Self‐harm in people with dementia – assessing risk factors, health profiles and healthcare pathways using big data

Abstract

AbstractBackgroundDementia is often associated with poorer mental health and higher rates of self‐harm compared to older people without dementia. This study investigated risk factors for self‐harm in dementia and risk factors for developing dementia following self‐harm. A further aim was to elucidate the health profiles and healthcare pathways of individuals with dementia who self‐harm as a critical step to develop effective prevention strategies.MethodUsing linked health data from hospital admissions, emergency department presentations and ambulatory mental health visits, we established a population‐based cohort of individuals with dementia and self‐harm in New South Wales, Australia spanning 13 years. The project was guided by an advocate advisory group, including people with dementia and care‐partners who inform all stages of the project.ResultThe cohort included 154,811 people with dementia, of which 652 (0.4%) had a subsequent diagnosis of self‐harm. People with dementia who self‐harmed were younger at the time of their dementia diagnosis (median age 69.6 (IQR 52.7‐80.1) versus 83.5 (IQR 78.0‐88.1)) and had a lower proportion of females (39.4% versus 59.6%) compared to people with dementia without self‐harm. A diagnosis of self‐harm most often occured within 24 months after a dementia diagnosis. Men living with dementia, and people with complex psychiatric profiles had the greatest risk of self‐harm. People with dementia and self‐harm had more comorbidities compared to those without self‐harm. The most frequent comorbidities in people with dementia and self‐harm were drug/alcohol use (19.9%), depression (13.5%), anxiety (11.8%), and psychotic disorder (10.9%); these comorbidities were observed in 2.7%, 2.7%, 2.2% and 2.1% of people with dementia without self‐harm, respectively. People with dementia and self‐harm had more ambulatory mental health visits, ED presentations and involuntary admissions in the year before a dementia diagnosis compared to those without self‐harm.ConclusionThe health profiles and healthcare pathways are significantly different for people with dementia who self‐harm versus those who do not. Poor mental health, dementia, and self‐harm are substantially intertwined in older adults. Post‐diagnostic counselling and support should be provided following a dementia diagnosis. This project will inform strategies for health services to better meet the needs of people with dementia who self‐harm.