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Self-harm in the very old one year later: has anything changed?

  • Anne Pamela Frances Wand (a1) (a2), Brian Draper (a1) (a2), Henry Brodaty (a1) (a3) and Carmelle Peisah (a2) (a4)

Abstract

Objectives:

To follow-up a cohort of older people who self-harmed, their carer, and general practitioner (GP) and examine their reflections on the self-harm, care experiences, and outcomes.

Design:

Qualitative in-depth interviews.

Setting:

Two teaching hospitals and associated community services.

Participants:

Twelve-month follow-up of participants aged 80 or older who self-harmed, their nominated carers, and GPs.

Measurements:

A geriatric psychiatrist gathered data through patient and carer interviews using a narrative inquiry approach and from medical records. Interviews were audio recorded and transcribed. N-VIVO facilitated data organization for thematic analysis. Questionnaires sent to the patient’s GP examined their perspectives and aspects of care relating to the self-harm.

Results:

Nineteen patients (63% baseline sample), 29 carers (90.6%), and 11 GPs (36.7%) were available at follow-up. Themes emerging from patients were “denial and secrets;” “endless suffering;” “more invalidation;” “being heard;” and “miserable in care.” Themes from carer interviews were “denial and secrets;” “patient’s persistent wish to die;” “abandonment by clinicians;” “unending burden for the carer;” and “distress regarding placement.” General practitioner themes were “the problem is fixed;” “the troops have arrived;” and “I understand.”

Conclusions:

Factors contributing to self-harm persisted at follow-up. Positive and negative responses were identified in the older person’s system, highlighting areas for potential intervention. A conceptual framework for understanding self-harm in the very old was derived that emphasized the importance of understanding individual needs, the interpersonal context of the older person, and carer burden. Interventions should improve communication, facilitate shared understanding of perspectives, and provide support at all levels.

Copyright

Corresponding author

Correspondence should be addressed to: Anne Wand, Department of Aged Care Psychiatry, Euroa Centre, Level 1, Prince of Wales Hospital, Barker St. Randwick, New South Wales, NSW 2213, Australia. Phone: +61 2 9382 3753; Facsimile: +61 2 9382 3039; Email: a.wand@unsw.edu.au.

