A public health approach to understanding suicide in long-term care

点击翻译按钮获取中文摘要

Summary The goal of this research is to investigate the relationship between long-term care, housing transitions in later life, and completed suicide among older adults using a large, prospective, population-based registry of suicide deaths. Suicide is the 10th leading cause of death in the US, and older adults have among the highest suicide risk. A key element of suicide prevention is the identification of “points of engagement” to interact with potential victims prior to suicide crisis. Forty percent of adults aged ≥65 will need residential long-term care (LTC) at some point in their lifetime, and currently 1.5 million older adults reside in nursing homes and another 1 million reside in assisted living facilities. Risk factors for suicide, such as social isolation, depression, and functional impairment, are common among LTC residents, and thus suicide risk may be substantial in these settings despite countervailing factors such as regular monitoring by staff. Suicidal behavior in LTC likely reflects a combination of factors shared with community cases (i.e., history of depression) as well as factors that are specific to LTC such as availability, accessibility, and cost. Finally, few studies have examined whether the process of transitioning to LTC is a risk factor for suicide. This project will use Restricted-Access Data from the National Violent Death Reporting System (RAD-NVDRS) to investigate these questions about the relationship between LTC and suicide among adults aged ≥50. The RAD-NVDRS spans from 2003 to 2012, collates data from 18 states, and includes information on approximately 40,000 suicide deaths among older adults. The dataset includes both quantitative data on individual-level characteristics of decedents and qualitative text narratives that describe the most salient circumstances surrounding the suicide. This combination of quantitative and qualitative data makes the RAD-NVDRS the most comprehensive registry on the circumstances related to suicide. This study will employ both quantitative and qualitative methodologies to: Aim 1: Characterize and model change suicide in long-term care settings over a 10-year period in terms of social and demographic factors, health history, means of injury, and recent life events; Aim 2: Examine the characteristics and contexts of suicide related to transitioning into long-term care through qualitative text analysis of approximately 40,000 suicide decedent case narratives; and Aim 3: Examine whether geographic variability in suicide in later life is associated with state policies that regulate the availability, accessibility, and cost of long-term care. By merging the RAD-NVDRS with information on state LTC regulatory environments we are able to examine macro-level factors and provide a more generalizable understanding of suicide in LTC. By leveraging the detailed qualitative text narratives we are we are able to gain a higher resolution of knowledge regarding suicide in LTC than could be achieved from relying on quantitative analysis alone. This project embodies the public health model of suicide prevention by focusing on residential and healthcare settings as potential “points of engagement” for promoting mental health in later life.