these cues and gently respond 

with a clarifying question such as, "You said you're feeling tired. Is that similar to feeling 

down or depressed?"

4. Normalize experiences, such as feeling lonely, depressed, or anxious, to remove any 

perceived stigma about these feelings. You might say, "I know this is a difficult time and 

many people in your situation are feeling [lonely], [down and depressed], [jittery and 

anxious]. Do you ever feel that way?"

5. Provide empathic responses when older adults share struggles. You can simply name 

what they are feeling when you get a sense of what that is (Examples: "it's scary", "you 

miss having meals with your friends", "it's lonely", "you've got a lot on your mind", etc.).

6. Don't give advice or problem solve, listen instead! What is needed is for someone to 

take the time to listen, care, and understand. Paradoxically, they feel better when 

someone else has heard them and genuinely cares, not when advice has been given. 

7. When you think you understand the story, listen some more. It takes time and 

investment to really connect. When you have truly connected, the other person may 

share more things that are going on that are below the surface.

8. Ask open-ended questions as opposed to closed-ended questions. Open-ended 

questions are not answered with Yes-No. Instead, they elicit a dynamic response from 

the other person. Open-ended Example: "What is on your mind?", “What did you have 

for dinner?”, "Last time we talked about x, y, z, how are you doing with those?", or "Can 

you share with me a low, and a high experience since the last time we spoke?". Closedended question, such as "Do you have any needs? Are you ok?” are unlikely to elicit 

discussion.

9. Ask about their lives. People have amazing life stories, and are often eager to share. 

Ask them things like "How far back can you remember?", "Can you share a favorite 

childhood memory?", "Might you remember what it was like in elementary school?", 

"What is the most impressive thing you can remember from your teenage years?", "Are 

there meaningful life events that come to mind from middle age or older adulthood?", 

"Who were the influential people in your life?", "Can you tell me about... College (if 

attended)? Your work/career? Significant relationships? Major life events? Marriage? 

Kids?"

10. Many older people love talking about their families, prior professional lives, and happy 

memories from their past. When they start talking about these, you can always reflect

that they "love talking about their loved ones", and ask them "what else", "what 
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happened next", "what happened just before", etc. to get them to elaborate on 

something that matters to them.

11. It may be helpful to take notes either during your conversation or immediately 

afterwards. That will allow you to reference information you learned in prior 

conversations. It means a lot when you remember specifics that are important to the 

person you are talking to, e.g. remembering the name of their child or grandchild.

12. Consider preparing for the conversation. It is not necessary to have a script, but try to 

have some general conversation prompts handy in the event that older adult that isn’t

very talkative.

13. Remind the older person you’re speaking with that they are not a burden. During hard

times it is easy to believe you need more than you have to give. Note that we all need 

help at times.

14. Foster a sense of belonging by listening for meaningful relational connections in the 

older person’s life. Describe how the older person matters to others, and to you.

15. If you hear references to not wanting to live, be with them in their pain. Ask directly 

about suicide (e.g. “sometimes when there are so many problems, people start to think 

about suicide, are you thinking about suicide?”). Contrary to the myth that it is a danger, 

research shows that asking about suicide will bring relief -- they are no longer alone with 

those thoughts. You can’t take away the stressful life events, but you can hear and 

understand their suffering. The hard work is the heart work. Your sincere care and 

concern is a strong life promoter, and buffers suicide. Be sure that you understand and 

follow your organization’s protocols for seeking help when an older adult expresses 

suicidal thoughts. The National Suicide Prevention Lifeline is also available to help: 1-

800-273-8255.

16. Ask whether the client is planning to come back to congregate meal site if/when it’s 

possible again. Let them know that you are looking forward to seeing them again in 

person when it’s safe.

17. Express gratitude. There will be things you will get from the calls that you might not 

even know you needed or wanted. Thank older adults for talking with you, and for 

sharing their wisdom.

