A new study of seniors in long-term care facilities in Italy found that seniors in assisted living and skilled nursing facilities are more likely to commit suicide than their community-dwelling counterparts.

The survey of Italian seniors living in long-term care facilities revealed that the suicide rate was nearly 19 per 100,000 people. The average rate for seniors over the age of 65 is 14 per 100,000 people, according to researchers from the University of Rochester in New York. Risk factors for suicide include depression, anxiety, and feelings of isolation or loss.

Millions of seniors in the U.S. live in assisted living or skilled nursing facilities. These institutions can help by screening for depression upon admission, monitoring a new resident’s adjustment to the facility, and helping to control any pain the resident experiences, according to researchers.