Deliberate self‐harm in the elderly: A survey of one London Borough

Abstract

SUMMARYThis article details the results of a retrospective case note study on deliberate self-harm in the elderly in the London Borough of Tower Hamlets. There were 56 females and 32 males included in the study. The ages of the patients ranged from 65 to 90. Fifty-seven per cent of the sample had a depressive illness, most commonly found in the younger females and the older males. Over 50% of the sample had evidence of multiple health problems, particularly heart disease and arthritis. Over 900/0 of cases used self-poisoning as the means of self-harm. Sixty-one per cent used benzodiazepines and 25% salicylates. Over 30% used multiple drug combinations. Thirty-eight per cent of the sample had evidence of previous self-harm, 17% had repeated self-harm within a year and 6% were dead through suicide. Although the characteristics of the patients bore some resemblance to those identified in the literature as being risk factors for self-harm among younger patients, they bore a much closer resemblance to known risk factors for suicide. This may have ramifications for further research into the prevention of suicide.KEY woms-Elderly, attempted suicide.Deliberate self-harm has been defined as 'a deliberate non fatal act, whether physical, drug overdosage or poisoning, done in the knowledge that it was potentially harmful, and in the case of drug overdosage that the amount taken was excessive' (Morgan et al., 1975).The elderly account for over 15% of the population and more than 25% of suicides. Although it is known that a previous episode of deliberate selfharm is one of the highest risk factors for subsequent suicide, very little work has been directed towards the similarities and differences between the elderly who commit an act of self-harm and those who commit suicide. In fact, the vast majority of studies on deliberate self-harm have concentrated on the younger population. Those which sampled the total population demonstrated that the elderly accounted for a very small proportion of the total cases, ranging from 4% to 6% (Bancroft et al., 1975;Morgan et al., 1975;Pierce, 1977). A few more recent papers have concentrated on the elderly

Editorial Review. Attempted suicide in old age

“…These findings contrast with rates for suicide in old age, where the male to female ratio is around 4-6 : 1 (McIntosh, 1992). The majority of attempters were not married (Pierce, 1987;Upadhyaya et al, 1989;Merrill and Owens, 1990;Frierson, 1991;Nieto et al, 1992;Lyness et al, 1992;Nowers, 1993;Draper, 1994b;Schmid et al, 1994), with at least 45% of those aged 65 years and over being widowed. The divorcedlseparated account for 4-13% of attempts and have been reported to have the highest population rates (Hawton and Fagg, 1990).…”

“…Overall, drug overdose was consistently the most frequent method chosen, with up to a further 6% taking an overdose in combination with self-injury. Prescription drugs were most often used, mainly benzodiazepines (37-79% of overdoses), followed by analgesics (1 1-30%) and antidepressants (1 1-32%) (Hawton and Fagg, 1990;Merrill and Owens, 1990;Lyness et al, 1992;Nowers, 1993;Rifai et al, 1993;Draper, 1994b). This contrasts with the earlier studies, where barbiturates were the predominant drugs used (Batchelor and Napier, 1953;Burston, 1969).…”

“…There is a trend for the proportion of males attempting suicide to increase with age, particularly in those aged 75 years and over (Hawton and Fagg, 1990;Frierson, 1991;Nowers, 1993;Draper, 1994b). These findings contrast with rates for suicide in old age, where the male to female ratio is around 4-6 : 1 (McIntosh, 1992).…”

Psychiatric Disorders in the Elderly

“…205 Suicidal attempts in the elderly are often characterized by a greater degree of lethal intent. 208,211 Although it is often suggested that suicide in the elderly primarily is a question of undiagnosed, untreated depression, it was reported that two-thirds of elderly people who died by suicide in Gothenburg, Sweden, had a history of treatment for affective illness and 48% had had such treatment 6 months before their suicide. 212 These findings emphasize that once diagnosed, depression in the elderly must be managed with persistence.…”

Face to face with the suicidal

“…In the same population, sampling those with mental illness, 29% felt that life was not worth living, 9% had thought about taking their own life and 2% had seriously considered suicide. The relationship between suicidal ideation, deliberate self-harm and subsequent suicide is a complex one, but there is no doubt that the elderly are over-represented both in the statistics of suicide committed after deliberate self-harm and in the suicide statistics more generally (Nowers, 1993(Nowers, ,1997Hepple & Quinton, 1997).…”