Suicide-Related Behaviour in Later Life: Examining Risk and Protective Factors among Older Adults Receiving Home Care Services in Ontario, Canada
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Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.