Suicide among Older Adults with Dementia: Effects of Korea’s Long-Term Care Insurance System

Abstract

South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a “dementia special grade” in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the “Older Adults Cohort DB” of the National Health Insurance Service. We conducted Kaplan–Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183–0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061–4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.

How Residing in a Long-Term Care Facility Affects Suicidal Risk in Patients With Dementia: A Systematic Review

“…Six studies examined the risk of suicide in nursing home residents [2,3,16,17,20,21]. Among these studies, four articles carefully examined the relationship between dementia and suicide, and all confirmed the hypothesis that staying in LTCs reduces the risk of suicide in patients with dementia [2,3,16,17].…”

“…Six studies examined the risk of suicide in nursing home residents [2,3,16,17,20,21]. Among these studies, four articles carefully examined the relationship between dementia and suicide, and all confirmed the hypothesis that staying in LTCs reduces the risk of suicide in patients with dementia [2,3,16,17]. The reason could be facilitated contact with peers, more excellent monitoring of daily activities, more contact with health and mental health professionals, and presumably less access to lethal means of suicide in LTCs [26].…”

“…Sungje Moon and colleagues 2021, mentioned that the suicide risk of 62,282 older adults with dementia and using long-term care in South Korea was about 0.256-times lower than those who did not use it, whereas it increased after the expansion of the dementia grading [2].…”

“…Few studies endorsed that the group of patients with more severe cognitive and/or physical limitations who would thus have more difficulty preparing and executing a suicide plan have a lower risk of suicide [2,3,23].…”

“…In all types of dementia, people will experience problems and cognitive functioning and are likely to experience behavioral and psychological symptoms of dementia [1]. The number of patients with dementia worldwide is expected to increase from about 50 million today to 152 million in 2050 [2].…”