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A new study published in the International Journal of Geriatric Psychiatry looked into use of psychoactive medications and suicide in older adults residing in long-term care facilities.

 “The study is about suicide in Swedish older adults aged 75+ residing in long-term care facilities (LTCF),” study author Khedidja Hedna told us. “We also aimed to investigate risk factors including use of psychoactive medications and psychiatric and medical conditions.”

According to previous studies, it has been shown that in the US, over 27 per cent of  long term care residents experience depressive symptoms. Almost 80 per cent of all long term care residents in the US have a cognitive impairment, and over 20 per cent of those individuals experience depressive symptoms. 

Considering the rarity of research on suicide in LTCF, this study may be considered to be exploratory, and as a result, researchers did not have a hypothesis on results. They considered older adults residing in LTCF are different than those residing in their homes and therefore results found in the general 75+ population should not be extrapolated to that setting.

“We chose this study topic because of the lack of research on suicide in this geriatric setting,” Hedna told us. “Older adults residing in LTCF who often suffer from both mental morbidities and stressful life transitions, previously found to contribute to an increased risk of late-life suicide. Therefore, a better understanding on how these factors are associated with suicide is needed in order to inform the policy makers and staff personal to implement suicide preventive strategies.”

Researchers identified older adults aged 75+ who were residing in LTCF from the National Register of Care and Social Services for Older Adults, held by the National Board of health and welfare. Participants were followed over a year period or until death if it occurred during the follow-up time. Their data was linked with multiple registers using the Swedish Unique Identity numbers with multiple national registers to investigate the factors associated with suicide.

“We found an increased risk of suicide in those taking medications for sleeping problems while the risk was lower in those taking antidepressants,” Hedna told us. “The most contributing risk factor was a previous episode of self-harm either before or during residence in the LTCF. We also found that half of suicides occurred in the first year of residence in the LTCF.”

The lower risk of suicide in users of antidepressants was not surprising to researchers but differed from what is reported in the general 75+ population. This could be potentially due to the indication of use of antidepressants in this setting. However, more research is needed to further elucidate this finding.

“Our results indicate that more can be done to improve the mental health of older adults residing in LTCF, including a need to know about their background prior entering the LTCF and to review and monitor those using medications for sleeping problems,” Hedna told us. “Future studies need to address the effect of the organization of LTCF and staff knowledge about mental health and attitude in the occurrence of suicide. We are now planning a study of attitudes to late life mental illness and suicidal behavior among LTCF staff, which will provide the basis for an intervention project.”