Objectives: To investigate the risk of suicide in nursing home residents aged 75 and above and the role of psychiatric and physical conditions.
Methods: A Swedish national register-based cohort study of nursing home residents aged ≥75 years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N=288 305). Fine and Gray regression models were used to analyse associations with suicide.
Results: The study identified 110 suicides (15.8 per 100,000 person-years). The median time spent in nursing home before suicide was 292 days (Interquartile Q1-Q3: 115 – 489) and about one half occurred within a year after moving to nursing home. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42 to 0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46 to 3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to nursing home residence (15.78, 10.01 to 24.87).
Conclusions: A lower risk of suicide in nursing home residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics, and in those with previous self-harm. Our findings suggest that more can be done to prevent suicide in this setting.
Khedidja Hedna, University of Gothenburg, Sweden
Margda Waern, University of Gothenburg, Sweden