Deliberate Self-Harm and the Elderly: A Volatile Combination—An Overview from the Plastic Surgery Perspective

Abstract

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

Attempted Suicide in Older People: A Review of the Evidence

“…Marriage was not protective against suicide attempts in the elderly UK group studied by Packer et al (2012). This correlates to findings in the literature that marriage may no longer be a protective factor in preventing suicide attempts, particularly among older men.…”

“…Abdul-Hamid et al (1999) described the profile of elderly suicide attempters as 'mostly female, divorced or widowed, who have experienced life events in terms of bereavement and who have had chronic health problems for more than a year' (p. 95). Males were significantly represented (70%) in the elderly UK suicide attempters studied by Packer et al (2012).…”

“…The proportions of those living in an institution were almost identical in the two groups. Whilst living with family is normally thought of as protective against mental illness, 60% of patients who presented in Packer et al (2012) UK study were living with family. Murphy et al (2012) identified independent risk factors for non-fatal repetition of self-harm in people aged 60-74 years, with previous episode of self-harm and previous psychiatric treatment.…”

Self-harm in older adults: systematic review

“…A total of 27 studies [20][21][22]24,25,27,28,[31][32][33]35,37,40,[42][43][44][45][46][48][49][50][51][53][54][55]57,58 reported the marital status of their participants (n = 4161): approximately half were not married (51%, n = 2121), 38% (n = 1582) were married and the marital status of the remaining 11% (n = 461) was unknown. Over half of the studies 19,20,[23][24][25][26][27][28]31,35,41,[44][45][46]48,50,51,53,[55][56][57][58] (n = 3103) reported participants' living situation: 53.5% (n = 1658) were either living with family or in care, followed by 40% (n = 12...…”

“…A total of 30 studies [19][20][21][22][23][24][25][26][27][28][29]31,32,35,37,[39][40][41][42][43][44][45][46]48,51,[54][55][56][57][58] reported participants' previous psychiatric history (n = 10 976), including alcohol and substance misuse, schizophrenia and personality disorder, with 30% of participants having previous psychiatric history (n = 3279). Depression was the most commonly reported psychiatric diagnosis (n = 7893) across the 29 studies reporting depression.…”