Aged care recipients and suicide: new data from Australia

Approximately 36% of Australians over the age of 65 years access aged care services each year (Australian Government Department of Health, 2021). Over the course of their lives, two-thirds of older adults use either temporary, permanent, or home-based care services (Chomik and Townley, Reference Chomik and Townley2019). Data on suicide mortality in old people requiring assistance are very limited or virtually absent. To fill this gap, Cations et al. (Reference Cations2023) wanted to propose an exploratory study, through the analysis of a cohort of older adults who died by suicide in Australia during access or while waiting to receive assistance services, permanent residential or home care, between 2008 and 2017. The data they obtained and presented in International Psychogeriatrics provide insight into the sociodemographic and clinical characteristics of those who have died by suicide and help identify psychosocial risk factors associated with suicide at contexts of care for older individuals, as well as investigating the prevalence of their access to mental health services and the use of psychotropic drugs in the year preceding death.

The study by Cations et al. (Reference Cations2023) was conducted using the National Historical Cohort of the Registry of Senior Australians (ROSA) (Inacio et al., Reference Inacio2019), that is, a platform made up of anonymous data of older adults users receiving assistance services in Australia, which contains data in liaison with the National Aged Care Data Clearinghouse and the Australian Institute of Health and Welfare (AIHW) National Death Index (NDI), the Australian Government Medicare Benefits Schedule (MBS) and PBS (Pharmaceutical Benefits Scheme), as well as state hospital data collections (New South Wales, Victoria, South Australia and Queensland only). The study included all people aged 65 years and over who were assessed as eligible for formal aged care, home-based, or permanent residential services. The multi-professional assessments aimed at the person’s functional and cognitive impairments in order to determine as accurately as possible the level of support required by older individuals and to offer personalized services capable of guaranteeing the person’s safety and well-being. The analyses of the data used for the study were carried out considering the type of service received by the older adults at the time of death. Indeed, existing evidence suggests that suicide rates and factors influencing death by suicide differ between those living in settings where lifelong residential care is offered and those living in the community (Murphy et al., Reference Murphy, Bugeja, Pilgrim and Ibrahim2018).

Overall, Cations et al’ study found that the suicide death rate among home care and continuing residential care recipients is lower than that of the general population of older Australians (Australian Institute of Health and Welfare, 2022). This could suggest that care services for older adults have a protective function able of modulating the risk of suicide, perhaps because they are capable of providing continuous monitoring and greater safety of the person, as well as reducing access to means of suicide. In their study, Cations et al. (Reference Cations2023) positively emphasize the protective role of care services for older adults, attributing them the ability to promote the psychological well-being of the frail person and to reduce social isolation by promoting, where possible, greater autonomy of the person (Royal Commission into Aged Care Quality and Safety, 2019). Those authors have also highlighted that the growing frailty of individuals with cognitive impairment or dementia is associated with a lower probability of death by suicide among those who live in residential facilities or are waiting to receive assistance, a fact probably explained by the fact that the person’s functional and cognitive limitations may also reduce the ability to perform a suicidal act (Murphy et al., Reference Murphy, Bugeja, Pilgrim and Ibrahim2018). Another interesting result concerns the fact that within the analyzed cohort, people waiting to receive assistance died by suicide more frequently than those who were receiving it (Cations et al., Reference Cations2023). This finding confirms the results of a previous study, which highlighted that a prolonged transition to residential care was a risk factor for suicide in older adults (Mezuk et al., Reference Mezuk, Ko, Kalesnikava and Jurgens2019).

Additionally, older men were more likely to die by suicide than women. This is consistent with general population-based data that older men have the highest age-adjusted suicide rate of any group both in Australia (Australian Institute of Health and Welfare, 2022) and internationally (WHO, 2021). The research by Cations et al. (Reference Cations2023) also showed that older adults who died by suicide had greater access to mental health services in the year prior to their death than those who died from other causes. The authors take the opportunity to point out that also in Australia, government-subsidised mental health services tend to be underutilized by both healthy older adults and older care recipients, a problem that should certainly attract the attention of public health planners (Cations et al., Reference Cations2022).