Prediction of mortality in nursing home residents: impact of passive self-harm behaviors.
OBJECTIVE
The aim of this study was to determine whether indirect self-destructive behaviors predict mortality in nursing home residents.


METHODS
This cross-sectional study with follow-up after 2 years and 3 months surveyed 593 residents in 10 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviors Scale (HBS), Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale, Resident Classification Index, Cumulative Illness Rating Scale, Even Briefer Assessment Scales for Depression, and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnoses of depression, dementia, and psychosis were obtained from nursing home records. Mortality data were obtained in August 1999.


RESULTS
At follow-up, 297 (50.1%) residents were still alive with a mean survival time of 565.4 days. Survival analyses found that mortality was predicted by older age, male gender, lower level of functioning, lower levels of behavioral disturbance on the BEHAVE-AD, and higher scores on the HBS "passive self-harm" factor-based subscale, which includes refusal to eat, drink, or take medication.


CONCLUSIONS
These results suggest that passive self-harm behaviors predict mortality in nursing home residents.
Draper
Brian
B
School of Psychiatry, University of New South Wales, Sydney, Australia. b.draper@unsw.edu.au
Brodaty
Henry
H
Low
Lee-Fay
LF
Richards
Vicki
V
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000401:mortality*; D003866:Depressive Disorder / Q000401:mortality; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009517:New South Wales; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011594:Psychometrics; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000401:mortality*; D016019:Survival Analysis; D016312:Treatment Refusal / Q000706:statistics & numerical data*