Health profiles of older nursing home residents by suicidal ideation: A latent class analysis

Identify the health profiles of older nursing home residents with and without at-admission self-reported suicidal ideation (SI) and examine the association between the identified profiles and self-reported SI at 90 days.

Using the Minimum Data Set 3.0 and the ninth Patient Health Questionnaire-9 (PHQ-9) item, we identified 15,277 older residents with and 562,184 without self-reported SI at nursing home admission. Latent class analysis, using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators, identified health profiles by at-admission SI and the BCH method estimated their association with SI at 90 days.

Profiles identified for residents without at-admission SI were: (1) frail and depressed_NoSI (prevalence: 33.9%); (2) frail and severe cognitive impairment_NoSI (38.1%); (3) pre-frail_NoSI (28.0%). Residents in the frail and depressed_NoSI group had greater odds [adjusted OR: 2.80; 95% Confidence Interval: 2.60-3.00] while those in the frail and severe cognitive impairment_NoSI group had lower odds [aOR: 0.79; 95% CI: 0.71-0.86] of 90-day SI than those in the pre-frail_NoSI group. Profiles identified for residents with at-admission SI were: (1) frail and all depressive symptoms_SI (22.8%); (2) frail and some depressive symptoms_SI (32.2%); (3) frail and severe cognitive impairment_SI (22.9%); (4) pre-frail_SI (22.0%). Compared to those in the pre-frail_SI group, residents in the frail and all depressive symptoms_SI group had greater odds of continuing reporting SI at 90 days [aOR: 1.22; 95% CI:1.09-1.35].

Findings indicated unique health profiles of nursing home residents at higher risk of new onset of or continued SI.