Related resources:

• Talking Points Table (see below)

• Social Isolation and Loneliness Among Older Americans during COVID-19: Evidence, 

Policy, and Advocacy (2020, National Council on Aging)

• Addressing Social Isolation for Older Adults during the COVID-19 Crisis (2020, 

ADvancing States) 

• Tools for Reaching a Remote Audience (2020, National Council on Aging) 

Contributors: Matthew Fullen, Ph.D. and Laura Shannonhouse, Ph.D., ACL Innovation in Nutrition 

Grantee (project summary at: https://acl.gov/programs/nutrition/innovations-nutrition-programs-andservices-0)
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Talking Points Table

Day/Time of Call ___________________ Older Adult Name _______________________ 

Names to keep track of....

Children

Grandchildren

Siblings

Parents

Friends

Favorite things...

Hobbies / activities

Places

Movies / Shows

Sports teams

Foods

Other...

Significant Life Events...

Career

Education

Military service
Page 5 of 5

Challenges / Stressors...

Medical Issues

Significant Losses

Thwarted belongingness

Perceived burdensomeness

Suicide risk (y/n)?

Contact nutrition services coordinator?

“Reasons for Living”...

Specific Family/Friends

Strengths and Hopes

Things to look forward to

Congregate Meal site

Returning (y/n)?
8 

Suicide Intervention 

Response Inventory (SIRI

2) with Scoring

Tool for assessing a volunteer’s ability to recognize 

appropriate responses to suicidal clients 
1 

REPLICATION GRANT

Georgia

PLEASE CUSTOMIZE 

Suicide Intervention Response Inventory (SIRI-2)

DATE: / / PROGRAM/TRACK: 

CODE NUMBER: (The code number is used to track survey and assures the confidentiality of the respondents)

What is the second letter of your first name?........................... 

What are the two digits of the year of your birth date? ........... 

What are the two digits of the day of your birth date? ............. 

What is the last letter in your last name (if female use 

maiden name) ............................................................................... 

The following items represent a series of excerpts from counseling sessions. Each excerpt begins with 

an expression by the client concerning some aspect of the situation he or she faces, followed by two 

possible helper responses to the client’s remark.

You are to rate each response in terms of how appropriate or inappropriate you feel the reply is to the 

client’s comment. In the blank, you should record a rating from –3 to +3, corresponding to the chart 

below. Be sure to respond to each item and try not to leave any blanks.

+3 Highly appropriate response

+2 Appropriate response

+1 Marginally appropriate response

0 Neither appropriate, nor inappropriate

-1 Marginally inappropriate response

-2 Inappropriate response

-3 Highly inappropriate response

1. Person at-risk: I decided to call in tonight because I really feel like I might do something to 

myself ... I’ve been thinking about suicide.

______________ Helper A: You say you’re suicidal, but what is it that’s really bothering you?

______________ Helper B: Can you tell me more about your suicidal feelings?

2. Person at-risk: And now my health is going downhill too, on top of all the rest. Without my 

husband around to care for me anymore, it just seems like the end of world.

____________ Helper A: Try not to worry so much about it. Everything will be alright.

____________ Helper B: You must feel pretty lonely and afraid of what might happen.
2 

3. Person at-risk: But my thoughts have been so terrible ... I could never tell them to 

anybody. 

______________ Helper A: You can tell me. I’m a professional and have been trained to be 

objective about these things. 

______________ Helper B: Some of your ideas seem so frightening to you, that you imagine 

other people would be shocked to know you are thinking such things. 

4. Person at-risk: No one can understand the kind of pain I’ve been through. Sometimes I just 

feel like I have to hurt myself, so I cut my wrists. 

____________ Helper A: It seems like you’ve been suffering so much that cutting your wrists is 

the only way you can make the pain go away. 

____________ Helper B: But you’re so young, you have so much to live for. How can you 

think of killing yourself? 

5. Person at-risk: What are you anyway? Are you a doctor? How do you know what I’ve been 

going through? You’ve probably had it pretty soft. 

____________ Helper A: So you’re wondering if I can understand how you feel. 

____________ Helper B: You’re not even giving me a chance. I’ve had a pretty rough life 

too; you’re not the only one who’s seen some hard time. 

6. Person at-risk: My life has been worthless ever since my wife, Emma, died four years ago. 

The kids are grown and married now, and I’ve been retired from my job at the railroad for some 

time. It just seems that I’d be better off dead. 

____________ Helper A: But try to think of what Emma would want for you. She’d want 

you to continue leading a productive life, wouldn’t she? 

