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Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services

Published online by Cambridge University Press:  18 December 2020

Gary Cheung Open the ORCID record for Gary Cheung [Opens in a new window] ,
Yi Chai ,
M. Isabela Troya Open the ORCID record for M. Isabela Troya [Opens in a new window]  and
Hao Luo Open the ORCID record for Hao Luo [Opens in a new window]
Gary Cheung*
Affiliation:
Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
Yi Chai
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
M. Isabela Troya
Affiliation:
School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, University College Cork, Cork, Ireland
Hao Luo
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
*
Correspondence should be addressed to: Gary Cheung, Department of Psychological Medicine, School of Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand. Phone: +64 9 373 7599; Fax: +64 9 373 7013. Email: g.cheung@auckland.ac.nz
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Abstract

Background:

Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand.

Methods:

interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales.

Results:

A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36–181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51–5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26–4.03), at-risk alcohol use (2.38, 1.30–4.35), and bipolar disorder (2.18, 1.25–3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36–0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35–0.89).

Conclusion:

Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.

Keywords

suicidedepressionolder peopleolder adultsinterRAI
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 9: Issue Theme: Non-Medical Social Determinants of Health , September 2022 , pp. 813 - 826
Copyright
© International Psychogeriatric Association 2020

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