References

Hide All
Berger, R. (2017). Aging in America: ageism and general attitudes toward growing old and the elderly. Open Journal of Social Sciences, 5, 183198.
Black, B. S., Wechsler, M. and Fogarty, L. (2013). Decision making for participation in dementia research. The American Journal of Geriatric Psychiatry, 21, 355363.
Boyle, G. (2005). The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings. Ageing and Society, 25, 731748.
Bradvik, L. and Berglund, M. (2009). Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression. BMC Psychiatry, 9, 62.
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.
Corbin, J. and Strauss, A. (2015). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. London: Sage Publications Inc.
De Leo, D., et al. (2002). Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. Journal of Affective Disorders, 72, 291295.
Draper, B., Brodaty, H., Low, L. F., Richards, V., Paton, H. and Lie, D. (2002). Self-destructive behaviors in nursing home residents. Journal of the American Geriatrics Society, 50, 354358.
Draper, B., Krysinska, K., Snowdon, J. and De Leo, D. (2018). Awareness of suicide risk and communication between health care professionals and next-of-Kin of suicides in the month before suicide. Suicide and Life-Threatening Behavior, 48, 449458.
Draper, B., Peisah, C., Snowdon, J. and Brodaty, H. (2010). Early dementia diagnosis and the risk of suicide and euthanasia. Alzheimer’s & Dementia, 6, 7582.
Draper, B. M. (2014). Suicidal behaviour and suicide prevention in later life. Maturitas, 79, 179183.
Dudas, R., Malouf, R., Mccleery, J. and Dening, T. (2018). Antidepressants for treating depression in dementia. Cochrane Database of Systematic Reviews, 8, CD003944.
Dunn, L. B. and Jeste, D. V. (2001). Enhancing informed consent for research and treatment. Neuropsychopharmacology, 24, 595607.
Epstein, R. M., et al. (2010). “I didn’t know what was wrong:” how people with undiagnosed depression recognize, name and explain their distress. Journal of General Internal Medicine, 25, 954961.
Finkelstein, Y., et al. (2015). Risk of suicide following deliberate self-poisoning. Jama Psychiatry, 72, 570575.
Forbes-Thompson, S. and Gessert, C. E. (2006) Nursing homes and suffering: part of the problem or part of the solution? Journal of Applied Gerontology, 25, 234252.
Harwood, D., Hawton, K., Hope, T. and Jacoby, R. 2002. The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study. Journal of Affective Disorders, 72, 185194.
Kendall, S. and Reid, E. 2017. Person-centred acute hospital care for older people transitioning to residential aged care- whose needs are being met? Ethics and Social Welfare, 11, 353364.
Lebret, S., Perret-Vaille, E., Mulliez, A., Gerbaud, L. and Jalenques, I. (2006) Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 10521059.
Levi, Y., Horesh, N., Fischel, T., Treves, I., Or, E. and Apter, A. (2008) Mental pain and its communication in medically serious suicide attempts: an “impossible situation”. Journal of Affective Disorders, 111, 244250.
Lincoln, Y. S. and Guba, E. G. (1985). Naturalistic Inquiry. Beverly Hills, CA: Sage.
Miret, M., et al. (2010). Differences between younger and older adults in the structure of suicidal intent and its correlates. The American Journal of Geriatric Psychiatry, 18, 839847.
Mitchell, R. (2018) Self-harm in older adults: room to improve clinical care. Lancet Psychiatry, 5, 859860.
Morgan, C., et al. (2018). Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death. Lancet Psychiatry, 5, 905912.
Murphy, B. J., Bugeja, L., Pilgrim, J. and Ibrahim, J. E. (2015). Completed suicide among nursing home residents: a systematic review. International Journal of Geriatric Psychiatry, 30, 802814.
Murphy, B. J., Bugeja, L. C., Pilgrim, J. L. and Ibrahim, J. E. (2018). Suicide among nursing home residents in Australia: a national population-based retrospective analysis of medico-legal death investigation information. International Journal of Geriatric Psychiatry, 33, 786796.
Murphy, E., et al. (2012). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry, 200, 399404.
O’Connor, D. W., Rabins, P. and Sanwick, G. (2015) Module 5. Non-pharmacological treatments. In Draper, B., Brodaty, H. and Finkel, S. I. (eds.), The International Psychogeriatric Association Complete Guides to BPSD–Specialists Guide. Northfield, IN: International Psychogeriatric Association.
Ortega, V., Qazi, A., Spector, A. E. and Orrell, M. (2014). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, CD009125.
Peisah, C., Kim, S. and Vollmer-Conna, U. (2012). Capacity to consent to research: the evolution and current concepts. Asia-Pacific Psychiatry Journal, 4, 219227.
Peters, K., Murphy, G. and Jackson, D. (2013). Events prior to completed suicide: perspectives of family survivors. Issues in Mental Health Nursing, 34, 309316.
Tanner, D. (2003). Older people and access to care. British Journal of Social Work, 33, 499515.
Testoni, I., Francescon, E., De Leo, D., Santini, A. and Zamperini, A. (2018). Forgiveness and blame among suicide survivors: a qualitative analysis on reports of 4-year self-help-group meetings. Community Mental Health Journal, 55, 360368.
Van Orden, K. (2018). The interpersonal context of suicide and self-harm in later life: an invited commentary on “Why do the very old self-harm? A qualitative study”. The American Journal of Geriatric Psychiatry, 26, 872873.
Van Orden, K. A. and Conwell, Y. (2016). Issues in research on aging and suicide. Aging and Mental Health, 20, 240251.
Van Orden, K. A., Wiktorsson, S., Duberstein, P., Berg, A. I., Fassberg, M. M. and Waern, M. (2015). Reasons for attempted suicide in later life. The American Journal of Geriatric Psychiatry, 23, 536544.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A. and Joiner, T. E. Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575600.
Wand, A. P., Peisah, C., Draper, B. and Brodaty, H. (2018a). How do general practitioners conceptualise self-harm in their older patients? A qualitative study. Australian Journal of General Practice, 47, 146151.
Wand, A. P. F., Peisah, C., Draper, B. and Brodaty, H. (2018b). Why do the very old self-harm? A qualitative study. The American Journal of Geriatric Psychiatry, 26, 862871.
Wand, A. P. F., Peisah, C., Draper, B. and Brodaty, H. (2019). Carer insights into self-harm in the very old: a qualitative study. International Journal of Geriatric Psychiatry, 34, 594600.
Wiktorsson, S., Runeson, B., Skoog, I., Ostling, S. and Waern, M. (2010). Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. The American Journal of Geriatric Psychiatry, 18, 5767.
Zweig, R. A. and Hinrichsen, G. A. (1993). Factors associated with suicide attempts by depressed older adults: a prospective study. The American Journal of Psychiatry, 150, 16871692.

Keywords

Self-harm in the very old one year later: has anything changed?

  • Anne Pamela Frances Wand (a1) (a2), Brian Draper (a1) (a2), Henry Brodaty (a1) (a3) and Carmelle Peisah (a2) (a4)

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