____________ Helper B: It sounds like everything just collapsed around you when Emma 

died...But what has happened recently to make things even worse, to make you 

think that dying is the only way out?

7. Person at-risk: I really need help ... It’s just ... [voice breaks: silence] 

____________ Helper A: It must be hard for you to talk about what’s bothering you. 

____________ Helper B: Go on. I’m here to listen to you talk. 

8. Person at-risk: When you sum up my problem like that, it makes it seem less confusing 

and not so scary. 

____________ Helper A: See, it really isn’t so bad after all. It certainly isn’t anything you 

would think of killing yourself over, is it? 

____________ Helper B: Sometimes talking about problems does make them a bit clearer. 

I think you realize how dangerous your suicidal feelings were, that’s why you 

decided to contact me. 

9. Person at-risk: You were supposed to help me, but you’ve only made things worse. 

____________ Helper A: I’m sorry. I was only trying to help. 

____________ Helper B: You sound pretty angry. 

10. Person at-risk: How could you ever help me? Have you ever wanted to kill yourself? 

____________ Helper A: It sounds like you’re concerned about whether I can understand and 

help you. 

____________ Helper B: Sure. I’ve thought about suicide sometimes. But I always found 

more realistic solutions to my problems. 

11. Person at-risk: I don’t know ... this whole thing with my wife really gets to me. [Sobs] I try 

so hard to keep from crying ... 

___________ Helper A: Do you think that the reason it’s hard for you to cry is because 

You’re a man? 

____________ Helper B: With all the hurt you’re feeling, it must be impossible to hold 

those tears in. 
3 

12. Person at-risk: How can I believe in God anymore? No God would ever let this happen to 

me; I’ve never done anything to deserve what’s happened. 

___________ Helper A: Things have gotten so bad, that it’s difficult to see any meaning in the 

things that have happened to you. 

____________ Helper B: Well. God works in mysterious ways. Maybe this is His way of 

testing your faith. 

13. Person at-risk: I don’t know why I’m calling you. My family is financially well off, and my 

husband spends plenty of time with me, even though he has a successful law career. Even my kids 

have been doing well. They get good marks at school and have lots of free time activities with their 

friends. But nothing seems to interest me. Life is just a bore ... 

___________ Helper A: Considering all you have going for you, your problems can’t be 

all that serious. Try to focus more on the positive aspects of your situation. 

____________ Helper B: So even though things seem to be going well at one level, life 

still seems pretty depressing, even if it’s hard to say exactly why. 

14. Person at-risk: I have to hang up now. My mother’s coming home soon and I don’t want 

her to know I’ve been talking to you.

___________ Helper A: Okay, but if you keep feeling suicidal, remember you can always call 

back. 

____________ Helper B: All right, but first I want you to promise me you won’t do 

anything to hurt yourself, until you call and talk to me. Will you repeat that 

promise? 

15. Person at-risk: Is it really true, that many people feel this way? I thought I was the only one 

who had such dreadful, sinful ideas. 

___________ Helper A: No, there are many people who suffer from mental illness. But with 

appropriate treatment by a qualified physician, some of these patients can be 

cured. 

____________ Helper B: It is true. You’re not the only one who has suicidal thoughts. And you 

can be helped to get through this crisis, just as others have been. 

16. Person at-risk: I’m so lonely, so tired. [crying] There just isn’t anywhere left to turn. 

___________ Helper A: You seem so alone, so miserable. Have you been feeling suicidal? 

____________ Helper B: Come on now. Things can’t be all that bad. 

17. Person at-risk: [over telephone] It’s hard to talk here, with all these people. 

___________ Helper A: Would it help if I asked questions? 

____________ Helper B: Why don’t you call back some other time when you can talk more 

easily? 

18. Person at-risk: I have a gun pointed at my head right now, and if you don’t help me, I’m 

going to pull the trigger! 

___________ Helper A: You seem to be somewhat upset. 

____________ Helper B: I want you to put down the gun so we can talk. 

19. Person at-risk: Why should you care about me, anyway? 

___________ Helper A: I’ve been trained to care about people. That’s my job. 

____________ Helper B: Because I think your death would be a terrible waste, and it concerns 

me that things are so that you are considering suicide. You need help to get 

through this critical period. 

20. Person at-risk: I really hate my father! He’s never shown any love for me, just complete 

disregard. 

