Suicide in Long-term Care Facilities—The Exception or the Norm?

Barak, Yoram; Gale, Christopher

doi:10.1001/jamanetworkopen.2019.5634

Cited by 6 publications

(7 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients discharged to these long term care facilities might have reduced function and cognitive impairment, with reduced capacity, which could also account for the lower incidence of suicide and self-harm. 38 While the overall magnitude of risk of suicide among ICU survivors (compared with non-ICU hospital survivors) does not appear to be substantial, it might have important implications at the population level. Firstly, determination of post-discharge suicide risk among patients admitted to hospital is complex, 17 and thus further identification of possible prognostic factors has value.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

“…values are numbers (%) unless stated otherwise health diagnoses was also found among patients who died by suicide or had self-harm events.We further evaluated prognostic factors associated with suicide, self-harm, or the composite outcome among ICU survivors (table3). Previous mental health diagnoses were strongly associated with increased prognosis for either suicide or self-harm, including depression or anxiety (hazard ratio 5.69, 95% confidence interval 5 38. to 6.02), PTSD (1.87, 1.64 to 2.13), schizophrenia (1.39, 1.28 to 1.52) and bipolar disorder (2.38, 2.20 to 2.58).…”

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confidence: 99%

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Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design Population based cohort study using linked and validated provincial databases. Setting Ontario, Canada between January 2009 and December 2017 (inclusive). Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

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confidence: 99%

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Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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“…70 Furthermore, in a systematic review on residents in long-term care facilities, suicide was found to be associated with social isolation, depression, and functional impairment. 71 Similarly, abuse in the RACF population has been linked to medical illness, mental health issues, and personality disorders. 72 RACF residents with advanced dementia, urinary catheter usage, low body mass index, and anemia are also more prone to pressure ulcers.…”

Section: Discussionmentioning

confidence: 99%

<p>Using the Delphi Method to Identify Risk Factors Contributing to Adverse Events in Residential Aged Care Facilities</p>

Shi

Zhang

et al. 2020

RMHP

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/yyCI1tbp6vkPurpose: This study aimed to identify risk factors associated with adverse events in residential aged care facilities in China.Patients and Methods: After compiling a list of risk factors for adverse events generated from in-depth interviews with managers of residential aged care facilities, a three-round Delphi method was used to reach consensus. The synthesized risk factors were presented on a Likert scale to the expert panelists three times to validate their responses.Results: The list identified 67 items as risk factors for adverse events, attached to four firstlevel indexes (ie, environmental facility, nursing staff, older adults' characteristics, and management factors). The experts' authority coefficient was 0.87. The positive coefficients were 82.76%, 91.67%, and 100%, and the coordination coefficients were 0.154, 0.297, and 0.313 in the first, second, and third rounds, respectively. Conclusion: Using a Delphi method, this study established a consensus on risk factors contributing to adverse events and developed a risk assessment grade for use in future aged care practice and research. The resulting list is useful in prioritizing risk-reduction activities and assessing intervention or education strategies for preventing adverse events in residential aged care facilities. Impact: This study fills the gap in risk identification in the Chinese residential aged care system to ensure provision of best-practice care to this vulnerable population. Nursing staff and management factors at the top of the list are not only the most common causes of adverse events but also the core elements in creating a secure and error-free environment. This list was intended to support predictive and prevention-oriented decision-making by managers and nursing supervisors to reduce preventable adverse events.

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“…[7][8][9] High prevalence of these manifestations and great variability in BH services across NHs are of significant concern among providers and policymakers. 10,11 Empirical evidence demonstrating how BH service availability may impact presentations of these manifestations among residents is lacking. Several prior studies, however, have found associations between presentation of BH manifestations and facility-level factors.…”

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confidence: 99%

Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

Orth

Simning

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES: Despite high prevalence of behavioral health (BH) manifestations among nursing home (NH) residents, availability of BH services in this care setting is often inadequate. Our objective was to examine associations between availability of BH services and the presence of severe depression, suicidal ideation (SI), and severe aggressive behaviors (ABs) among NH residents. DESIGN: Cross-sectional. SETTING/PARTICIPANTS: This study used 2017 survey data about BH service availability obtained from 1,051 NHs. The Minimum Data Set (MDS) was used to identify long-stay residents in these facilities (N = 101,238) and the prevalence of BH manifestations. Descriptive statistics and multivariable logistic regressions were used. MEASUREMENTS: We constructed measures of three severe BH manifestations based on the MDS: presence of depression, SI, and ABs. Three independent measures of service availability based on survey items asked about degrees of inadequate (1) staff BH education, (2) coordination/collaboration between facility/community providers, and (3) facility infrastructure (ie, ability to make referrals/transport residents to services). RESULTS: Odds of severe depression were 21% higher (odds ratio [OR] = 1.21; P < .001) when NHs reported inadequate BH staff education. Residents with SI had 13% higher odds (OR = 1.13; P = .027) of living in NHs that reported inadequate coordination between facility and community providers. Severe ABs were 10% more likely among residents in NHs reporting inadequate facility infrastructure (OR = 1.10; P = .002) and 7% more likely in facilities with self-reported inadequate coordination between facility/community providers (OR = 1.07; P = .019). Several facilitylevel factors (eg, staffing, training, turnover) were also statistically significantly associated with these severe BH manifestations. CONCLUSION: Residents in NHs reporting inadequate BH services were more likely to experience adverse severe BH manifestations even after controlling for individual and facility-level risk factors. Higher nurse staffing and more staff psychiatric training were associated with lower prevalence of severe BH manifestations. Policy changes and modifications to Medicaid NH reimbursements may be warranted to better incentivize NHs to improve provision of BH services.

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Suicide in Long-term Care Facilities—The Exception or the Norm?

Cited by 6 publications

References 9 publications

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Suicide and self-harm in adult survivors of critical illness: population based cohort study

<p>Using the Delphi Method to Identify Risk Factors Contributing to Adverse Events in Residential Aged Care Facilities</p>

Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

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