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

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.

Longitudinal big data needs to meet the individual to inform self-harm and suicide prevention in older adults

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Longitudinal big data needs to meet the individual to inform self-harm and suicide prevention in older adultsA well-established close relationship exists between self-harm and suicide in older adults, yet the detailed longitudinal outcome data needed to guide pathways for identification of at-risk individuals and intervention are lacking. The big data study of Cheung and colleagues extends our knowledge of self-harm in older adults by moving beyond simply identifying risk factors for self-harm crosssectionally, to ranking their relative importance, and longitudinally examining the incidence of self-harm in a large community-dwelling cohort (Cheung et al, 2020). This brings us a step closer to understanding factors contributing to self-harm in older people.

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“…The New Zealand-based retrospective cohort study of Cheung and colleagues utilized data from over 93,000 community-dwelling older adults (aged 60 + ) who had a comprehensive geriatric assessment using interRAI-Home Care (HC) over a 5-year period (Cheung et al, 2020). The interRAI-HC assessment is required for all older adults who want to access public home-based care services or placement in long-term residential aged care facilities.…”

“…Thus their study population was a group of older adults needing support services and likely to have physical illness and disability; known risk factors for self-harm and suicide (Fassberg et al, 2016) and therefore most relevant for selective prevention. Importantly, all self-harm was captured, regardless of intent, which they rightly highlight may be difficult to determine (Cheung et al, 2020). The 24 people who died by suicide were excluded from the study, including two individuals who had selfharmed in the study period.…”

“…This may be considered a limitation of the study if our fundamental interest in self-harm is about intervening to prevent suicide. Over the 5-year period, 251 people (0.27%) had selfharmed at least once (Cheung et al, 2020). The incidence of non-fatal self-harm was 160.39/ 100,000 person years, highest in the first year of follow-up and the "young" old (age 60-79); with a standardized incidence ratio of 5.12.…”

“…The hierarchy of risk factors for non-fatal selfharm identified through multivariate analysis were depression (hazard ratio [HR] = 3.02), at-risk alcohol use (HR = 2.38), and bipolar disorder (HR = 2.18) (Cheung et al, 2020). Significant effects were also reported for demographic factors such as younger age and being separated/divorced, and clinical features such as fair/poor self-rated health, daily tobacco smoking, and moderate to severe depressive symptoms.…”