Deaths by suicide and drug and alcohol use in aged care users
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Key findings Death by suicide in aged care users Alcohol and other drug related deaths Notes on data qualitySensitive content warning
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Key findings
- The average yearly age-standardised suicide rate among people aged 65 years and over receiving a home care package from 1 July 2017 to 30 June 2022 was 21.5 per 100,000 users.
- The average yearly age-standardised suicide rate among people aged 65 years and over living in permanent residential aged care 1 July 2017 to 30 June 2022 was 13.0 per 100,000 users.
- This compares to an average yearly rate of 12.9 deaths per 100,000 people in Australia aged 65 years and over that died by suicide during the same time period.
- Most aged care users that died by suicide were men.
- Suicide deaths among aged care users became less common with age. This is different to the general population of older adults, in which the rate of suicide increases with increasing age. This is due to differences in the underlying distribution of people using aged care compared to the general population of older adults. People using aged care are older than the general population of older adults, with most aged 80–89 years. In contrast, the size of the general population gets smaller with increasing age over 65 years.
- Most people using a home care package that died by suicide were living alone at the time of their death.
Death by suicide in aged care users
Suicide deaths were examined for all people aged 65 years and over who used a home care package or lived in permanent residential aged care before or at the time of their death in 2017–18 to 2021–22. Deaths that occurred in people using aged care aged under 65 years are not reported here due to small numbers.
Home care packages
Out of 371,864 people aged 65 years and over who were receiving a home care package from 2017–18 to 2021–22, 135 had died by suicide by 30 June 2022. The average yearly crude suicide rate in this group was 15.0 per 100,000 users. Additionally, the average yearly age-standardised suicide rate, which adjusts for differences in age among the population, among these people was 21.5 suicides per 100,000 users.
Permanent residential aged care
Out of 475,060 people aged 65 years and over living in residential aged care from 2017–18 to 2021–22, 75 died by suicide by 30 June 2022. The average yearly crude suicide rate in this group was 6.3 per 100,000 users. The average yearly age-standardised suicide rate, which adjusts for differences in age among the population, among these people was 13.0 suicides per 100,000 users.
Figure 13: Age-standardised rate (per 100,000) of suicide deaths among people aged 65 years and over using aged care services, 2017–18 to 2021–22
In those receiving a home care package, the age-standardised rate of suicide deaths remained stable over time at around 22 suicides per 100,000 users. For those living in permanent residential aged care, the age-standardised rate declined from 11 suicides per 100,000 users in 2017-18 to 4 suicides per 100,000 users in 2018-19 and rose steadily over time to 21 suicides per 100,000 users in 2021-22.
Most suicide deaths in aged care users occurred in men. Suicide deaths became less common with increasing age (Figure 14).
This pattern is different to the pattern of suicide deaths in the general population of Australians aged 65 years and over, in which the rate of suicide increases with increasing age (see Suicide & self-harm monitoring – Deaths by suicide over time). This is because of differences in the distribution of the population of people using aged care, compared to the general population of older adults. People using aged care are older than the general population of older people, with most aged 80–89 years at the time of entry to care. In contrast, in the general population the number of people decreases with increasing age.
Figure 14: Age-and-sex-specific crude rate (per 100,000) of suicide deaths among people aged 65 years and over using aged care services, 2017–18 to 2021–22
For women receiving a home care package, the highest crude rate was in the 65-69 age group with 41 suicides per 100,000 users, with rates declining dramatically in the older age groups. For men receiving a home care package, the highest crude rate was also in in the 65-69 age group with 32 suicides per 100,000 users, with rates declining gradually in the older age groups. A similar pattern was observed in both women and men living in permanent residential aged care although rates were lower in each age group compared to those using home care.
Among aged care users aged 65 years and over who died by suicide, most were living alone and about two-thirds were unpartnered at the time of their assessment (Figure 15).
Figure 15: Characteristics of people aged 65 years and over that died by suicide while using a home care package or permanent residential aged care, 2017–18 to 2021–22
Among home care users who died by suicide, 11% had a CALD background, 4% were living with dementia, 4% were First Nations people, 50% lived alone, 60% did not have a partner and 30% lived outside urban areas. Among those living in permanent residential aged care who died by suicide, 5% had a CALD background, 24% were living with dementia, 4% were First Nations people, 39% lived alone prior to entry, 52% did not have a partner and 24% lived outside urban areas prior to entry.
Alcohol and other drug related deaths
In addition to suicide, other causes of deaths can be reflective of mental distress and/or self-neglect. Data about drug and alcohol poisoning (both accidental and undetermined intent) and deaths due to chronic liver diseases and cirrhosis are included here as one proxy (though not exhaustive) indicator of long-term mental distress in aged care users. (Figure 16)
Home care packages
Out of 371,864 people aged 65 years and over who were receiving a home care package from 2017–18 to 2021–22, 51 had died by drug and alcohol poisoning by 30 June 2022. The average yearly crude rate of death by drug and alcohol poisoning in this group was 6.3 per 100,000 users. The average yearly age-standardised rate, which adjusts for differences in age among the population, was 13.2 deaths per 100,000 users.
