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

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.

Hospital-presenting self-harm among older adults living in Ireland: a 13-year trend analysis from the National Self-Harm Registry Ireland

“…Recent international studies have shown increases in rates in older adults aged 60 years and over presenting to hospitals with self-harm (Patel et al ., 2023). Internationally, rates of self-harm in older adults aged 60 years and over vary from 19 to 65 per 100,000 according to a systematic review (Troya et al ., 2019), with the most recent evidence showing increases in England 83.8 per 100,000 (Patel et al ., 2023).…”

“…Recent international studies have shown increases in rates in older adults aged 60 years and over presenting to hospitals with self-harm (Patel et al ., 2023). Internationally, rates of self-harm in older adults aged 60 years and over vary from 19 to 65 per 100,000 according to a systematic review (Troya et al ., 2019), with the most recent evidence showing increases in England 83.8 per 100,000 (Patel et al ., 2023). A previous Irish study calculated presentation rates for older adults aged 55 years and over from 2006 to 2008 (Corcoran et al ., 2010), with presentation rates of 83.4 per 100,000 in female presentations and 67.4 per 100,000 in male presentations.…”

“…Comprehensive assessment and management of self-harm can help reduce repeat self-harm and suicide risk (Carroll et al ., 2014). Management of self-harm in older adults should include tailored biopsychosocial assessments for older adults, incorporating evidence specific to common characteristics in this age group (psychiatric history, comorbid physical health problems, alcohol use, loneliness, social isolation, among others) (Patel et al ., 2023; Troya et al ., 2019). This is of particular importance considering the increased risk of comorbid physical and mental health conditions in older adults (Troya et al ., 2019).…”

A much-needed focus on self-harm in older adults

“…Crucially, Troya et al's (2023) study reminds us to not view older adults as one homogenous group. Mental and physical health concerns are commonly reported problems that precede self-harm in older adults (Morgan et al, 2018;Patel et al, 2023;Troya et al, 2019a), but gender comparisons have long shown differences in a multitude of other risk factors or precipitating problems, which may be equally important considerations for assessment and treatment (Hawton and Harriss, 2006).…”

“…Some individuals are still regularly working and displaying characteristics closely aligned with a younger working age group, whereas others may be newly or several decades into retirement, and some experiencing significant deterioration in physical and/or mental health and cognitive function. Troya et al (2023), attempt to overcome some of these issues through their age subgroup analysis, adding to the existing knowledge of within group differences in the older adult population (Morgan et al, 2018;Murphy et al, 2012;Patel et al, 2023), which may provide important considerations for care provision.…”