摘要：Objectives. We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. Methods. In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. Results. Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. Conclusions. Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up. In 2009, 15 700 nursing homes in the United States provided services to 1.4 million individuals. 1 In 2008, 36 035 individuals died by suicide in the United States, and suicide was the 10th leading cause of death. 2 Men have higher suicide rates than women, and national suicide rates in 2007 were highest among men aged 75 years and older. 3 Despite concerns regarding self-destructive behavior among nursing home residents, 4,5 few studies have examined suicide mortality related to nursing home stays. 6,7 Furthermore, although the literature documents elevated suicide risk following discharge from inpatient psychiatric settings, 8,9 we are not aware of any studies that have examined suicide risk following discharge from nursing homes. Assessment of suicide risk following nursing home discharge provides an important opportunity to identify high-risk periods for suicide and to inform discharge planning, outreach, and care coordination activities. Since passage of federal nursing home reform legislation in 1987, 10 improving quality of care in US nursing homes has been a national focus. Initiatives target community facilities that are eligible for Medicare and Medicaid reimbursement as well nursing homes in the US Department of Veterans Affairs (VA) health system, which are today called Community Living Centers (CLCs). Central to this effort are quality and performance measures derived from information from the national nursing home resident assessment instrument, the Minimum Data Set (MDS). MDS assessments are mandated for all nursing home residents shortly after admission, at periodic intervals, and when there is a change in health status. The MDS includes indicators specific to quality of life within nursing homes as well as quality of care, focusing on medical, rehabilitative, and mental health issues. The national focus on improving the quality of services provided in nursing homes has not addressed continuity of care after discharge. The VA has begun to evaluate this issue. Previous work has characterized resident risk factors for all-cause mortality following discharge from VA nursing homes. 11 We evaluated suicide rates following discharge from VA nursing homes. Because previous research suggests that psychopathology and challenging behaviors are associated with increased suicidal ideation and behavior, 4,12–15 we evaluated measures of serious mental illness, depression, dementia, behavior problems, and pain as predictors of suicide after discharge.
