Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information.

OBJECTIVES: Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. METHODS: This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. RESULTS: The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = <0.001). Over half of the residents who died from suicide had a diagnosis of depression (n = 93, 66.0%) and had resided in the nursing home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). CONCLUSIONS: This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base.

Completed suicide among nursing home residents: a systematic review.

OBJECTIVE: The aim of this study is to systematically review published research describing the frequency, nature, and contributing factors of completed suicides among nursing home residents. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed literature published in English between 1 January 1949 and 31 December 2013 describing completed suicides among nursing home residents. Information extracted for analysis included: study and population characteristics, method of suicide, potential risk factors, and interventions. RESULTS: Eight studies were identified; the majority (n = 5) conducted in the United States of America. There were 113 suicides in nursing homes reported in the literature, 101 with detailed information available for aggregate analysis. The majority were male (n = 62, 61.4%), aged between 61 and 93 years. Suicide was most commonly by hanging (n = 27, 38.0%) or falling from a height (n = 27, 38.0%). Risk factors were considered in a proportion of studies. Depression was examined in 27 cases and present in 18 (67%). Duration of residence was examined in 25 cases, 13 (52%) of which had resided in the nursing home less than 12 months. Physical health was examined in 22 cases, 11 (50%) of whom were experiencing physical decline. Prior suicidal behaviour, cognitive function, and personal loss were also examined. Organizational risk factors and intervention strategies were rarely considered. CONCLUSIONS: There is a paucity of research describing completed suicide among nursing home residents. More large-scale research is required using standardized methods for reporting information to better understand and prevent completed suicides in this setting.

Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review.

BACKGROUND: resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. OBJECTIVE: the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. METHODS: in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). RESULTS: eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. CONCLUSIONS: we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.

Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia.

OBJECTIVES: To describe the nature and extent of external-cause deaths of residents of nursing homes in Victoria, Australia. DESIGN: A retrospective cohort study of all decedents using routinely collected data contained within the National Coronial Information System. SETTING: Accredited nursing homes in Victoria. PARTICIPANTS: Nursing home residents who had died from external causes and whose deaths were reported to the Coroners Court between July 1, 2000, and December 31, 2012. MEASUREMENTS: Basic descriptive analysis was conducted to measure frequencies and proportion of exposures within each outcome group, and rates were calculated using population data. RESULTS: One thousand two hundred ninety-six external cause deaths of nursing home residents were identified. Deaths were due to falls (n=1,155, 89.1%), choking (n=89, 6.9%), suicide (n=17, 1.3%), complications of clinical care (n=8, 0.6%) and resident-on-resident assault (n=7, 0.5%). Deaths occurred more frequently in women (n=814, 62.8%), in keeping with the sex distribution in nursing homes, and residents aged 85 and older (n=923, 71.2%). The number of inquests held to investigate a death as a matter of public interest was small (n=24, 1.9%). CONCLUSION: A significant proportion of nursing home resident deaths are from external causes and are potentially preventable. A shift in community attitudes is required toward an understanding that premature death of a resident from injury is not a natural part of life.