Deaths by suicide and drug and alcohol use in aged care users
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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
The line graph shows measures related to suicide deaths among people aged 65 years and over using aged care services from 2017-18 to 2021-22. The graph is dynamic, allowing users to filter by different measures: 'Number of suicide deaths (numerator)', 'Crude rate (per 100,000) of suicide deaths', and 'Age-standardised rate (per 100,000) of suicide deaths'. The sub-title, y-axis and data will update based on the selected measure. The x-axis is unchanged and represents the financial years. The graph includes two cohorts: home care (green line) and permanent residential aged care (dark blue line).
The green line for home care shows a steady increase in the number of suicide deaths over the years, while the dark blue line for permanent residential aged care shows fluctuations but eventually stabilises. To explore specific data, please use the 'Measure' filter options provided.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_13-Suiciderate.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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
The bar graph shows the age-and-sex-specific crude rate (per 100,000) of suicide deaths among people aged 65 years and over using aged care services in the period 2017-18 to 2021-22. The x-axis represents age groups, ranging from 65-69 to 100+, and is divided into two sections for females and males. The y-axis represents the crude rate of suicide deaths per 100,000 people.
The graph is dynamic, allowing users to filter by cohort: home care or permanent residential aged care. The sub-title and data will update based on the selected cohort. To explore specific data, please use the 'Cohort' filter options provided.
In both home care and permanent residential aged care, for females, the green bars indicate that the highest crude rate is in the 65-69 age group, with a noticeable decline in older age groups. For males, the dark blue bars show a more consistent rate across the age groups, with the highest rates also in the 65-69 and 70-79 age groups.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_14-Suicidecruderate-sexage.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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
The bar graph shows the characteristics of people aged 65 years and over that died by suicide while using home care packages or permanent residential aged care in the period 2017-18 to 2021-22. The graph is dynamic, allowing users to filter by various characteristics such as culturally and linguistically diverse, dementia status, indigenous status, living alone, partnered, and remoteness. The sub-title and data will update based on the selected characteristic. To explore specific data, please use the 'Characteristic' filter options provided. Some characteristics were not reported to protect confidentiality as some small cells that contain only one or two people.
The x-axis represents the cohort, divided into 'Home care' and 'Permanent residential aged care'. The y-axis represents the percentage, ranging from 0% to 100%. The bars are stacked to show the proportion of residents in three categories: 'Unknown' status (purple) if any, and two specific characteristics (dark blue and green) which vary based on the selected filter.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_15-Suicidebycharacteristic.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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
The line graph shows measures related to deaths by drug and alcohol poisonings and chronic liver disease and cirrhosis among people aged 65 years and over using aged care services from 2017-18 to 2021-22. The graph is dynamic, allowing users to filter by groups – 'Drug and alcohol poisoning' or 'Chronic liver diseases and cirrhosis' – with different measures: 'Number of deaths (numerator)', 'Crude rate (per 100,000) of deaths', or 'Age-standardised rate (per 100,000) of deaths'. The sub-title, y-axis, and data will update based on the selected measure. The x-axis is unchanged and represents the financial years from 2017-18 to 2021-22. The graph includes two cohorts: home care (green line) and permanent residential aged care (dark blue line).
To explore specific data, please use the 'Group' and 'Measure' filter options provided.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_16-Self-neglectdeathrate1.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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 bar graph shows the 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 home care services from 2017-18 to 2021-22. The graph is dynamic, allowing users to filter by cohort (home care or permanent residential aged care) and group (drug and alcohol poisoning or chronic liver diseases and cirrhosis).
The x-axis represents age groups and is divided into two sections for females (green bars) and males (dark blue bars). Age grouping is adjusted when needed to protect confidentiality by suppressing small cells that contain only one or two people. The y-axis represents the crude rate of deaths per 100,000 people.
The subtitle and data will update based on the selected filters. To explore specific data, please use the 'Cohort' and 'Group' filter options provided.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_17-Self-neglectdeathrate2.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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
The bar graph shows the characteristics of people aged 65 years and over that died by drug and alcohol poisoning and chronic liver disease and cirrhosis while using home care packages or permanent residential aged care in the period 2017-18 to 2021-22. The graph is dynamic, allowing users to filter by various characteristics such as culturally and living alone, partnered, and remoteness. The sub-title and data will update based on the selected characteristic. To explore specific data, please use the ‘Group’ and 'Characteristic' filter options provided. Some characteristics were not reported to protect confidentiality as some small cells that contain only one or two people.
The x-axis represents the cohort, divided into 'Home care' and 'Permanent residential aged care'. The y-axis represents the percentage, ranging from 0% to 100%. The bars are stacked to show the proportion of residents in three categories: 'Unknown' status (purple) if any, and two specific characteristics (dark blue and green) which vary based on the selected filter.
![](https://viz.aihw.gov.au:443/t/Public/views/AGE115_MentalhealthinAgedCare_19072024/Fig_18-Selfneglectdeathsbycharacteristic.png?:embed=y&:showVizHome=no&:display_spinner=no&:host_url=https%3a%2f%2fviz.aihw.gov.au)
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.