___________ Helper A: You must really be angry at him for not being there when you need 

him. 

____________ Helper B: You shouldn’t feel that way. After all, he is your father, and he 

deserves some respect. 
4 

21. Person at-risk: I don’t think there’s really anyone who cares whether I’m alive or dead. 

___________ Helper A: It sounds like you’re feeling pretty isolated. 

____________ Helper B: Why do you think that no one cares about you anymore? 

22. Person at-risk: I tried going to a therapist once before, but it didn’t help...Nothing I do now 

will change anything.

___________ Helper A: You’ve got to look on the bright side! There must be something you 

can do to make things better, isn’t there? 

____________ Helper B: Okay, so you’re feeling hopeless, like even a therapist couldn’t help 

you. But has anyone else been helpful before – maybe a friend, relative, 

teacher, or clergyman? 

23. Person at-risk: My psychiatrist tells me I have an anxiety neurosis. Do you think that’s 

what’s wrong with me? 

___________ Helper A: I’d like to know what this means to you, in this present situation. How 

do you feel about your problem? 

____________ Helper B: I’m not sure I agree with that diagnosis. Maybe you should seek out 

some psychological testing, just to be certain. 

24. Person at-risk: I can’t talk to anybody about my situation. Everyone is against me. 

___________ Helper A: That isn’t true. There are probably lots of people who care about you if 

you’d only give them a chance. 

____________ Helper B: It must be difficult to find help when it’s so hard to trust people. 

25. Person at-risk: [Voice is slurred, unclear over telephone.] 

___________ Helper A: You sound so tired. Why don’t you get some sleep and call back in the 

morning? 

____________ Helper B: Your voice sounds so sleepy. Have you taken anything? 
5 

SCORING FOR SIRI-2 

To score the revised Suicide Intervention Response Inventory (SIRI-2), simply compute the difference 

(taking into account the sign) between the respondent’s rating for a particular item and the mean rating 

assigned by the criterion group of experts, as indicated in the following table. The total score on the 

SIRI-2, therefore, represents the total discrepancy between the individual and the panelist ratings across 

all items. Item 14 proved to be psychometrically ambiguous in our validation study, and we therefore 

recommend its exclusion from the SIRI-2. Unlike the original SIRI, whose scores range from 0-25, with 

larger scores representing greater degrees of competency, scores on the revised version span a much 

larger range, and represent degrees of variation from a hypothetically ideal score. Therefore, larger 

scores represent less, not more, competence in recognizing facilitative responses to a suicidal 

individual.

Mean Ratings (and Standard Deviations) of Appropriateness of

Response Options in Items on the Suicide Intervention Response

Inventory Form 2 by Panel of Experts

1. Remember to not use question #14 

2. A lower total score indicates more competence in recognizing facilitative responses to a suicidal 

individual.

Response Option M SD Response Option M SD

1A -2.71 .49 13A -2.57 .54

1B 1.86 .38 13B 2.29 .95

2A -2.71 .49 15A -2.57 .79

2B 1.86 .69 15B 2.14 .69

3A -2.14 1.07 16A 2.14 .69

3B 2.14 .38 16B -2.86 .38

4A 1.29 1.11 17A 1.57 1.27

4B -2.71 .49 17B -1.71 .95

5A 2.43 .54 18A -2.00 1.41

5B -2.71 .49 18B 1.43 1.72

6A -2.00 1.16 19A -2.39 .76

6B 2.57 .53 19B 1.57 .54

7A 2.00 .86 20A 2.00 1.41

7B -1.29 1.70 20B -2.86 .38

8A -2.29 .49 21A 1.86 1.35

8B 2.14 .90 21B -1.57 .79

9A -1.29 1.50 22A -2.71 .49

9B 1.29 1.80 22B 1.43 1.62

10A 2.29 .76 23A 1.57 1.40

10B -2.43 .98 23B -2.57 .54

11A -2.42 .54 24A -2.43 .79

11B 2.43 .79 24B 2.14 .69

12A 2.00 .82 25A -2.57 .79

12B -3.00 .00 25B 2.43 .79

Sources:

Validation for the SIRI-2 Inventory

Scoring Methodology 1: Suicide Intervention Response Inventory

Scoring methodology 2