Why Do the Very Old Self-Harm? A Qualitative Study

Wand, Anne; Peisah, Carmelle; Draper, Brian; Brodaty, Henry

doi:10.1016/j.jagp.2018.03.005

Cited by 29 publications

(64 citation statements)

References 28 publications

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“…7 There were similarities between themes of communication difficulties which emerged in relation to both carers and health professionals. 4 The findings from this carer study are consistent with psychological autopsy studies regarding lack of communication between members of the system and the perceptions of unsupportive health systems. This is not surprising given the wider systemic context of ageism, context with perceptions of old age as depressing and associated with loss and loneliness.…”

Section: Shared Shame and Stigmasupporting

confidence: 81%

“…4 One participant was interviewed per patient, unless an additional carer requested to take part. 4 One participant was interviewed per patient, unless an additional carer requested to take part.…”

Section: Participantsmentioning

confidence: 99%

“…1 Self-harm may be direct, resulting in immediate pain, injury, or death (eg, overdose) or indirect, which over time may cause harm or death (eg, refusing to eat or drink). [3][4][5] Theoretical mapping of late life suicidal behaviour incorporates systemic factors such as perceived burdensomeness and not belonging. [3][4][5] Theoretical mapping of late life suicidal behaviour incorporates systemic factors such as perceived burdensomeness and not belonging.…”

Section: Introductionmentioning

confidence: 99%

“…9 Notable is the lack of communication between members of the system, 6,9 and families' perceptions of the health system as unsupportive, invalidating, and inadequate. 8 We have previously reported the reasons for self-harm and its consequences from the perspective of older persons 4 and their GPs. 8 We have previously reported the reasons for self-harm and its consequences from the perspective of older persons 4 and their GPs.…”

Section: Introductionmentioning

confidence: 99%

“…8 We have previously reported the reasons for self-harm and its consequences from the perspective of older persons 4 and their GPs. 4 General practitioners identified individual patient factors contributing to self-harm but did not see themselves as having a role in addressing them. The themes for consequences of self-harm included becoming closer to, or more distant from family, solving the problem, gaining control, and rejection by health professionals.…”

Section: Introductionmentioning

confidence: 99%

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Carer insights into self‐harm in the very old: A qualitative study

Wand

Peisah

Draper

et al. 2019

Int J Geriat Psychiatry

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Objective To examine the insights of carers to better understand self‐harm in their older relatives. Methods An in‐depth interview was conducted with the nominated relative/friend (carer) of a person over 80 who had self‐harmed within the last month. Carer interpretation and experience of the self‐harm and clinical care were explored qualitatively. Audio recordings were transcribed and the content thematically analyzed using N‐VIVO. Results Thirty‐two carers of 30 older people who self‐harmed were interviewed. Physical, social, and psychological issues were identified as contributory to self‐harm. Themes relating to the perceived barriers to seeking help included “they can't communicate,” “suicide and secrets,” and “invalidation.” Themes for the intent of self‐harm were “attention seeking” and “wanting to die.” Themes which emerged for consequences of self‐harm for carers were “anger,” “guilt and self‐blame,” and “it made us ill.” Themes for solutions to address the underlying factors leading to self‐harm were “more practical support and structure,” “improving communication,” “removing means of self‐harm,” “advance care directives as a solution for suffering,” and “ignoring self‐harm.” Clinical care themes were “shared shame and stigma,” “safety and supervision vs being locked up,” “clinicians dismissing the carer,” and “relief and support.” Conclusions Validation of carer perspectives and understanding family dynamics may improve communication at various system levels and inform interventions for older persons, concurrently support families, and potentially reduce risk of repeat self‐harm. Good care must be holistic, be person‐centred, and relieve carer burden. A shared understanding and psychotherapeutic approaches to management of self‐harm in late life should be considered.

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Section: Shared Shame and Stigmasupporting

confidence: 81%

Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Carer insights into self‐harm in the very old: A qualitative study

Wand

Peisah

Draper

et al. 2019

Int J Geriat Psychiatry

Self Cite

View full text Add to dashboard Cite

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Risk factors for dementia and self‐harm: A linkage study

Walker

Srasuebkul

Trollor

et al. 2023

Alzheimer's & Dementia

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IntroductionPeople living with dementia experience poor mental health and high rates of self‐harm. We investigated risk factors for self‐harm in people aged > 40 years living with dementia and risk factors for dementia after self‐harm.MethodsUsing linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self‐harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self‐harm for the dementia cohort, and predictors of dementia for the self‐harm cohort.ResultsWe found self‐harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self‐harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self‐harm. Men who had self‐harmed had the greatest risk of dementia diagnoses.DiscussionMen and people with complex psychiatric profiles and dementia may particularly benefit from post‐diagnosis mental and behavioral support to reduce risk of self‐harm.

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A qualitative study of multiple voices to inform aftercare services for older persons following self‐harm

Wand

Karageorge

Browne

et al. 2023

Int J Geriat Psychiatry

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Objectives: Self-harm and suicide are closely related in older adults, highlighting the opportunity for Aftercare interventions in targeted suicide prevention. The study aims were to explore strengths and shortfalls of current Aftercare services for older adults from the perspective of key stakeholders and researchers; and inform a set of guiding principles for older persons' Aftercare.Methods: Semi-structured interviews were undertaken with a convenience sample of older people with lived experience of self-harm, clinicians and suicide researchers (n = 22). Interviews were focussed on current practice (strengths and limitations), potential improvements, and identifying the core components of an acceptable Aftercare model. Interviews were audio-recorded, transcribed and subjected to a reflexive thematic analysis grounded in interpretive description.Results: Current practice strengths included validation, a person-centred approach and optimising aftercare delivery. Limitations included ageism, practical limitations (lack of service awareness, fragmented service provision, barriers to access, and traumatising approaches), and limited services, funding and training. Overarching themes included anti-ageism; anti-stigma; empowerment and agency; conveying hope; patience and pace; accessible; and finding purpose: connections and meaningful activity. Conclusions:Older people who have self-harmed have complex, individualised needs. They sit within intersecting systems traversing healthcare, support services, family, and the social environment. Systemic, coordinated Aftercare founded upon core principles of anti-ageism, anti-stigma, partnership, empowerment, accessibility and provision of connections and meaning are needed.

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Why Do the Very Old Self-Harm? A Qualitative Study

Cited by 29 publications

References 28 publications

Carer insights into self‐harm in the very old: A qualitative study

Carer insights into self‐harm in the very old: A qualitative study

Risk factors for dementia and self‐harm: A linkage study

A qualitative study of multiple voices to inform aftercare services for older persons following self‐harm

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