Care service use in 2 years preceding suicide among older adults: comparison with those who died a natural death and those who lived longer
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The aim of the study is (1) to describe and analyse health and social service use and medicine purchases in the last 2 years of life among older adults who died by suicide and (2) to compare use and purchases between three groups: those who died by suicide, died a natural death or who lived longer. Nation-wide Finnish register data were used. The data consist of 316,639 decedents who died at the age of 70 years or older in 1998–2008 and 222,967 people who lived longer. Use of hospital, long-term care and home care, and the purchase of prescribed psychotropic medications were studied for the 2-year period. Binary logistic regression analyses were applied. 1118 older adults died by suicide (0.4 % of all deaths). A majority of older adults who died by suicide had multiple somatic diseases and mental disorders, especially depression, and had contact with health and social services in the last 2 years of life. At the same level of morbidity, use of hospital and long-term care was less common among those who died by suicide than among those who died of natural causes, but more common than among those who lived longer. Those who died by suicide received less home care than those who lived longer. A high proportion of suicides occurred in the first month following hospital discharge. Health and social services should improve support for older adults with chronic diseases and depression.
KeywordsSuicide Health and social service use Psychotropic drugs Last years of life Depression Finland
The authors thank Professor Sami Pirkola for his valuable comments on the manuscript. This work was supported by Academy of Finland (250602 to MJ and 276189 to LF).
This study was funded by Academy of Finland (Grant Number 250602 to MJ and 276189 to LF).
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- Andersen UA, Andersen M, Rosholm JU, Gram LF (2000) Contacts to the health care system prior to suicide: a comprehensive analysis using registers for general and psychiatric hospital admissions, contacts to general practitioners and practising specialists and drug prescriptions. Acta Psychiatr Scand 102:126–134. doi: 10.1034/j.1600-0447.2000.102002126.x CrossRefGoogle Scholar
- Erlangsen A, Nordentoft M, Conwell Y, Waern M, De Leo D, Lindner R, Oyama H, Sakashita T, Andersen-Ranberg K, Quinnett P, Draper B, Lapierre S, International Research Group on Suicide Among the Elderly (2011) Key considerations for preventing suicide in older adults: consensus opinions of an expert panel. Crisis 32:106–109. doi: 10.1027/0227-5910/a000053 CrossRefGoogle Scholar
- Forma L (2011) Health and social service use among older people - the last two years of life (Acta Universitatis Tamperensis 1673). Tampere University Press, Tampere. http://tampub.uta.fi/bitstream/handle/10024/66837/978-951-44-8616-6.pdf?sequence=1
- Järventie I (1993) Social psychological and social psychiatric viewpoint to suicides. [Selviytyä hengiltä: Sosiaalipsykologinen ja sosiaalipsykiatrinen näkökulma itsemurhiin.]. National Research and Development Centre for Welfare and Health Research, Helsinki 34/1993Google Scholar
- Joiner T (2005) Why people die by suicide. Harvard University Press, CampbridgeGoogle Scholar
- Keskimäki I, Aro S (1991) Accuracy of data on diagnoses, procedures and accidents in the Finnish hospital discharge register. Int J Health Sci 2:15–21Google Scholar
- Klaukka T (2004) Using registers on medicines. Lecture at University of Tampere, TampereGoogle Scholar
- Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, Gallo J, Szanto K, Conwell Y, Draper B, Quinnett P, International Research Group for Suicide among the Elderly (2011) A systematic review of elderly suicide prevention programs. Crisis 32:88–98. doi: 10.1027/0227-5910/a000076 CrossRefGoogle Scholar
- Lubitz J, Prihoda R (1984) The use and costs of medicare services in the last 2 years of life. Health Care Financ Rev 5:117–131Google Scholar
- Martikainen P, Murphy M, Metsä-Simola N, Häkkinen U, Moustgaard H (2012) Seven-year hospital and nursing home care use according to age and proximity to death: variations by cause of death and socio-demographic position. J Epidemiol Community Health 66:1152–1158. doi: 10.1136/jech-2011-200756 CrossRefGoogle Scholar
- Official Statistics of Finland (OSF) (2009) Families. Living alone is more common among women than men. [Perheet. Naiset asuvat miehiä useammin yksin.] Statistics FinlandGoogle Scholar
- Paraschakis A, Douzenis A, Michopoulos I, Christodoulou C, Vassilopoulou K, Koutsaftis F, Lykouras L (2012) Late onset suicide: distinction between “young-old” vs. “old-old” suicide victims. How different populations are they? Arch Gerontol Geriatr 54:136–139. doi: 10.1016/j.archger.2011.02.011 CrossRefGoogle Scholar
- Sund R (2003) Utilisation of administrative registers using scientific knowledge discovery. Intell Data Anal 7:501–519Google Scholar