Mental health in aged care

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

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

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

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

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

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

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.