Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China.
J Am Med Dir Assoc. 2021 Oct;22(10):2160-2168.e18. doi: 10.1016/j.jamda.2020.12.022. Epub 2021 Jan 15.
This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC).
Retrospective cohort study.
The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included.
Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models.
Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant.
There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.
本研究旨在调查加拿大长期护理（LTC）机构中老年人自我伤害的发生率及相关因素。
回顾性队列研究。
使用居民评估工具-最低数据集（RAI-MDS）和居民评估工具-家庭护理（RAI-HC）收集 LTC 数据，并与出院摘要数据库（DAD）链接，以获取自我伤害诊断的医院记录。2003 年 4 月 1 日至 2015 年 3 月 31 日，首次评估时年龄为 60 岁以上的成年人被纳入研究。
使用 Fine & Gray 竞争风险模型计算与潜在相关因素（包括人口统计学、临床和心理社会特征）相关的自我伤害的调整后的风险比（HR）。
共收集了 465870 名长期护理设施（LTCF）和 773855 名接受家庭护理（HC）的人的记录。每 100000 人年的自我伤害发生率为 LTCF 为 20.76（95%置信区间[CI]：20.31-25.40），HC 为 46.64（44.24-49.12）。在 LTCF 中，最强的风险因素是年龄较小（60-74 岁与 90+岁：HR，6.00；95%CI，3.24-11.12）、精神障碍（双相障碍：3.46；2.32-5.16；精神分裂症：2.31；1.47-3.62；抑郁症：2.29；1.80-2.92）、每日严重疼痛（2.01；1.30-3.11）和每日吸烟（1.78；1.29-2.45）。对于接受 HC 的人，最强的风险因素是年龄较小（60-74 岁与 90+岁：2.54；1.97-3.28）、精神障碍（2.20；1.93-2.50）、每日吸烟（2.08；1.81-2.39）和频繁跌倒（1.98；1.46-2.68）。所有设置和因素之间的模型交互作用均具有统计学意义。
LTCF 居民的自我伤害入院率低于 HC 接受者。我们发现，与一些可修改的风险因素相关的自我伤害存在相当大的风险，其中一些可以通过更好的治疗和护理（精神障碍和疼痛）来直接解决，而其他风险则需要通过更复杂的干预措施来解决，这些干预措施针对的是潜在的因素和原因（烟草和跌倒）。这些发现强调需要针对特定环境和风险制定预防策略，以解决老年人群中的自我伤害问题。
