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

摘要 这项研究的目的是调查长期护理、后期住房过渡之间的关系 在老年人中使用基于人群的大型前瞻性自杀登记的生活和完全自杀 死亡。自杀是美国第十大死因，老年人自杀率最高 风险。预防自杀的一个关键要素是确定与潜在的人互动的“接触点” 自杀危机前的受害者。≥65岁的成年人中有40%将需要住院长期护理(LTC) 在他们一生中的某个时候，目前有150万老年人住在养老院，另有100万老年人 居住在辅助生活设施中。自杀的危险因素，如社交孤立、抑郁和功能性 精神损害，在LTC居民中很常见，因此在这些环境中自杀风险可能很大 尽管存在工作人员定期监督等不利因素。LTC中的自杀行为可能反映了 社区病例共有的因素(即抑郁症病史)以及以下因素的组合 具体到LTC，如可用性、可获得性和成本。最后，很少有研究研究是否 过渡到LTC的过程是自杀的危险因素。此项目将使用来自 国家暴力死亡报告系统(RAD-NVDRS)调查这些问题的关系 在≥50岁的成年人中，长期监禁与自杀之间的关系。RAD-NVDRS的范围从2003年到2012年，整理数据 来自18个州，包括大约40,000名老年人自杀死亡的信息。这个 数据集既包括关于被继承人个体水平特征的定量数据，也包括定性文本 描述围绕自杀的最突出情况的叙述。这一组合 定量和定性数据使RAD-NVDRS成为 与自杀有关的情况。这项研究将采用定量和定性方法来： 目标1：描述和改变10年来长期护理环境中自杀的特征和模式 社会和人口因素、健康史、受伤方式和最近的生活事件；目标2：检查 通过定性文本过渡到长期护理相关自杀的特征和背景 对大约40,000名自杀死者的案例叙述进行分析；目标3：检查地理位置 晚年自杀的可变性与国家政策有关，这些政策规范了自杀的可用性、可及性和 长期护理费用。通过将RAD-NVDRS与州LTC监管环境信息合并，我们 能够考察宏观层面的因素，并提供对LTC自杀的更普遍的理解。通过 利用详细的定性文本叙述，我们能够获得更高的知识分辨率 关于长期监禁中的自杀问题，仅依靠定量分析是不可能实现的。这个项目 体现了预防自杀的公共卫生模式，重点关注住宅和医疗保健环境，如 在以后的生活中促进心理健康的潜在“接合点”。

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.