Elder suicide risk persists in long-term care

By Joene Hendry

NEW YORK (Reuters Health) - Suicide has not declined among elderly people living in long-term care facilities as it has among community-living elders, research hints.

In a review of the 1,771 suicide deaths between 1990 and 2005 among New York City residents aged 60 and older, researchers found a significant decrease in the relative rate of suicide in community-dwelling adults, but no change among elders living in long-term care facilities.

Elders 60 to 69 years old accounted for about 42 percent, while approximately 31 and 27 percent, respectively, occurred among individuals aged 70 to 79 years and 80 years and older. Most of the suicides, roughly 70 percent, occurred among men.

"The individual characteristics associated with suicide in the community -- male gender and older age -- were also associated with suicide in long-term care," Dr. Briana Mezuk, from the University of Michigan in Ann Arbor, who was involved in the research, told Reuters Health.

A total of 1,724 suicides were among elders living freely in the community, 30 percent were due to long falls, 29 percent to hangings, and 16 percent were the result of firearms.

By contrast, of the 47 suicides among elders in long-term care facilities, 51 percent were from long falls and 36 percent were due to hangings. None involved firearms, likely due to the restrictive long-term care environments, the investigators surmise.

According to Mezuk, "suicide prevention strategies aimed at older adults living in the community are either not reaching or are not effective at reducing suicide risk in long-term care settings."

"Factors that predict admission to long-term care facilities and nursing homes, such as social isolation, depression, functional limitations, and cognitive impairment, are also associated with suicide," she added. Therefore, it crucial to proactively address these factors for the increasing numbers of older adults who utilize these facilities.

Mezuk's group calls for additional research into suicide risk among elders residing in long-term care and assisted-living facilities across the U.S., not only to classify likely existing regional risk variations, but also to identify effective preventive interventions.

SOURCE: Journal of the American Geriatrics Society, November 2008