Briony Jain, Research Fellow in Social Care and Social Policy, Middlesex University London

Cutting edge research from Australia may help to understand and prevent suicidal behaviour among care home residents in the UK

Older adults living in care are one of society’s most vulnerable populations. They are often living with comorbid physical and mental health issues; isolated from friends and family; and dependent on others for carrying out their Activities of Daily Living. In addition, older adults aged 65 and over have one of the highest suicide rates in many countries around the world (http://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf?sequence=1). Most people don’t like to think about how nursing home residents die and most probably assume they simply die of ‘old age’ or natural causes. However, recent research from Australia has uncovered that many nursing home residents in fact die from external causes such as falls, choking and suicide, which are considered premature and potentially preventable (https://www.mja.com.au/journal/2017/206/10/premature-deaths-nursing-home-residents-epidemiological-analysis).

My name is Briony Jain and I am a mixed-methods public health and injury prevention researcher, specialising in the collection and use of health and mortality data to improve quality of life and social outcomes for older adults. I am currently employed as a Research Fellow in Social Care and Social Policy with the Department of Mental Health and Social Work at Middlesex University. Prior to this I was living and working in Melbourne, Australia where I completed my PhD with the Department of Forensic Medicine at Monash University from 2014 to 2017. My PhD research examined the epidemiology and prevention of intentional deaths from suicide and resident-to-resident aggression among nursing home residents in Australia. This work primarily involved me travelling to each State and Territory Coroner’s Office in Australia to review and collect information from the original files compiled by Coroners during their investigation into the deaths of nursing home residents who had died from suicide and assault between 2000 and 2013.

My research investigating deaths from suicide among nursing home residents in Australia through examination of coroners’ reports was recently published in the International Journal of Geriatric Psychiatry (https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4862). As this research was the first of its kind in Australia and one of the largest studies in the world to examine this issue (https://onlinelibrary.wiley.com/doi/pdf/10.1002/gps.4299), the research received national media interest, and over 35,000 reads of my summary article in The Conversation (http://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112).

The study found 141 nursing home residents had died by suicide in Australia over a 13-year period from 2000 to 2013. The majority of residents who died from suicide were male (n=97, 68.8%); 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%). Major life stressors identified in suicide cases included: health deterioration (n=112, 79.4%); isolation and loneliness (n=60, 42.6%); and maladjustment to nursing home life (n=42, 29.8%). The most common methods of suicide were found to be hanging (n=45, 31.9%), fall from height (n=24, 17.0%), and plastic bag asphyxia (n=20, 14.2%).

Recommendations for prevention of suicide among nursing home residents were also explored in the PhD research. These were developed in consultation with key experts and stakeholders and have since been published in a book of over 100 recommendations for prevention of premature deaths and improved care in Australia’s nursing homes (http://vifmcommuniques.org/wp-content/uploads/2017/12/Recommendations-for-Prevention-of-Injury.pdf). The top three recommendations for suicide included: (1) expanding state and national suicide prevention frameworks to include older adults and those residing in institutional settings as priority groups; (2) aligning nursing home life with community living to make nursing homes a place where most people would be happy to live; and (3) improving residents’ access to mental health services.

This research not only has implications for policy and practice in Australia, but could have implications for countries with similar healthcare systems and care home settings around the world, including the UK. Following on from this research, and in collaboration with my colleagues at Middlesex University, I am now interested in determining the prevalence of suicidal behavior among older adults in care and nursing homes in the UK; developing, testing, and implementing appropriate interventions; and working on other initiatives aimed at improving the overall quality of care and quality of life for older adults living in care.

Following an exploratory study in South East England last year led by Middlesex University, we have begun to think more about what we can learn in the UK context on self-harm and suicide behaviours in UK Care homes specifically and our recent review of interventions has found that there is scope to be more creative in prevention and support of those involved.

We are looking for partners to guide and/or participate in research addressing suicidal behavior among older adults in care settings. If you are interested in learning more or would like a copy of any publications on the above issues, please contact myself (b.jain@mdx.ac.uk) or Prof Trish Hafford-Letchfield (p.hafford-letchfield@mdx.ac.uk) whose staff profile is available for viewing at the below address.
http://eprints.mdx.ac.uk/view/creators/Hafford-Letchfield=3ATrish=3A=3A.html