Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand.
Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Int Psychogeriatr. 2022 Sep;34(9):813-826. doi: 10.1017/S1041610220003853. Epub 2020 Dec 18.
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.
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.
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).
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.
由于身体疾病和功能障碍等已知风险因素，接受支持服务的老年人存在自我伤害的风险。本研究旨在调查新西兰接受支持服务评估的老年人非致命性自我伤害的预测因素的相对重要性。
对年龄≥60 岁的老年人的 interRAI-Home Care (HC) 全国数据与 2012 年 1 月 1 日至 2016 年 12 月 31 日期间的死亡率和出院数据进行了链接。我们计算了每 10 万人年的自我伤害粗发生率，以及性别和年龄调整后的标准化发病率比（SIR）。使用 Fine 和 Gray 竞争风险回归模型来估计与各种人口统计学、心理社会、临床因素和综合量表相关的自我伤害风险的危害比（HR；95%CI）。
共纳入 93501 名老年人。在随访期末，有 251 人（0.27%）至少发生过一次非致命性自我伤害，36333 人（38.86%）死亡。非致命性自我伤害的总发生率为 160.39（95%CI，141.36-181.06）/100000 人年，SIR 为 5.12（95%CI，4.51-5.78），随访第一年的发生率最高。诊断为抑郁症（HR，3.02，2.26-4.03）、有风险的饮酒（2.38，1.30-4.35）和双相情感障碍（2.18，1.25-3.80）是最显著的风险因素。癌症（0.57，0.36-0.89）和日常生活活动（ADL）等级量表（0.56，0.35-0.89）测量的严重功能障碍水平具有保护作用。
精神因素是接受支持服务的老年人非致命性自我伤害的最显著预测因素。我们的研究结果可以为医疗保健专业人员提供信息，以便及时识别有自我伤害高风险的人群，并制定更有效和有针对性的预防策略，特别关注在随访的第一年中患有抑郁症或抑郁症状的人群。
