The characteristics, life problems and clinical management of older adults who self-harm: Findings from the multicentre study of self-harm in England

Patel, Anita; Ness, Jennifer; Kelly, Samantha; Waters, Keith; Townsend, Ellen; Kapur, Navneet; Clements, Caroline; Farooq, Bushra; Geulayov, Galit; Casey, Deborah; Hawton, Keith

Abstract

Background
Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision.

Objectives
To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 60 years and over presenting to hospital following self-harm.

Method
Data on Emergency Department (ED) presentations for self-harm from 2003 to 2016 from three centres in the Multicentre Study of Self-Harm in England were analysed. Changes in self-harm rates were examined using Poisson regression. Univariable logistic regression was used to investigate factors associated with 12-month self-harm repetition.

Results
There were 3850 presentations for self-harm by 2684 individuals aged 60 years and over. Self-harm rates increased over time for 60–74-year-old men (Incident Rate Ratio = 1.04, 95% Confidence Interval 1.02–1.06, p < 0.0001). Problems most frequently reported to have preceded self-harm were mental health (40.5%) and physical health (38.3%) concerns. Problems with alcohol, finances, employment and relationship with partner were found more frequently in 60–74-year-olds compared with those aged over 74 years. Physical health problems were common with increasing age, as were problems with alcohol for men. One in ten (10.8%) individuals presented to hospital with self-harm within 12 months of their index presentation.

Conclusions
Self-harm-related ED attendances in older men have increased, particularly for men aged 60–74 years. Prevention and clinical management should involve a comprehensive psychosocial assessment to target common precipitants for the wide range of problems preceding self-harm and may include support with physical and mental wellbeing and advice on safer alcohol use.

Citation

Patel, A., Ness, J., Kelly, S., Waters, K., Townsend, E., Kapur, N., …Hawton, K. (2023). The characteristics, life problems and clinical management of older adults who self-harm: Findings from the multicentre study of self-harm in England. International Journal of Geriatric Psychiatry, 38(3), Article e5895. https://doi.org/10.1002/gps.5895

• Journal Article Type: Article
• Acceptance Date: Feb 19, 2023
• Online Publication Date: Mar 11, 2023
• Publication Date: May 11, 2023
• Deposit Date: May 12, 2023
• Publicly Available Date: May 16, 2023
• Journal: International Journal of Geriatric Psychiatry
• Print ISSN: 0885-6230
• Electronic ISSN: 1099-1166
• Peer Reviewed: Peer Reviewed
• Volume: 38
• Issue: 3
• Article Number: e5895
• DOI: https://doi.org/10.1002/gps.5895
• Keywords: Psychiatry and Mental health, Geriatrics and Gerontology
• Public URL: https://nottingham-repository.worktribe.com/output/18222885
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/gps.5895