In addition, 325 people aged 65 years and over receiving a home care package died due to chronic liver diseases and cirrhosis. The average yearly crude rate of death due to chronic liver diseases and cirrhosis in this group was 36.8 per 100,000 users. Additionally, the average yearly age-standardised rate, which adjusts for differences in age among the population, was 68.5 deaths per 100,000 users.
Permanent residential aged care
Out of 475,060 people aged 65 years and over that lived in residential aged care from 2017–18 to 2021–22, 32 had died by drug and alcohol poisoning by 30 June 2022. The average yearly crude rate of death by drug and alcohol poisoning in this group was 2.7 per 100,000 users. The average yearly age-standardised rate, which adjusts for differences in age among the population, was 3.4 deaths per 100,000 users.
In addition, 704 people aged 65 years and over living in residential aged care died due to chronic liver diseases and cirrhosis. The average yearly crude rate of death due to chronic liver diseases and cirrhosis in this group was 59.3 per 100,000 users. The average yearly age-standardised rate, which adjusts for differences in age among the population, was 151.3 deaths per 100,000 users.
Figure 16: Age-standardised rate (per 100,000) of deaths by drug and alcohol poisoning and chronic liver disease and cirrhosis among people aged 65 years and over using aged care services, 2017–18 to 2021–22
Age standardised rates of death by drug and alcohol poisonings in those using home care decreased over time from 22 deaths per 100,000 users in 2017-18 to 6 deaths per 100,000 users in 2021-22. Rates in those living in permanent residential aged care increased over time from no deaths in 2017-18 to 6 deaths per 100,000 users in 2021-22.
Rates of death by chronic liver disease and cirrhosis in those using home care fluctuated a little over time but remained steady at 74 deaths per 100,000 users in both 2017-18 and 2021-22. Rates in those living in permanent residential aged care fluctuated but increased over time from 137 deaths per 100,000 users in 2017-18 to 171 deaths per 100,000 users in 2021-22.
Most deaths caused by drug and alcohol poisoning and chronic liver disease and cirrhosis in aged care users occurred in men. These deaths became less common with increasing age (Figure 17).
Figure 17: Age-and-sex-specific crude rate (per 100,000) of deaths by drug and alcohol poisoning and chronic liver disease and cirrhosis among people aged 65 years and over using aged care services, 2017–18 to 2021–22
The age- and sex-specific crude rates per 100,000 of death by drug and alcohol poisonings in those using home care were highest in women aged 65-69 and decreased with increasing age in both women and men. The rates in those living in permanent residential aged care were highest in men aged 65-69 and decreased with increasing age in men only. The rates of death by chronic liver disease and cirrhosis in those accessing home care or permanent residential aged care were highest in men aged 65-69 and decreased with increasing age in both women and men.
Among those that died by these causes of death, about a third were living outside urban areas (Figure 18). Note that some characteristics are not displayed in Figure 18 to protect confidentiality.
Figure 18: Characteristics of people aged 65 years and over that died by drug and alcohol poisoning and chronic liver disease and cirrhosis while using a home care package or permanent residential aged care, 2017–18 to 2021–22
Among those using a home care package that died by drug and alcohol poisoning, 51% lived alone, 55% did not have a partner and 25% lived outside urban areas. Among those living in permanent residential aged care that died by drug and alcohol poisoning, 31% lived alone prior to entry, 34% did not have a partner and 19% lived outside urban areas prior to entry.
Among those using a home care package that died by chronic liver disease and cirrhosis, 37% lived alone, 43% did not have a partner and 31% lived outside urban areas. Among those living in permanent residential aged care that died by chronic liver disease and cirrhosis, 31% lived alone prior to entry, 47% did not have a partner and 29% lived outside urban areas prior to entry.
Notes on data quality
The National Death Index provides national data with scope to include all deaths in Australia since 1980.
Limitations of this data source include that deaths by suicide reported in death certificates are vulnerable to underreporting, because there is an inherent ambiguity in the intent of the person who has died and potential bias in the person assessing that intent.
Coding quality can also be affected where a Coroner’s case is not yet closed or where not all information is yet available. In these cases, less specific codes are applied until the case is closed (ABS 2023).
The quality of coding of causes of death in aged care service users who died by suicide (and the frequency of the problems described above) has not been established. To align with previous analysis of suicide and other deaths data by the Institute, only main cause of death codes were used for this analysis. This analysis excludes people who had suicide or other death recorded as an ‘other cause of death’ but not the main cause.
The context in which a death occurred is not available within the available data sets. Suicide deaths in people using aged care services may or may not reflect underlying mental distress. Similarly, deaths caused by drug and alcohol poisoning and chronic liver disease and cirrhosis may or may not reflect long-term distress and self-neglect.
ABS (Australian Bureau of Statistics_ (2022), Causes of Death, Australia, ABS, Australian Government, accessed 11 April 2024.