The Effects of Long-Term Care Insurance Infrastructure on Elderly Suicide Rate in Regions

Abstract Background: South Korea has the highest older adults’ suicide rate in the world. This study proposed a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of the expanded long-term care insurance coverage.Methods: About 62,282 older adults with dementia were selected as study samples from the National Health Insurance Service’s “Older Adults Cohort DB (2002 to 2015).” This study confirmed how the demographic characteristics, health status, and the long-term care services (LTCS) of older adults with dementia affect their suicide. Data analysis was conducted with the Kaplan-Meier, Cox-regression to represent the yearly survival curve from 2002 to 2015, and the suicide rate was identified by demographic characteristics, health status, and policy. Also, difference-in-differences (DID) estimation was conducted to analyze the effect of LTCS on suicide rates by comparing statuses before and after 2014.Results: The results revealed statistically significant differences in sex, activities of daily living, cognitive ability, caregivers, and use of LTCS (Log-rank test p<0.001). The suicide risk of older adults using LTCS was about 0.256 times lower than those who did not use it (p<.001), after adjusting controls. Regarding the policy effect of LTCS, their suicide rate increased after the expansion of dementia grade (OR=2.131, 95% CI=1.061-4.280) but was still lower among LTCS users than non-users (OR=0.296, 95% CI=0.183-0.478). The interaction term indicating whether older adults with dementia use LTCS after the expansion of dementia grade was not statistically significant. Conclusions: This study not only identified differences in suicide rates depending on the sex, ADL, and type of caregiver at the individual level, but also confirmed that national policies and long-term care services could protect their lives. It highlights the importance of national level management to prevent suicide among older adults with dementia and offers effective policy suggestions.

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Suicide Among Older Adults with Dementia: Effect of Korea’s Long- Term Care Insurance System

10.21203/rs.3.rs-287648/v1 ◽

2021 ◽

Author(s):

Sungje Moon ◽

Mankyu Choi ◽

Minsung Sohn

Keyword(s):

Older Adults ◽

Suicide Rate ◽

Suicide Risk ◽

Long Term Care ◽

Cox Regression ◽

Rank Test ◽

Term Care ◽

Suicide Rates ◽

Long Term Care Insurance

Abstract Background: South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a “dementia special grade” in 2014 to improve care service accessibility and extend health life for older adults with dementia. This study proposed a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of the using the long-term care services (LTCS) and of the expanded LTCI coverage.Methods: A sample of 62,282 older adults was selected from the “Older Adults Cohort DB” of the National Health Insurance Service. First, we selected older adults diagnosed with dementia at least once from 2002 to 2015. Second, all causes of death excepted for suicide are deleted. Third, older adults got the LTCS grading is selected after the introduction of the LTCI in 2008. Data were analyzed using the Kaplan-Meier estimator, Cox regression to represent the yearly survival curve from 2002 to 2015 according to individuals’ risk factors. Also, difference-in-differences estimation was conducted to analyze the effect of LTCS on suicide rates by comparing statuses before and after 2014.Results: There were statistically significant differences in suicide rate by sex, daily living activities, cognitive ability, caregiver type and use of LTCS (Log-rank test p<0.001). The suicide risk of older adults using LTCS was about 0.256 times lower than those who did not use it (p<.001), after adjusting controls. Regarding the policy effect of LTCS, the suicide rate increased after the expansion of the dementia grading (OR=2.131, 95% CI=1.061-4.280) but was still lower among LTCS users than non-users (OR=0.296, 95% CI=0.183-0.478). Conclusions: This study not only identified the parameters affecting suicide rates depending on the sex, ADL, and type of caregiver at the individual level, but also confirmed that access to LTCS could minimize suicide risk. It highlights the importance of national system management to prevent suicide among older adults with dementia and offers effective policy suggestions.

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